Physical Activity Goals Research Articles

Motivational strategies to improve adherence to physical activity in breast cancer survivors: A systematic review and meta-analysis

Two behavioral change-based strategies for promoting adherence to physical activity (PA) suggested to have the greatest potential are the pedometer and Motivational Interviewing (MI). However, there are no comparisons between these two strategies identifying which one is more effective for improving PA adherence. This systematic review and meta-analysis aimed to determine which PA motivation strategy is more effective for promoting adherence to self-directed PA in female breast cancer survivors. Studies implementing self-directed PA which used a step tracker and/or MI for motivation in female breast cancer survivors were identified from the following databases at two timepoints, September 2019 and June 2020: CENTRAL, PubMed, CINAHL, PsycINFO, and Sportdiscuss. Sixteen randomized controlled trials (RCTs) were selected for data extraction, whereas ten RCTs were included in meta-analysis. Meta-analysis was performed on pooled data to estimate the standardized mean differences in PA duration and step count, and 95% confidence intervals. The number of participants meeting PA recommendations was also analyzed. Subgroup analysis was performed for three motivational strategies (pedometer combined with counselling, with print material or with motivational interviewing). Meta-analysis showed that pedometer combined with another intervention has a small effect on step count (p = 0.03) and a moderate effect on duration of moderate-vigorous physical activity (MVPA) (p = <0.0001) compared to controls. Additionally, motivational strategies increase the number of participants who meet a PA goal (p = 0.005). The findings of this review endorse the use of a step tracker combined with counselling, print material or MI based on behavioral change theory. This approach provided the most consistent positive effect on adherence to self-directed PA among breast cancer survivors. Future studies should evaluate differences between measures of adherence to self-directed PA, to identify the best motivation strategy for improving patient adherence and health outcomes.Systematic review registration: PROSPERO Registration number CRD42020148542

Technology and Human Connection to Prevent Diabetes in Rural United States

This quality improvement pilot project implemented a diabetes prevention program using physical activity trackers and human connection to increase physical activity (PA) and reduce the risk of diabetes among adults with prediabetes from a rural primary care clinic. The outcomes included PA steps, PA minutes, the achievement of self-established PA goals, hemoglobin A1C level, weight, and body mass index. During the 3 months of the project, PA steps significantly increased, and most participants reached self-established PA goals. Overall, the program outcomes were positive. Participants and health care team members reported additional benefits and drawbacks to the project, confirming the study’s feasibility.

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.

Personalized paths for physical activity: developing a person-centered quantitative function to determine a customized amount of exercise and enhancing individual commitment

BackgroundNon-Communicable Diseases (NCDs) are leading causes of mortality. These conditions are also known as chronic diseases of long duration and generally slow progression. Physical activity (PA) is a main factor to delay symptoms and consequences of NCDs. In last decades, reduced physical exercise has been observed across all ages. Despite educational campaigns aimed at modifying unhealthy habits, it is difficult to promote healthy lifestyles in general population. Poor interest, lack of motivation, as well as career and family commitments hinder people’s participation in regular PA programs. In this study we propose a theoretical person-centred approach to actively involve general population in enhancing their opportunity to perform PA based on personalized needs and targets.MethodsWe defined four profiles of baseline PA levels (inactive, moderately inactive, moderately active, and active people) by referring to Metabolic equivalents (METs) based on individual answers to General Practice Physical Activity Questionnaire (GPPAQ).ResultsBased on the answers to the GPPAQ and by computing the related METs for each profile of baseline exercise levels, we developed an innovative person-centered web-based algorithm/function for enhancing and measuring PA participation in community settings. This function can compute evidence-based standardized profiles of participants, personalized goals of PA being functional to the purpose of maintaining or gaining health benefits, as well as the type and duration of PA needed to reach these goals.ConclusionIt might be speculated that this approach would be a reliable method for increasing people’s self-efficacy and population adherence to recommended levels of PA. However, this theoretical proposal requires to be implemented in further research.

МЕДИКО-БІОЛОГІЧНА СКЛАДОВА ПІДГОТОВКИ УЧИТЕЛЯ ФІЗИЧНОЇ КУЛЬТУРИ

The purpose of the work is to characterize the biomedical component in the training of specialists in the field of knowledge 01 Education / Pedagogy in specialties 014 Secondary education (physical culture), 014 Secondary education (human health), 017 Physical culture and sports. Research methods. To obtain the most significant research results and their interpretation, the following methods were used: theoretical analysis and synthesis, systematization, generalization of information presented in scientific sources of information. Medical and biological support of physical culture is most justified, connected with the influence of physical exercises on the human body, the subject of which is the problems of human physical development, the activity of the main functional systems of the body, biochemical processes in the implementation of motor activity. This is due to the study of human health, the health-improving effect of motor exercises, adaptation to physical activity, determination of the influence of intense muscular activity on the body systems, adaptive changes in the life support system and regulation of human motor activity. Human motor activity associated with physical activity is one of the main factors that ensures normal vital activity, the basis for mental and physical development in ontogenesis. At the same time, mainly in the biomedical sciences, the physical qualities of a person are considered as natural (biological) properties without taking into account the integral individuality. Medical and biological education in physical culture of a person has recently been due to the active study of integrative approaches to the physical condition of a person. A future teacher of physical culture in the learning process should form a universal competence based on the sports and physical culture of the individual, reflecting its integrative nature. An integrated factor in physical culture and sports is movement, the direction of which is determined by operational, current and long-term goals of physical activity.

985-P: Black New Yorkers with Type 2 Diabetes: Afro-Caribbean Immigrants Have Better Cardiometabolic Health than African Americans

Using the 2013/14 New York City Health and Nutrition Examination Survey population sample, this study compared Afro Caribbean immigrants and US-born African American New Yorkers to determine a) whether prevalence and odds of type 2 diabetes (T2DM) differed between ethnic groups; and b) whether cardiometabolic health profiles differed among those with T2DM. T2DM was defined by prior diagnosis, HbA1c≥6.5%, or fasting glucose ≥126mg/dL. Weighted logistic regression estimated odds of T2DM adjusting for BMI, waist circumference, age, sex, education, income, marital status and physical activity. T2DM prevalence in Afro Caribbeans (n=81, age (Mean±SE) 49±2y, BMI 29.2 ±0.7kg/m2) was 31%, and 21% in African Americans (n=118, age 46±2years, BMI 30.3±0.9kg/m2). Afro Caribbeans had more than three times greater odds of T2DM than African Americans [aOR=3.32 (95%CI 1.11-9.88), P=0.0313]. Compared to African Americans with T2DM (n=21, Age 60.3±3.3y, BMI 34.6±1.7kg/m2), Afro Caribbeans with T2DM (n=23, Age 57.9±2.5y, BMI 29.9±0.8kg/m2) were less likely to have obesity (33.2% vs. 74.7%) and had lower waist circumference (102±2cm vs. 114±3cm, P=0.002). Although fewer Afro Caribbeans with T2DM met HP2010 physical activity goals (42.9% vs. 75.5%, P=0.0335), their mean HDL levels tended to be higher than those of African Americans with T2DM (50.6±2.5 mg/dL vs. 42.5±3.2mg/dL, P=0.0519). Afro Caribbean immigrants in New York City have higher odds of T2DM than African Americans. Nevertheless, Afro Caribbeans with T2DM have better cardiometabolic health than African Americans with T2DM. Differences in anthropometrics, blood lipids and health behaviors illustrate important intraethnic variations which affect future risk of T2DM complications among populations of African descent. Disclosure M. Farag: None. L. Khosla: None. S. Bhat: None. F. A. Montiel ishino: None. F. Williams: None. M. F. Horlyck-romanovsky: None.

Abstract P063: Afro Caribbeans With Type 2 Diabetes Have Lower Body Mass Index And Lower Waist Circumference Than African Americans: New York City Health And Nutrition Examination Survey 2013/14

African descent populations are experiencing a disproportionate burden of type 2 diabetes. In New York City, almost one third of the Black population are foreign-born Afro-Caribbeans and two thirds are African American. We compared type 2 diabetes risk profiles and disease burden among foreign-born Afro-Caribbean and US-born African American New Yorkers by estimating: a) Prevalence of type 2 diabetes; b) Type 2 diabetes risk profile by ethnicity and c) Odds of type 2 diabetes. Using the 2013/14 New York City Health and Nutrition Examination Survey probability sample weighted to the New York City population, we analyzed data for Afro-Caribbean (n=81) and African American (n=118) participants. Type 2 diabetes was defined as prior diagnosis; or HbA1c≥6.5%; or fasting glucose ≥126mg/dL. Logistic regression estimated odds of type 2 diabetes by BMI category, waist circumference (cm), and physical activity; adjusting for age, sex, education, income, and marital status. Among Afro-Caribbeans (Age (Mean ±SE) 49±2years, BMI 29.2 ±0.7kg/m 2 ) and African Americans (Age 46±2years, BMI 30.3 ±0.9kg/m 2 ) type 2 diabetes prevalence was 31% (25 of 81) and 21% (25 of 118) respectively. Compared to African Americans with type 2 diabetes, Afro-Caribbeans with type 2 diabetes had lower mean BMI (29.9 ±0.8kg/m 2 vs. 34.6 ±1.78kg/m 2 , P =0.01), and lower waist circumference (102 ±2cm vs. 114 ±3cm, P =0.0015). Afro-Caribbeans with type 2 diabetes were more likely to be overweight (57.2% vs. 13.5%) rather than obese (33.2% vs. 74.7%), yet less likely to meet HP2010 physical activity goals (23.6% vs 35.3%). Overall type 2 diabetes odds were no different between groups. In the total population odds were 5% higher for each cm waist circumference [aOR=1.05 (95% CI 1.01-1.10), P =0.0194]. Compared to the youngest age group, ages 20-49y, type 2 diabetes odds were higher among ages 50-59y [aOR=7.12 (95% CI 2.29-22.14)], and ages 60+ [aOR=5.04 (95% CI 1.65-15.39), P =0.0482]. In stratified logistic regression analyses among Afro-Caribbean New Yorkers, odds were 18% greater per cm waist circumference [aOR=1.18 (95% CI 1.03-1.35), P =0.0194]. For Afro-Caribbeans, low physical activity was associated with seven times greater odds of type 2 diabetes [aOR=7.03 (95% CI 1.19-41.53), P =0.0314]. Compared to African Americans, Afro-Caribbeans with type 2 diabetes are more likely to have lower waist circumference and be overweight rather than obese despite reporting less physical activity. Further examination of the relationship between BMI, waist circumference and visceral vs. subcutaneous adipose tissue may elucidate important intraethnic differences in diabetes risk. To enhance detection of diabetes among Afro-Caribbeans and African Americans in New York City, screening criteria should consider unique diabetes phenotypes.

A symptom-adapted physical activity intervention during induction chemotherapy for older adults with acute myeloid leukemia (AML) to maintain physical function.

12009 Background: Older adults are at risk for physical function decline during therapy for AML. Impaired physical function after induction therapy is associated with shorter survival Interventions designed to maintain function may improve treatment outcomes. We piloted a physical activity (PA) intervention among older adults receiving intensive chemotherapy for AML designed to prevent functional decline. Methods: Single institution randomized pilot study of PA vs. usual care. Eligibility included age ≥60 years, newly-diagnosed AML, ambulatory, planned intensive induction chemotherapy. Intervention participants were offered a PA session five days/week tailored daily to symptoms and conditions during the induction hospitalization. Session options were: 1) Standard (ward-based), walking + balance trahining + resistance exercises; 2) Intermediate (room-based), upper-body ergometer + balance training + resistance exercises; 3) Low-intensity (bed-based), upper-body ergometer + resistance exercises. Behavioral counseling sessions to establish PA goals and overcome barriers were conducted weekly during hospitalization and continued monthly by phone for 6 months. Assessment of physical function occurred at baseline, weekly during hospitalization (approximately 4-6 weeks), 3 months, and 6 months. The primary functional outcome of interest was the Short Physical Performance Battery (SPPB; 5 repeat chair stands, gait speed, balance tests; score 0-12 higher indicates better function). Clinically significant change in physical function was defined as ≥1.0 on the SPPB. Proportions of those that declined, remained stable, or improved on the SPPB were compared by group using an exact test for trend. Results: Among 96 eligible patients 70 enrolled (recruitment rate 73%, average participation 3 sessions/week). The mean age was 72.1±6.3 years, 70% were male. Mean baseline SPPB score was 7.0±3.8. In the surviving intention to treat population (N = 66), more intervention participants, compared to controls, maintained or improved their SPPB score (38% vs. 25%) during induction hospitalization (p = 0.278). Among those who achieved remission (N = 42), function was maintained or improved in a greater proportion of intervention participants (55%) compared to controls (23%), p = 0.047. Maintenance or improvement in SPPB from baseline to last follow-up (3 or 6 months post enrollment) was 62% vs 54% for intervention versus control among the intention to treat cohort (N = 50) and 67% vs. 55% among those who achieved remission (N = 40). Conclusions: A symptom adapted PA intervention with behavioral counseling during induction chemotherapy shows promise in preventing clinically meaningful decline in physical function among older adults with AML who achieve remission. Continued maintenance intervention may sustain benefits. Clinical trial information: NCT01519596.

Evaluating psychosocial and physical activity outcomes following an intervention among Filipino Americans.

Background: Physical activity (PA) is a strong contributor to enhancing a healthy lifestyle and preventing numerous chronic diseases. As ethnic minorities engage in low levels of PA, psychosocial and activity-based interventions for sustaining PA are crucial. Methods: The 6-month intervention incorporated culturally tailored educational workshops and weekly PA classes at a community center. Educational workshops were led by six trained community health workers (CHWs). Participants (n=37) completed pre- and post-intervention questionnaires regarding PA related self-efficacy, outcome expectations, social support, enjoyment, self-regulation, goal setting, and overall PA. Results: Following the intervention, study participants exhibited increases in weekly PA levels. Wilcoxon Signed-Rank test revealed higher median scores for Exercise Self-Efficacy Scale (ESES), Identified Regulation, and Intrinsic Motivation. Positive changes were observed for Physical Outcome Expectations, Social Outcome Expectations, Self-Evaluative Outcome Expectations, Physical Activity Enjoyment, Social Support for Exercise Scale – Family, Social Support for Exercise – Friends, and Exercise Goal-Setting. Conclusion: Community-based PA interventions may provide potential benefits to Filipino Americans, an ethnic Asian minority group, in identifying exercise benefits, developing proper exercise goals, increasing motivation, promoting PA behavior, and facilitating long-term PA adherence.

LiveWell in early childhood: results from a two-year pilot intervention to improve nutrition and physical activity policies, systems and environments among early childhood education programs in South Carolina

BackgroundEarly childhood education (ECE) settings are critical intervention targets for obesity prevention. This study evaluated a pilot two-year community-based participatory research (CBPR) project designed to assist ECE center directors and caregivers in policy, systems and environmental (PSE) change for improving healthy eating (HE) and physical activity (PA).MethodsA two-year CBPR study was conducted in 10 licensed ECE centers in Greenville, South Carolina. The intervention consisted of five steps: [1] baseline data collection and self-assessment using the Nutrition and Physical Activity Self-Assessment for Child Care (Go-NAP SACC), [2] tailored goal setting and action planning, [3] technical assistance and access to resources, [4] post intervention data collection and re-assessment, and [5] celebration of success. Main outcome measures (HE and PA environments, practices and policies) were assessed using the Environment and Policy Assessment and Observation (EPAO) tool at baseline and 24 months. One classroom of 3–5-year-olds was randomly selected for observation from each center (mean of 12 children per classroom). Means and standard deviations were calculated for total PA, total nutrition and each subscale of PA and nutrition. Paired sample t-tests were calculated to assess changes in EPAO scales from baseline to post intervention.ResultsTen ECE centers enrolled in the pilot study and eight completed the two-year intervention. Center-based goals were accomplished across all 8 ECE centers over the two-year intervention: 16 child nutrition goals, 6 outdoor play goals, 11 physical activity goals and 8 screen time goals across the entire sample. Nutrition policy and PA policy significantly improved (p < 0.05), with greater improvements in PA (10.0 point increase, p = .048) as compared to nutrition (3.3 point increase, p = 0.02).ConclusionsUtilizing a CBPR approach, this two-year nutrition and PA PSE intervention in ECE centers improved ECE center HE and PA policies.

Feasibility of Using Mobile Technology to Improve Physical Activity Among People Living with Diabetes in Asia.

Background: Chronic conditions such as diabetes (DM) and cardiovascular disease are associated with disability and poor quality of life. Asians are 30% more likely than non-Hispanic Whites to develop type 2 DM. The important roles of wearable technological applications or devices in maintaining individuals’ motivation to attain their physical activity (PA) goal have been reported. However, evidence of the feasibility and impact of the mobile technology on the PA in Thailand is limited. This study aims to examine the feasibility and the impact of the immediate performance feedback feature of the wearable device on PA.Methods: This pilot study recruited persons aged 18 or older with diabetes from two diabetes clinics in Chiang Mai, Thailand. Participants were randomly assigned into three groups: the aware group (AW: can see the step count on the device screen), the unaware group (UW: the device screen was completely covered), and the control group (usual care). Participants in the AW and UW groups were asked to wear the device for 2 full days while the usual care group did not wear the device. All participants completed a questionnaire package at their first study visit. Data analysis of univariate and multivariate general linear models were conducted using SAS version 9.4 (SAS Institute Inc., Cary, NC). All significance levels were set at 5%.Results: One hundred and fourteen participants age ranged from 39 to 75 years old were included in this analysis. The majority were female (n = 86, 69%) and married (n = 103, 82%). No adverse events were reported among device users. Within 2 days, there were less than 10% missing data and more than 70% of participants liked the devices mainly because they could see the step count. More than 63% of participants who wore the device had an average of steps greater than 10,000 per day. Although the number of steps and sleep hours were not significantly different between the AW and UW groups, 68% of the AW participants found that the device help them with their exercise.Discussion: The results demonstrate the feasibility of the use of the wearable device among people living with chronic conditions. Participants found that the step count screen provided immediate physical performance feedback that was helpful with their exercise. The behavioral changes, however, could not be examined due to the short duration of the usage. Future studies that require longer device usage in larger sample sizes are needed.

Elementary Students' Knowledge Development during the Implementation of "After School Exercise" Program.

Physical education should focus not only on students’ motor and emotional development but also on their cognitive development. The purpose of the present study was to examine whether elementary students’ health-related knowledge and physical activity-related goal setting increased after they participated in a program. The program aimed at promoting after school physical activity among students. Participants were 244 fifth- and sixth-grade students (116 boys and 128 girls). Students’ knowledge was examined by means of a multiple-choice test, cognitive assignments and a retrospective pre–post questionnaire. The results from the three measures indicated that students enhanced their knowledge both regarding the health benefits of physical activity (PA) and effective goal setting. Hence, it can be argued that the program was effective in promoting students’ skills and knowledge related to PA.

Low Resting Energy Expenditure Is Associated with High Gestational Weight Gain Only When Resting Energy Expenditure Fluctuates.

Resting energy expenditure (REE) may be useful for individualizing energy intake (EI) and physical activity (PA) goals, and in turn, regulating gestational weight gain (GWG). Limited research, however, has examined the association between REE and GWG. This study examined (1) change in REE from 14 to 28 gestation, (2) time-varying associations between REE and GWG, and (3) EI and PA patterns during the weeks when REE and GWG were significantly associated. Pregnant women with overweight/obesity (N = 27) participating in the Healthy Mom Zone study completed weekly point estimates of EI (back-calculation), PA (wrist-worn activity monitor), REE (mobile metabolism device), and weight (Wi-Fi scale) from 14 to 28 weeks gestation. Analyses included descriptives and time-varying effect modeling. REE fluctuated, increasing on average from 14 to 28 weeks gestation, but decreased at gestational weeks 17, 20, 21, 23, 26, and 28. Most women increased in REE; however there was large between-person variability in the amount of change. Associations between REE and GWG were small but time-varying; low REE was associated with high GWG between gestational weeks 25 to 28 when there was observably larger fluctuation in REE. Moreover, over half of the women were categorized as having excessive EI and most as low active during this time. EI needs may be overestimated and PA needs may be underestimated when REE is fluctuating, which may increase the risk for high second trimester GWG. Researchers should consider the role of REE to inform EI and PA goals to regulate GWG.

Web-based physical activity intervention for people with progressive multiple sclerosis: application of consensus-based intervention development guidance

ObjectivesPeople with progressive multiple sclerosis (PwPMS) report that they recognise the benefits of activity on their physical and psychological health but need support to achieve their physical activity goals. We...

Two sides of editorial queries: Editors and authors

Two sides of editorial queries: Editors and authors

The Endothelium as a Therapeutic Target in Diabetes: A Narrative Review and Perspective.

Diabetes has reached worldwide epidemic proportions, and threatens to be a significant economic burden to both patients and healthcare systems, and an important driver of cardiovascular mortality and morbidity. Improvement in lifestyle interventions (which includes increase in physical activity via exercise) can reduce diabetes and cardiovascular disease mortality and morbidity. Encouraging a population to increase physical activity and exercise is not a simple feat particularly in individuals with co-morbidities (obesity, heart disease, stroke, peripheral vascular disease, and those with cognitive and physical limitations). Translation of the physiological benefits of exercise within that vulnerable population would be an important step for improving physical activity goals and a stopgap measure to exercise. In large part many of the beneficial effects of exercise are due to the introduction of pulsatile shear stress (PSS) to the vascular endothelium. PSS is a well-known stimulus for endothelial homeostasis, and induction of a myriad of pathways which include vasoreactivity, paracrine/endocrine function, fibrinolysis, inflammation, barrier function, and vessel growth and formation. The endothelial cell mediates the balance between vasoconstriction and relaxation via the major vasodilator endothelial derived nitric oxide (eNO). eNO is critical for vasorelaxation, increasing blood flow, and an important signaling molecule that downregulates the inflammatory cascade. A salient feature of diabetes, is endothelial dysfunction which is characterized by a reduction of the bioavailability of vasodilators, particularly nitric oxide (NO). Cellular derangements in diabetes are also related to dysregulation in Ca2+ handling with increased intracellular Ca2+overload, and oxidative stress. PSS increases eNO bioavailability, reduces inflammatory phenotype, decreases intracellular Ca2+ overload, and increases antioxidant capacity. This narrative review and perspective will outline four methods to non-invasively increase PSS; Exercise (the prototype for increasing PSS), Enhanced External Counterpulsation (EECP), Whole Body Vibration (WBV), Passive Simulated Jogging and its predicate device Whole Body Periodic Acceleration, and will discuss current knowledge on their use in diabetes.

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

Interaction of diabetes genetic risk and successful lifestyle modification in the Diabetes Prevention Programme.

To test whether diabetes genetic risk modifies the association of successful lifestyle changes with incident diabetes. We studied 823 individuals randomized to the intensive lifestyle intervention (ILS) arm of the Diabetes Prevention Programme who were diabetes-free 1 year after enrolment. We tested additive and multiplicative interactions of a 67-variant diabetes genetic risk score (GRS) with achievement of three ILS goals at 1 year (≥7% weight loss, ≥150 min/wk of moderate leisure-time physical activity, and/or a goal for self-reported total fat intake) on the primary outcome of incident diabetes over 3 years of follow-up. A lower GRS and achieving each or all three ILS goals were each associated with lower incidence of diabetes (all P < 0.05). Additive interactions were significant between the GRS and achievement of the weight loss goal (P < 0.001), physical activity goal (P = 0.02), and all three ILS goals (P < 0.001) for diabetes risk. Achievement of all three ILS goals was associated with 1.8 (95% CI 0.3, 3.4), 3.1 (95% CI 1.5, 4.7), and 3.9 (95% CI 1.6, 6.2) fewer diabetes cases/100-person-years in the first, second and third GRS tertiles (P < 0.001 for trend). Multiplicative interactions between the GRS and ILS goal achievement were significant for the diet goal (P < 0.001), but not for weight loss (P = 0.18) or physical activity (P = 0.62) goals. Genetic risk may identify high-risk subgroups for whom successful lifestyle modification is associated with greater absolute reduction in the risk of incident diabetes.

Effect of physical activity goals on aerobic physical activity: testing the mediating role of external and internal motivation

ABSTRACT Prior work has shown that primary care patients endorse one or more of the following PA goals, weight maintenance, overall benefits, stress reduction, weight loss, tone/body shape, overall well-being, cardiovascular fitness, and increased energy. Using self-determination theory as a guide, the present study tested whether these eight goals had indirect effects on likelihood of meeting aerobic PA guidelines through internal motivation, external motivation or both. Patients (N = 642; 60.7% female; 44.5% Black; Mage = 50.26 years) were recruited from the waiting room of a primary care clinic to complete a questionnaire. Results showed that PA goals of tone/shape, weight maintenance, and stress reduction had dual, opposing influences on likelihood of meeting aerobic PA guidelines via internal and external motivation. The goal of weight loss had a negative indirect effect on likelihood of meeting guidelines via external motivation. The PA goals of overall health benefits and cardiovascular health had singular, positive indirect effects on PA via internal motivation. Well-being had a direct positive effect on PA and a negative indirect effect via external motivation. Finally, the goal of improved energy had a direct positive effect on likelihood to meet PA guidelines. Implications for clinical practice and theory development are discussed.

Proof of Concept for the FLEX Intervention: Feasibility of Home Based Coaching to Improve Physical Activity Outcomes and Viral Load Suppression among African American Youth Living with HIV.

FLEX is a Motivational Interviewing, home-based coaching program that concurrently targets HIV-related and physical activity goals among African American youth living with HIV in the United States. To create and pilot test FLEX, we leveraged a 2-step exploratory sequential mixed methods design informed by the ORBIT model with initial qualitative work followed by pre-post analysis of quantitative outcomes, concluding with qualitative exit surveys. Data were evaluated pre- and 3-months post-intervention. Recruitment was 90%. Participants reported high program satisfaction and program adherence (76% completion rate). Preliminary findings indicate reductions in participants’ viral loads and improvements across 4 measures of physical activity.