Physical Activity Goal Setting Research Articles

Assessing the efficacy of the Stop OsteoARthritis (SOAR) program: A randomized delayed-controlled trial in persons at increased risk of early onset post-traumatic knee osteoarthritis

ObjectiveAssess the efficacy of an 8-week virtual, physiotherapist (PT)-guided knee health program (SOAR) to improve knee extensor strength in individuals at risk of post-traumatic knee osteoarthritis (PTOA). MethodIn this superiority, randomized delayed-control trial, persons aged 16-35 years, 1-4 years after a self-reported knee joint injury were randomly assigned (1:1) to receive the SOAR program immediately (experimental group) or after a 9-week delay (control group). SOAR includes 1) one-time Knee Camp (virtual PT-guided group education, knee assessment, 1:1 exercise and physical activity goal-setting); 2) Weekly personalized home-based exercise and physical activity program with tracking; 3) Weekly 1:1 PT counseling (virtual). The primary outcome was change in isokinetic knee extensor strength (baseline to 9-weeks). Additional outcomes included change in self-reported knee-related quality-of-life (QOL), self-efficacy, self-management and kinesiophobia, and physical activity (accelerometer) at 9 and 18-weeks. Linear regression models estimated the effect of the 8-week intervention at the primary endpoint (9-week). Results49 of 54 randomized participants completed the study (91%). Participants were a mean±SD age of 27±5.0 years, and 2.4±0.9 years post-injury. No mean between group differences for the primary (0.05; 95%CI: -0.10,0.19) or other outcomes were seen at 9 weeks except for greater improvements in perceived self-management (Partner in Health Scale; 11.3/96, 95%CI: 5.5,17.1) and kinesiophobia (Tampa Scale of Kinesiophobia; -4.4/33, 95%CI: -7.0,-1.8). ConclusionFor active persons with elevated risk of PTOA, an 8-week SOAR program did not change knee-related strength, QOL, self-efficacy, or physical activity, on average, but may benefit the ability to self-manage knee health and kinesiophobia.

Abstract MP70: Proof-of-Concept Trial of a Positive Psychology-Based Physical Activity Intervention After Bariatric Surgery: The Gaining Optimism After Weight Loss Surgery (GOALS) Project

Metabolic/bariatric surgery (MBS) is the most effective treatment available for severe obesity, but weight regain is common, increasing risk for cardiometabolic disease. Physical activity (PA) reduces these risks and aids with weight loss maintenance; however, over 90% of adults after MBS do not achieve at least 150 minutes/week of moderate-to-vigorous physical activity (MVPA) when measured objectively. Negative emotional associations with PA are common in this population (e.g., physical pain or injury, weight stigma). Positive psychological interventions are simple exercises shown to increase psychological well-being. The Gaining Optimism After weight Loss Surgery (GOALS) Project aims to target the emotional barriers to PA in adults with recent MBS using a positive psychological approach combined with motivational interviewing and goal-setting for PA. We tested feasibility, acceptability, and pre-post change in PA and psychological, behavioral, and physiological outcomes in a single-arm proof-of-concept trial to refine GOALS and prepare for a future RCT. GOALS included 10 weekly phone calls plus a written manual and a Fitbit to track PA. Each session included a positive psychology exercise, a PA-related topic, and setting a weekly PA goal. Participants were adults with MBS in the past 6-12 months who reported low physical activity. Primary outcomes were feasibility (session completion rates) and acceptability (participant ratings of session ease and utility). Pre-post assessments included physical activity measured with Actigraph GT3X-BT, a 6-minute walk test, BMI, percent body fat and waist circumference, and self-report measures of depression, anxiety, optimism, internalized weight bias, attitudes around physical activity, and post-MBS behavioral adherence. Mixed effects regression models with a random intercept measured change in outcomes including participants with missing data. Effect sizes (Cohen’s d) estimated magnitude of change given low study power. We enrolled 12 participants (58% female, M age 46 years, 67% non-Hispanic white). They completed 8.5/10 intervention sessions on average and gave high ratings ( M between 8.3 and 8.8/10) of ease and utility. There were increases in MVPA equivalent to an additional 17 minutes/day (d=0.61, p=0.09), 6-minute walk test distance (d=1.06, p=0.01) and reductions in BMI (d=0.81, p=0.04), depression (d=1.22, p<0.01), anxiety (d=0.51, p=0.16), and internalized weight bias (d=0.98, p=0.03), and increases in post-MBS adherence (d=1.44, p<0.01). The GOALS intervention demonstrated feasibility, acceptability, and pre-post improvements in PA and psychological well-being in a small proof-of-concept trial. The intervention is now being tested in a pilot RCT compared to a PA education control. If it continues to show similar effects, the intervention could be integrated into post-MBS clinical care to improve outcomes.

Improving physical activity behaviors, physical fitness, cardiometabolic and mental health in adolescents - ActTeens Program: A protocol for a randomized controlled trial

This trial aims to investigate the effects of the ActTeens physical activity program, on adolescents’ physical activity level, health-related fitness, cardiometabolic and mental health. The trial will aim to recruit ~140 adolescents (aged 13–14 years). Participants will be randomized into either intervention or control groups. The intervention will be guided by social cognitive theory and self-determination theory and implemented over one school term (24-weeks). The ActTeens Program will include: (1) structured physical activity sessions delivered within physical education, including movement-based games and dynamic stretching warm-ups; resistance training skill development; high-intensity training workouts; and cool-downs; (2) self-monitoring plus goal setting for physical activity by pedometer-smart wearable; and (3) healthy lifestyle guidance (social support) by WhatsApp® messages about healthy eating and regular physical activity for the intervention and parents groups. Study outcomes will be assessed at baseline, 24-weeks from baseline, and 12-months from baseline. Physical activity (accelerometer) is the primary outcome. Secondary outcomes include muscular and cardiorespiratory fitness, cardiometabolic profile, and mental health. A process evaluation will be conducted (i.e., recruitment, retention, attendance, and program satisfaction). This project will have the potential to address many questions and debates regarding the implementation of physical activity interventions in low-and- middle-income countries.Trial registration: ClinicalTrials.gov NCT05070377. Registered on 7 October 2021.

Telephone-based support for physical activity: Results and lessons learned during the COVID-19 pandemic

Physical activity is essential to maintain physical and mental well-being. During the COVID-19 pandemic, in-person physical activity opportunities were limited. This paper describes a telephone-based physical activity support strategy among racially/ethnically diverse patients during the COVID-19 pandemic. Adult patients at a large, Federally Qualified Health Center with an on-site exercise facility referral were eligible to transition to telephone support with personal fitness advisors during the pandemic stay-at-home orders. Baseline surveys assessed physical activity and environmental characteristics; follow-up phone calls used motivational interviewing and physical activity goal setting strategies. From March 23-July 23, 2020, 72 patients participated in 270 phone calls, or 3.8 (±2.1) calls per participant. Participants were, on average, aged 51.3 (±11.6) years, 87.5% female, 31.9% Hispanic/Latino, and 47.2% non-Hispanic Black. Patients meeting physical activity guidelines pre-pandemic reported more planned exercise (100.0% vs. 55.3%; p<0.001), exercise days at home (5.0 vs. 1.7; p<0.001), and accomplishment of personal physical activity goals (57.0% vs. 39.7%; p = 0.11) than patients not meeting guidelines pre-pandemic. Patients with a home treadmill participated in twice the rate of calls compared to those without (RR = 2.22; 95%CI:1.35,3.64), but no other home environmental characteristics predicted participation rate. Pre-pandemic physical activity behavior appeared to predict pandemic physical activity and telephone-based physical activity support was effective for maintaining physical activity for some participants. Long term applications of this work will support continuity of clinic-community partnerships for health behavior change and provide a model for patient physical activity support by community health centers without on-site exercise facilities.

Intervention Fidelity Focusing on Interaction between Participants and Facilitators in a Telephone-Delivered Health Coaching Intervention for the Prevention and Management of Type 2 Diabetes.

Self-management support and lifestyle interventions with an empowerment approach have been found to be effective strategies for health improvement among people at risk for or living with type 2 diabetes. Telephone coaching seems particularly efficient for individuals with low socioeconomic status and culturally and linguistically diverse backgrounds. In this mixed methods study, we investigate a telephone-delivered health coaching intervention provided by the diabetes project SMART2D (Self-Management Approach and Reciprocal learning for Type 2 Diabetes) implemented in socioeconomically disadvantaged areas in Stockholm, Sweden. We focus on the interaction between participants and facilitators as part of intervention fidelity. Recorded coaching sessions were scored using an interaction tool and analyzed by exploratory factor analysis and recorded supervisory discussions with facilitators analyzed using thematic analysis. The quantitative analysis showed that the intervention components were delivered as intended; however, differences between facilitators were found. The qualitative data highlighted differences between facilitators in the delivery, especially in relation to dietary and physical activity goalsetting. The level of language skills hindered the delivery flow and the tailoring of sessions to participants’ needs led to different delivery styles. The interaction between facilitators and participants is an important aspect of intervention implementation. Tailoring of interventions is necessary, and language-skilled facilitators are needed to minimize barriers in intervention delivery.

Using a consumer-based wearable activity tracker for physical activity goal setting and measuring steps in pregnant women with gestational diabetes mellitus: exploring acceptance and validity

BackgroundActivity monitoring devices may be used to facilitate goal-setting, self-monitoring, and feedback towards a step-based physical activity (PA) goal. This study examined the performance of the wrist-worn Fitbit Charge 3™ (FC3) and sought opinions on walking and stepping-in-place from women with gestational diabetes (GDM).MethodsParticipants completed six 2-min metronome-assisted over ground bouts that varied by cadence (67, 84, or 100 steps per minute) and mode (walking or stepping-in-place; N = 15), with the sequence randomized. Steps were estimated by FC3 and measured, in duplicate, by direct observation (hand-tally device, criterion). Equivalence testing by the two one-sided tests (TOST) method assessed agreement within ± 15%. Mean absolute percent error (MAPE) of steps were compared to 10%, the accuracy standard of the Consumer Technology Association (CTA)™. A subset (n = 10) completed a timed, 200-m self-paced walk to assess natural walking pace and cadence. All participants completed semi-structured interviews, which were transcribed and analyzed using descriptive and interpretive coding.ResultsMean age was 27.0 years (SD 4.2), prepregnancy BMI 29.4 kg/m2 (8.3), and gestational age 32.8 weeks (SD 2.6). The FC3 was equivalent to hand-tally for bouts of metronome-assisted walking and stepping-in-place at 84 and 100 steps per minute (i.e., P < .05), although walking at 100 steps per minute (P = .01) was no longer equivalent upon adjustment for multiple comparisons (i.e., at P < .007). The FC3 was equivalent to hand-tally during the 200-m walk (i.e., P < .001), in which mean pace was 68.2 m per minute (SD 10.7), or 2.5 miles per hour, and mean cadence 108.5 steps per minute (SD 6.5). For walking at 84 and 100 steps per minute, stepping-in-place at 100 steps per minute, and the 200-m walk, MAPE was within 10%, the accuracy standard of the CTA™. Interviews revealed motivation for PA, that stepping-in-place was an acceptable alternative to walking, and competing responsibilities made it difficult to find time for PA.ConclusionsThe FC3 appears to be a valid step counter during the third trimester, particularly when walking or stepping-in-place at or close to women’s preferred cadence.

Feasibility of a Wearable-Based Physical Activity Goal-Setting Intervention Among Individuals With Anterior Cruciate Ligament Reconstruction.

Individuals with a history of anterior cruciate ligament reconstruction (ACLR) demonstrate persistent reductions in physical activity (PA) volume that are not being addressed during rehabilitation. Currently, it is challenging for clinicians to prescribe exercise interventions that extend beyond in-person rehabilitative care in a manner that is responsive and acceptable to patients. To investigate the feasibility of using a novel, technology-driven, personalized goal-setting intervention over a 2-month period among young individuals with a history of primary unilateral ACLR. Single-blinded feasibility study. University community. Ten women and 2 men (age = 22.0 ± 3.0 years, time since surgery = 56.0 ± 36.3 months) with a history of primary unilateral ACLR. All participants completed a 28-day PA observation period immediately followed by a 28-day individualized PA goal-setting intervention period delivered via a commercially available PA monitor. Primary feasibility outcomes were days of PA monitor wear compliance and days of goal achievement during the intervention period. Participants also completed the Knee Osteoarthritis Outcome Score (KOOS) at study enrollment and after the intervention period, and the individual change in the KOOS Quality of Life subscale was compared with the minimal detectable change (7.2 points). Average PA monitor wear compliance was 95.5% ± 7.3% during the observation period and 97.7% ± 2.9% during the intervention period. Median goal achievement was 31.5% ± 6.8% during the intervention period. Five participants demonstrated meaningful improvements in the KOOS Quality of Life subscale during the study period. Individualized goal setting via mobile technology appears to be a feasible approach to PA promotion. However, based on the low rate of daily goal attainment during the intervention period, continued refinement of this intervention aproach would be beneficial before broad clinical implementation.

Acceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial

BackgroundA significant proportion of cancer survivors have overweight or obesity. Although this has negative implications for health, weight management is not a standard component of oncology aftercare. Mobile health (mHealth) technology, in combination with behavior change techniques (BCTs), has the potential to support positive lifestyle changes. Few studies have been carried out with cancer survivors; therefore, the acceptability of these tools and techniques requires further investigation.ObjectiveThe aim of this study is to examine the acceptability of a behavior change intervention using mHealth for cancer survivors with a BMI of 25 or more and to gather constructive feedback from participants.MethodsThe intervention consisted of educational sessions and an 8-week physical activity goal setting intervention delivered using mobile technology (ie, Fitbit activity monitor plus SMS contact). In the context of a two-arm randomized controlled trial, semistructured interviews were conducted to assess the retrospective acceptability of the intervention from the perspective of the recipients. The theoretical framework for the acceptability of health care interventions was used to inform a topic guide. The interviews were transcribed and analyzed using thematic analysis. A quantitative survey was also conducted to determine the acceptability of the intervention. A total of 13 participants were interviewed, and 36 participants completed the quantitative survey.ResultsThe results strongly support the acceptability of the intervention. The majority of the survey respondents held a positive attitude toward the intervention (35/36, 97%). In qualitative reports, many of the intervention components were enjoyed and the mHealth components (ie, Fitbit and goal setting through text message contact) were rated especially positively. Responses were mixed as to whether the burden of participating in the intervention was high (6/36, 17%) or low (5/36, 14%). Participants perceived the intervention as having high efficacy in improving health and well-being (34/36, 94%). Most respondents said that they understood how the intervention works (35/36, 97%), and qualitative data show that participants’ understanding of the aim of the intervention was broader than weight management and focused more on moving on psychologically from cancer.ConclusionsOn the basis of the coherence of responses with theorized aspects of intervention acceptability, we are confident that this intervention using mHealth and BCTs is acceptable to cancer survivors with obesity or overweight. Participants made several recommendations concerning the additional provision of social support. Future studies are needed to assess the feasibility of delivery in clinical practice and the acceptability of the intervention to those delivering the intervention.International Registered Report Identifier (IRRID)RR2-10.2196/13214

Participation in a Weekly Physical Activity–Related Book Club Improves Health Outcomes over 12 Weeks in Rural Women

ABSTRACT Despite the well-documented benefits of physical activity (PA) participation, over half of women do not meet PA guidelines, with greater disparities seen among rural populations. Interventions that include behavioral and cognitive strategies for promoting behavior change are important to improve health outcomes among women. This study aimed to determine whether a book club (i.e., Fit Minded) could improve PA participation, clinical markers of health, and psychosocial measures related to PA and self-perception in adult rural women. Women participated in a 12-wk book club that incorporated reading and discussions related to physical activity and self-worth. PA participation using Fitbits; clinical outcomes (e.g., weight and blood pressure); psychosocial measures related to PA and self-perception, including perceived exercise benefits and barriers, outcome expectations to exercise, PA goal setting, planning, and scheduling; physical self-worth; and global self-worth, were measured at pre- and postintervention (12 wk) in adult rural women. Thirty-two women (age, 48.09 ± 8.96 yr) completed at least 10/12 sessions and all pre- and postintervention measures. Steps per day did not increase from baseline to week 12; however, participants had significant reductions in weight (P = 0.022), body mass index (P = 0.022), and systolic blood pressure (P = 0.047). Participants had significant improvements in several psychosocial measures related to PA participation and self-worth (perceived exercise benefits and barriers, PA goal setting, PA planning and scheduling, all subscales of physical self-worth, and global self-worth; P values &lt; 0.001–0.032), but not outcome expectations related to exercise. Results demonstrate that Fit Minded, with no face-to-face PA component, can improve psychosocial factors related to PA participation and physical self-worth, along with modest improvements in clinical markers of health in rural women. Although objectively assessed PA did not increase, there is evidence of improved health behaviors, which may translate to greater effects over time.

A community-based positive psychology group intervention to promote physical activity among people with metabolic syndrome: Proof of concept results to inform a pilot randomized controlled trial protocol

BackgroundCommunity-based physical activity interventions can offset the burden of developing chronic diseases. Positive psychology (PP) interventions may improve health behaviors, but little is known about their effectiveness in community-based prevention settings. A multilevel PP-based intervention has never been studied in people at risk for chronic diseases. PurposeThe aim of the trial is to demonstrate feasibility, acceptability, and improve physical activity. The purpose is to describe the theory, design, and rationale of the randomized controlled trial (RCT) phase of an iteratively developed physical activity intervention for metabolic syndrome. The feasibility results of the proof-of-concept phase are presented. MethodsParticipants are adult primary care patients at community health centers with metabolic syndrome and low physical activity (target n = 64). The 8-week group intervention consists of weekly physical activity goal-setting and self-monitoring, positive psychology activities, and neighborhood walks. Participants rate feasibility and acceptability of sessions. Pre-post-intervention, and 24 weeks later, participants complete accelerometers, questionnaires, and biometrics. Feasibility resultsEight participants enrolled and seven completed. The median number of group sessions attended was 7 out of 8. Average ease and usefulness of sessions were rated as 7.0 (±0.5)/10 and 8.1 (±1.0)/10, respectively, indicating feasibility and acceptability. Average pre-post physical activity increased by 2152 steps and 29.25 min of MVPA/week. DiscussionThis proof-of-concept trial demonstrated high feasibility and acceptability, with increased physical activity. These positive findings suggest that the RCT phase will show high feasibility, acceptability, and initial impact on physical activity.

My Quest, a Community-Based mHealth Intervention to Increase Physical Activity and Promote Weight Loss in Predominantly Rural-Dwelling, Low-Income, Alabama Women

Rural-dwelling, overweight/obese, limited-resource individuals and women have the lowest leisure-time physical activity rates among Americans. This community-based, single-group pre- posttest study sought to increase physical activity, step counts, and promote weight loss in 104 low-income women (84% rural). Analyses included nonparametric and repeated-measures analyses of variance to determine physical activity behaviors, step counts, and weight loss. Results show, from pre- to postintervention, participants improved self-reported step counts, physical activity goal setting and behaviors, and body weight. This study adds support that text message programs can reach a high-risk, limited-resource, predominantly rural population to promote physical activity and weight loss.

Intervention Mediators in a Randomized Controlled Trial to Increase Physical Activity and Fatigue Self-management Behaviors Among Adults With Multiple Sclerosis.

People with multiple sclerosis (MS) often experience fatigue, which is aggravated by inactivity. Identifying mediators of changes in physical activity (PA) and fatigue self-management (FSM) behaviors could optimize future interventions that reduce the impact of MS fatigue. examine the effects of telephone-delivered interventions on Social Cognitive Theory constructs and test whether these constructs mediated secondary outcomes of PA and FSM behaviors. Participants with MS (n = 208; Mean age = 52.1; Female = 84.6%) were randomized into contact-control intervention (CC), PA-only intervention, and PA+FSM intervention. Step count (Actigraphy) and FSM behaviors as well as self-efficacy, outcome expectations, and goal setting for PA and FSM were measured at baseline, post-test (12 weeks), and follow-up (24 weeks). Path analyses using bias-corrected bootstrapped 95% confidence intervals (CI) determined whether constructs at post-test mediated behaviors at follow-up when adjusting for baseline measures. Path analysis indicated that PA-only (β = 0.50, p < .001) and PA+FSM interventions (β = 0.42, p < .010) had an effect on goal setting for PA, and that PA + FSM intervention had an effect on self-efficacy for FSM (β = 0.48, p = .011) and outcome expectations for FSM (β = 0.42, p = .029). Goal setting for PA at post-test mediated the effects of PA-only (β = 159.45, CI = 5.399, 371.996) and PA + FSM interventions (β = 133.17, CI = 3.104, 355.349) on step count at follow-up. Outcome expectations for FSM at post-test mediated the effects of PA + FSM intervention on FSM behaviors at follow-up (β = 0.02, CI = 0.001, 0.058). Goal setting for PA and outcome expectations for FSM may be important constructs to target in telephone-delivered interventions designed to reduce the impact of MS fatigue. Clinicaltrials.gov (NCT01572714).

Sensor-measured Physical Activity In Overweight And Obese Women In Early Pregnancy

Overweight and obese pregnant women may benefit from physical activity (PA) in pregnancy, yet few studies have examined sensor-measured PA in pregnancy. PURPOSE: To evaluate sensor-measured PA in overweight and obese pregnant women and its sociodemographic and psychological correlates. METHODS: We analyzed baseline data from an ongoing behavioral lifestyle intervention trial in Columbia, SC (n=202). PA was measured with the SenseWear Armband; compliance was set at wearing for 20+ hrs/d, 5+ days (including 1+ weekend day). PA measures were daily duration of light PA (LPA), moderate to vigorous PA (MVPA), daily steps, and meeting MVPA guidelines (≥150 min/wk of MVPA in ≥10 min bouts). PA was presented as median (interquartile range). Subgroup differences in medians were examined with quantile regression models. Correlations of PA measures with perceived stress, depressive symptoms, PA social support, PA self-efficacy, and PA self-regulation were studied. A logistic regression model was used to examine correlates of meeting MVPA guidelines. RESULTS: Participants (mean of 12.4 weeks gestation) had a median of 203 (154, 258) min/d LPA, 34 (20, 49) min/d MVPA, and 4,870 (3768, 6590) steps/d. LPA, MVPA, and steps were lower in African American and obese women (p<.05). LPA was lower in nulliparous women (p<.05). Participants with less than college education had lower MVPA and steps (p<0.05). Further, LPA, MVPA, and steps were positively associated with PA self-efficacy (r’s ranging from 0.13 to 0.16, p≤.05) and PA goal setting (r’s ranging from 0.16 to 0.21, p<.05). MVPA was positively associated with PA planning (r=0.16, p<.05). Only 10.4% of participants met MVPA guidelines, which was more prevalent in white (17.1%) vs African American (2.2%) women and in overweight (17.9%) vs obese women (3.7%) (p<0.05). After adjusting for age, parity, and marital status, white women and overweight women had higher odds of meeting MVPA recommendation than their counterparts: white: 5.8 (1.2-28.6); overweight: 5.2 (1.6, 16.9). CONCLUSION: Sensor-measured PA was low in overweight and obese pregnant women in early pregnancy with significant differences by race, education, parity, and pre-pregnancy weight status. Programs targeting PA are needed for this population. Funded by NIH/NICHD.

A Pilot Randomised Controlled Trial of a Text Messaging Intervention with Customisation Using Linked Data from Wireless Wearable Activity Monitors to Improve Risk Factors Following Gestational Diabetes.

Gestational diabetes (GDM) is a highly prevalent disorder of pregnancy which portends a high risk for future type 2 diabetes. Limited evidence indicates lifestyle intervention prevents the development of diabetes, but most previously studied interventions are resource-intensive. Intervention programs that utilise newer technologies may be scalable at lower cost. This 6-month pilot randomized controlled trial tested the delivery of text messages linked to an activity monitor, adaptive physical activity goal setting, and limited face-to-face counseling, as an intervention to improve rates of post-partum glucose tolerance testing and lifestyle behaviours amongst women following a GDM pregnancy. Sixty subjects were randomised 2:1 intervention vs. control. Compared to control subjects, there were trends for intervention subjects to improve diet, increase physical activity, and lose weight. There was no difference between the groups in the rate of glucose tolerance testing. Only 46 (77%) subjects completed some, and 19 subjects completed all the elements of the final evaluation. Feedback regarding the text messages and activity monitor was highly positive. Overall, results suggest that a text message and activity monitor intervention is feasible for a larger study or even as a potentially scalable population health intervention. However, low completion rates necessitate carefully considered modification of the protocol.

VA FitHeart, a Mobile App for Cardiac Rehabilitation: Usability Study.

BackgroundCardiac rehabilitation (CR) improves outcomes for patients with ischemic heart disease or heart failure but is underused. New strategies to improve access to and engagement in CR are needed. There is considerable interest in technology-facilitated home CR. However, little is known about patient acceptance and use of mobile technology for CR.ObjectiveThe aim of this study was to develop a mobile app for technology-facilitated home CR and seek to determine its usability.MethodsWe recruited patients eligible for CR who had access to a mobile phone, tablet, or computer with Internet access. The mobile app includes physical activity goal setting, logs for tracking physical activity and health metrics (eg, weight, blood pressure, and mood), health education, reminders, and feedback. Study staff demonstrated the mobile app to participants in person and then observed participants completing prespecified tasks with the mobile app. Participants completed the System Usability Scale (SUS, 0-100), rated likelihood to use the mobile app (0-100), questionnaires on mobile app use, and participated in a semistructured interview. The Unified Theory of Acceptance and Use of Technology and the Theory of Planned Behavior informed the analysis. On the basis of participant feedback, we made iterative revisions to the mobile app between users.ResultsWe conducted usability testing in 13 participants. The first version of the mobile app was used by the first 5 participants, and revised versions were used by the final 8 participants. From the first version to revised versions, task completion success rate improved from 44% (11/25 tasks) to 78% (31/40 tasks; P=.05), SUS improved from 54 to 76 (P=.04; scale 0-100, with 100 being the best usability), and self-reported likelihood of use remained high at 76 and 87 (P=.30; scale 0-100, with 100 being the highest likelihood). In interviews, patients expressed interest in tracking health measures (“I think it’ll be good to track my exercise and to see what I’m doing”), a desire for introductory training (“Initially, training with a technical person, instead of me relying on myself”), and an expectation for sharing data with providers (“It would also be helpful to share with my doctor, it just being a matter of clicking a button and sharing it with my doctor”).ConclusionsWith participant feedback and iterative revisions, we significantly improved the usability of a mobile app for CR. Patient expectations for using a mobile app for CR include tracking health metrics, introductory training, and sharing data with providers. Iterative mixed-method evaluation may be useful for improving the usability of health technology.

My Quest, an Intervention Using Text Messaging to Improve Dietary and Physical Activity Behaviors and Promote Weight Loss in Low-Income Women

ObjectiveTo evaluate changes in dietary and physical activity behaviors and weight after implementation of a 12-week text messaging initiative (My Quest). DesignThe researchers conducted a 1-group, pre- to posttest study design to determine changes after implementation of a text messaging initiative developed using the tenets of the Social Cognitive Theory. SettingA total of 55 Alabama counties (84% rural) with high rates of poverty, overweight/obesity, and chronic diseases. ParticipantsConvenience sample of low-income, primarily overweight/obese women (n = 104). InterventionShort texts (n = 2–3/d) provided health tips, reminders, and goal-setting prompts. Weekly electronic newsletters provided tips and recipes. Participant self-monitored body weight weekly. Main Outcome MeasureOutcomes included goal setting, self-efficacy, behavioral and environmental factors, self-monitoring, and body weight; data collection occurred through text message response and online surveys. AnalysisAnalyses were conducted using McNemar test (dichotomous data), Wilcoxon signed rank test (ordinal data), or paired t test (continuous data). ResultsParticipants significantly (P < .05) improved dietary and physical activity behaviors and food environment; increased dietary and physical activity goal setting; and reduced body weight. Conclusions and ImplicationsA low-cost, text messaging initiative particularly targeting women residing in rural communities with high rates of poverty and obesity can promote weight loss and improve dietary and physical activity behaviors. Future studies may include a control group and social support component such as group text messaging.

Pilot Trial of a Home-based Physical Activity Program for African American Women.

This study aimed to assess the feasibility of a Home-based, Individually-tailored Physical activity Print (HIPP) intervention for African American women in the Deep South. A pilot randomized trial of the HIPP intervention (N = 43) versus wellness contact control (N = 41) was conducted. Recruitment, retention, and adherence were examined, along with physical activity (7-d physical activity recalls, accelerometers) and related psychosocial variables at baseline and 6 months. The sample included 84 overweight/obese African American women 50-69 yr old in Birmingham, AL. Retention was high at 6 months (90%). Most participants reported being satisfied with the HIPP program and finding it helpful (91.67%). There were no significant between-group differences in physical activity (P = 0.22); however, HIPP participants reported larger increases (mean of +73.9 min·wk (SD 90.9)) in moderate-intensity or greater physical activity from baseline to 6 months compared with the control group (+41.5 min·wk (64.4)). The HIPP group also reported significantly greater improvements in physical activity goal setting (P = 0.02) and enjoyment (P = 0.04) from baseline to 6 months compared with the control group. There were no other significant between-group differences (6-min walk test, weight, physical activity planning, behavioral processes, stage of change); however, trends in the data for cognitive processes, self-efficacy, outcome expectations, and family support for physical activity indicated small improvements for HIPP participants (P > 0.05) and declines for control participants. Significant decreases in decisional balance (P = 0.01) and friend support (P = 0.03) from baseline to 6 months were observed in the control arm and not the intervention arm. The HIPP intervention has great potential as a low-cost, high-reach method for reducing physical activity-related health disparities. The lack of improvement in some domains may indicate that additional resources are needed to help this target population reach national guidelines.

A randomized trial of a motivational interviewing intervention to increase lifestyle physical activity and improve self-reported function in adults with arthritis.

Arthritis is a leading cause of chronic pain and functional limitations. Exercise is beneficial for improving strength and function and decreasing pain. We evaluated the effect of a motivational interviewing-based lifestyle physical activity intervention on self-reported physical function in adults with knee osteoarthritis (KOA) or rheumatoid arthritis (RA). Participants were randomized to intervention or control. Control participants received a brief physician recommendation to increase physical activity to meet national guidelines. Intervention participants received the same brief baseline physician recommendation in addition to motivational interviewing sessions at baseline, 3, 6, and 12 months. These sessions focused on facilitating individualized lifestyle physical activity goal setting. The primary outcome was change in self-reported physical function. Secondary outcomes were self-reported pain and accelerometer-measured physical activity. Self-reported KOA outcomes were evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for KOA (WOMAC scores range from 0 to 68 for function and 0 to 20 for pain) and the Health Assessment Questionnaire (HAQ) for RA. Outcomes were measured at baseline, 3, 6, 12, and 24 months. Multiple regression accounting for repeated measures was used to evaluate the overall intervention effect on outcomes controlling for baseline values. Participants included 155 adults with KOA (76 intervention and 79 control) and 185 adults with RA (93 intervention and 92 control). Among KOA participants, WOMAC physical function improvement was greater in the intervention group compared to the control group [difference = 2.21 (95% CI: 0.01, 4.41)]. WOMAC pain improvement was greater in the intervention group compared to the control group [difference = 0.70 (95% CI: -0.004, 1.41)]. There were no significant changes in physical activity. Among RA participants, no significant intervention effects were found. Participants with KOA receiving the lifestyle intervention experienced modest improvement in self-reported function and a trend toward improved pain compared to controls. There was no intervention effect for RA participants. Further refinement of this intervention is needed for more robust improvement in function, pain, and physical activity.

Effects of a brief, pedometer-based behavioral intervention for individuals with COPD during inpatient pulmonary rehabilitation on 6-week and 6-month objectively measured physical activity: study protocol for a randomized controlled trial

BackgroundPulmonary rehabilitation programs often fail to substantially enhance long-term physical activity in patients with chronic obstructive pulmonary disease (COPD). The reasons for successful physical activity changes in patients with COPD are not well understood. The need to better understand the determinants of physical activity in patients with COPD and effective rehabilitation strategies to improve physical activity is evident.Methods/designThe STAR study (Stay Active after Rehabilitation) investigates, in a randomized controlled trial, the additional effect of a pedometer-based behavior-change intervention during inpatient pulmonary rehabilitation on objectively measured physical activity 6 weeks and 6 months post rehabilitation. The intervention uses the behavior-change techniques (1) instruction on how, where and when to perform the behavior, (2) prompt goal setting for physical activity, (3) prompt self-monitoring of behavior, and (4) feedback on behavior. The primary outcome of physical activity will be measured using a physical activity monitor (Actigraph wGT3X-BT) for a period of 7 days, firstly 2 weeks before rehabilitation begins (t0) as well as 6 weeks and 6 months after rehabilitation (t3, t4). Additionally, to predict physical activity progression after rehabilitation, a complex personal diagnostics battery, including questionnaires as well as functional assessments, is to be carried out at the start and end of rehabilitation (t1, t2). This battery is based on the foundational ideas of the Physical Activity-Related health Competence model.Five hundred and two patients with COPD, aged 18 years or older and admitted for an approved pulmonary rehabilitation, will be enrolled in the STAR study.DiscussionThe STAR study is designed as a randomized controlled trial to gain a better understanding of the personal determinants of physical activity in patients with COPD and to evaluate a pedometer-based physical activity-change intervention in the context of inpatient pulmonary rehabilitation. The results enable the future identification of patients with COPD who will find it difficult to engage in long-term physical activity after rehabilitation. Based on this, intervention strategies to promote physical activity in the content of pulmonary rehabilitation can be optimized.Trial registrationClinicaltrials.gov, ID: NCT02966561. Registered retrospectively after the start of the recruitment in June 2016 on 22 November 2016. All protocol modifications will be registered in the trial registry.

Exercise Trials In Co-morbid Adults

PURPOSE: Exercise (EX) trials in adults with co-morbid conditions such as type 2 diabetes offer an opportunity to address behavior changes needed to increase physical activity (PA) and improve long-term health. The aim of this study was to determine whether it was feasible to include a low-dose PA behavior change intervention in an EX trial. METHODS: For the original EX trial, participants were randomized to one of four groups, to test the interactive effects of metformin and post-exercise ingestion of protein versus carbohydrate on mitochondrial protein synthesis, and the blunting effect of metformin on EX response. Participants were ≥55 years of age, had fasting glucose values ≥100 mg/dl, hemoglobin A1c 5.7-6.4%, two hour postprandial glucose 140-200 mg/dl, or a family history of type 2 diabetes. All participants received supervised EX sessions, three times per week for 12 weeks. For the behavior change intervention, participants were randomized to receive a one-hour PA counselling session, or not, held after completion of the 12 week EX intervention. The session was based on social-cognitive theory, and the primary goal was to increase post-intervention PA maintenance through discussion of PA benefits, PA goal setting, and identifying and overcoming PA barriers. Self-reported PA was measured using the International PA Questionnaire (IPAQ), pre, post and three-months after the EX intervention. RESULTS: There was no additional time burden for participants or the principal investigators of the original EX trial. Baseline, post-intervention PA questionnaires, and the counselling session were done while participants were in the laboratory doing their oral glucose tolerance test, and the follow-up PA questionnaire was completed by mail or online. PA questionnaire completion rates were high; 30/31 (96.7%) completed baseline, 100% (N=17) completed post-intervention PA questionnaire and counselling session (if randomized to receive it), and 7/8 (87.5%) have completed the three-month follow up PA questionnaire. CONCLUSIONS: Based on the high completion rates and no added time commitment, including behavior change strategies as part of an exercise trial is feasible. This trial is ongoing, and upon completion, effectiveness of the counselling session for increasing PA at three-month follow-up will be examined.