Physical Activity Goals Research Articles

DYADIC AND LONGITUDINAL STUDIES OF CLOSE RELATIONSHIPS: NEW INSIGHTS INTO HEALTH AND WELL-BEING ACROSS ADULTHOOD

Abstract This symposium includes 5 papers using intensive, longitudinal, and/or dyadic data on social relationships, revealing novel insights into health and well-being across adulthood. Fruhauf and colleagues conducted a feasibility and acceptability to test their Merging Yoga and self-management to develop Skills (MY-Skills) intervention, which targets caregiving dyads (caregivers and care receivers) dealing with persistent pain. Participants completed group interventions meeting twice a week for eight weeks, with each two-hour session including self-management education followed by yoga. A priori benchmarks for feasibility were met for the dyads, suggesting that these interventions may lead to improved well-being for caregiving dyads. Turner and Hooker conducted a 30-day microlongitudinal study of middle-aged daughters who are caring for their parents with dementia. On days when caregivers had more positive appraisals of caregiving than their own average, they had greater physical activity goal pursuit, independent of that day’s negative appraisals. Luong and colleagues also leverage an intensive longitudinal study spanning 3.5 month that prospectively tracked older adults and their close partners as they transitioned into senior housing facilities. Well-being varied by marital status, and changes over time varied by age. Weidmann & Chopik examined older romantic couples from 36 nations and found that between-partner correlations between depressive symptoms, self-rated health, and cognitive performance diffed across cultures. Finally, Purol et al. found that among middle-aged and older couples, similarity effects of personality facets on health and well-being were relatively small in magnitude, suggesting personality similarity among couples may be overstated in the literature.

Stepping towards More Intuitive Physical Activity Metrics with Wrist-Worn Accelerometry: Validity of an Open-Source Step-Count Algorithm.

Stepping-based targets such as the number of steps per day provide an intuitive and commonly used method of prescribing and self-monitoring physical activity goals. Physical activity surveillance is increasingly being obtained from wrist-worn accelerometers. However, the ability to derive stepping-based metrics from this wear location still lacks validation and open-source methods. This study aimed to assess the concurrent validity of two versions (1. original and 2. optimized) of the Verisense step-count algorithm at estimating step-counts from wrist-worn accelerometry, compared with steps from the thigh-worn activPAL as the comparator. Participants (n = 713), across three datasets, had >24 h continuous concurrent accelerometry wear on the non-dominant wrist and thigh. Compared with activPAL, total daily steps were overestimated by 913 ± 141 (mean bias ± 95% limits of agreement) and 742 ± 150 steps/day with Verisense algorithms 1 and 2, respectively, but moderate-to-vigorous physical activity (MVPA) steps were underestimated by 2207 ± 145 and 1204 ± 103 steps/day in Verisense algorithms 1 and 2, respectively. In summary, the optimized Verisense algorithm was more accurate in detecting total and MVPA steps. Findings highlight the importance of assessing algorithm performance beyond total step count, as not all steps are equal. The optimized Verisense open-source algorithm presents acceptable accuracy for derivation of stepping-based metrics from wrist-worn accelerometry.

Effects of a peer health coaching program on college student lifestyle behaviors

Objective: Health coaching (HC) may promote healthy behaviors in incoming college students. Participants: 187 undergraduate students (76% female; age 18.6 ± 1.6) were recruited to participate in a peer HC program. Methods: Participants received four HC sessions in eight-weeks to work toward self-selected goals of physical activity (PA), diet, or stress management. PA was assessed using the International Physical Activity Questionnaire Short-Form, diet with the Eating Habits Confidence Survey, and stress with the Perceived Stress Scale. Results: Repeated measures ANOVAs investigated lifestyle behavior changes in 130 participants. Significant effects of time were reported, with a 39.6% gain in PA, 9.9% increase in dietary habit, and 16.3% decline in stress levels with moderate to large effect sizes (ηp 2: 0.07-0.17; p< 0.01). Conclusion: The peer HC model promoted healthy lifestyles in college students. Additional research is needed to understand the effects of HC specifically for each goal, and student reactions to peer-led HC.

Active older adults goal setting outcomes for engaging in a physical activity app and the motivation characteristics of these goals (MOVEAGE-ACT)

Approximately 70% of older adults do not meet physical activity (PA) guidelines. While many interventions, are used in promoting PA, few target older adults or include substantial behavioural change techniques. Setting PA goals is often used but there is less research on goal setting outcomes, like improving health, preventing age effects, improving flexibility, goals that have been associated with increased likelihood of maintenance of PA. To understand the concept more fully in this cohort, the aim of this study was to identify older adults’ goal setting outcomes - the purpose of engaging in a PA app and through analysis determine the motivation characteristics of these.A cross-sectional, qualitative online survey was completed by 24, 60+, community dwelling, mostly active, French and Irish older adults. Thematic template analysis was used, and the motivation of these outcomes was assessed using the Self-Determination Theory of Motivation.The themes were: improving/staying healthy or physically active, maintaining functional aspects of physical health, continuing to do the things I want, sustaining mental wellbeing, and preventing disease and aging. Individuals cited goal setting outcomes that were generic, specific or both, and goals related to maintenance of PA and prevention of aging decline, were cited most. The motivation characteristics of these goals in mostly active older adults were autonomous and internally driven.Interventions, including apps, for older adults that encourage them to set specific goal setting outcomes/purposes for PA, are likely to generate stronger internally driven motivation, enhance ownership and participation, and may therefore increase effectiveness.

Adherence to in‐person vs. virtual delivery of a multi‐domain behavioral intervention to prevent cognitive decline: The US POINTER Study

AbstractBackgroundIn response to the global pandemic, U.S. POINTER procedures were adapted to include virtual intervention delivery. Here we describe the impact of this adaptation on adherence in a large community‐based lifestyle intervention trial.MethodU.S. POINTER is conducted through a partnership between the Alzheimer’s Association (AA) and five clinical sites. A total of 2000 older adults at risk for cognitive decline are assigned to one of two 24‐month multi‐domain lifestyle interventions. The Self‐Guided (SG) group works toward lifestyle goals that best meet their individual needs and schedules. The Structured (STR) group follows a coordinated program with specific goals for physical activity, diet, cognitive/social challenge, and health monitoring. Both groups meet in teams of 12‐15 participants throughout the study for support and guidance, which are led by trained staff. SG teams meet six times over 24 months, and STR teams meet weekly for the first 4 months, then 2x/month for 2 months, and then monthly. Although Team Meetings for both intervention groups were planned as in‐person events, the global pandemic necessitated a pivot to virtual delivery.ResultFrom January through December 2021, N = 2103 Team Meetings were conducted in‐person and N = 4663 Team Meetings were conducted virtually for 824 participants. For both intervention groups, in‐person and virtual Team Meeting attendance was the same, at 90%. When Team Meetings were held in‐person, STR participants completed a median of 93 very active Fitbit minutes/week (IQR = 38,185) and reported a median MIND Diet score of 11.0 (IQR = 9.5,12.0). When Team Meetings were virtual, adherence metrics were comparable with median values of 101 very active Fitbit minutes/week (IQR = 43,192) and a MIND Diet score of 11.0 (IQR = 9.8,12.0). Blood pressure monitoring and cognitive training metrics were also comparable without regard to Team Meeting delivery format.ConclusionOur findings demonstrate that a shift to virtual participant contact during the pandemic did not compromise adherence to a complex multi‐domain lifestyle intervention in older adults. These findings have high relevance for other ongoing lifestyle intervention studies within and outside of WW‐FINGERS, and highlight the importance of adaptability in clinical trial design and implementation to foster sustainability under challenging life circumstances.

Muva physical activity intervention to improve social functioning in people with a severe mental illness: study protocol of a pragmatic stepped wedge cluster randomized trial

BackgroundPeople with severe mental illness (SMI) often suffer from long-lasting symptoms that negatively influence their social functioning, their ability to live a meaningful life, and participation in society. Interventions aimed at increasing physical activity can improve social functioning, but people with SMI experience multiple barriers to becoming physically active. Besides, the implementation of physical activity interventions in day-to-day practice is difficult. In this study, we aim to evaluate the effectiveness and implementation of a physical activity intervention to improve social functioning, mental and physical health.MethodsIn this pragmatic stepped wedge cluster randomized controlled trial we aim to include 100 people with SMI and their mental health workers from a supported housing organization. The intervention focuses on increasing physical activity by implementing group sports activities, active guidance meetings, and a serious game to set physical activity goals. We aim to decrease barriers to physical activity through active involvement of the mental health workers, lifestyle courses, and a medication review. Participating locations will be divided into four clusters and randomization will decide the start of the intervention. The primary outcome is social functioning. Secondary outcomes are quality of life, symptom severity, physical activity, cardiometabolic risk factors, cardiorespiratory fitness, and movement disturbances with specific attention to postural adjustment and movement sequencing in gait. In addition, we will assess the implementation by conducting semi-structured interviews with location managers and mental health workers and analyze them by direct content analysis.DiscussionThis trial is innovative since it aims to improve social functioning in people with SMI through a physical activity intervention which aims to lower barriers to becoming physically active in a real-life setting. The strength of this trial is that we will also evaluate the implementation of the intervention. Limitations of this study are the risk of poor implementation of the intervention, and bias due to the inclusion of a medication review in the intervention that might impact outcomes.Trial registrationThis trial was registered prospectively in The Netherlands Trial Register (NTR) as NTR NL9163 on December 20, 2020. As the The Netherlands Trial Register is no longer available, the trial can now be found in the International Clinical Trial Registry Platform via: https://trialsearch.who.int/Trial2.aspx?TrialID=NL9163.

Abstract 15465: Associations Between Adherence to the Physical Activity Goal and Body Fat Changes in a MHealth Weight Loss Trial

Introduction: To date, few studies have examined the effectiveness of using wearable devices for promoting physical activity (PA) and improving body composition. Hypothesis: Adherence to the study-defined PA goal would be associated with greater body fat loss at 12 months than 6 months among adults with overweight or obesity during a weight loss intervention. Methods: SMARTER was a 12-mo, 2 arm weight loss trial with random assignment to (1) self-monitoring (SM, n=251) of diet, PA and weight, (2) self-monitoring plus ≤3 tailored feedback messages/day (SM+FB, n=251). The primary outcome was percentage of body fat % change assessed using Tanita scales and a body fat analyzer at 6 and 12 months relative to baseline. Adherence to the study-defined PA goal was assessed using weekly Fitbit moderate- and vigorous-intensity PA equivalents relative to ≥300 min/week PA goal and multiplied by 100%. Linear mixed modeling was used to estimate the effect of the percentage of adherence to the PA goal on the percentage of body fat % change at 6 and 12 months. Results: Participants (N=502) were mainly female (79.5%), White (82.5%), mean (± SD) age of 45.0 ± 14.4 years and BMI of 33.7 ± 4.0 kg/m2. Changes in the percentage of body fat % were similar at 6 and 12 months (time: F=3.48, P=.06) or by treatment assignment (treatment x time: F=1.33, P=.25). Overall, percentages of adherence to the PA goal were associated with greater percentages of body fat % loss (b [95% CI] -0.06 [-0.09, 0.03], F=18.61, P&lt;.0001), which did not vary over time (PA adherence x time: F=2.88, P = .09). Finally, percentages of adherence to the PA goal moderated treatment effects (PA adherence x treatment: 0.05 [0.01,0.09], F = 4.69, P = .03), which did not vary over time (PA adherence x treatment x time: F = 0.29, P = .59). Conclusions: PA adherence was associated body fat loss, which did not vary at 6 and 12 months in adults with overweight or obesity. Future studies need to examine the effect of using wearable devices on body composition when targeting behavior changes.

Abstract 11906: Association Between Neighborhood Environment and Physical Activity in Adults With Cardiovascular Disease in the United States

Introduction: Identifying attributes of the built environment that influence an individual’s adherence to recommended physical activity (PA) levels can inform cardiovascular-healthy urban-planning policies. However, no research has examined whether perceived neighborhood environment characteristics are associated with this among adults with CVD. Methods: Cross-sectional study using 2020 data from the National Health Interview Survey, which included 3191 adults with CVD. Perceived walkability and safety barriers were captured from 9 questions on participants’ feelings about the neighborhood’s safety and amenities to allow for walking. Meeting PA recommendation was evaluated based on 2012 ACC/AHA guidelines for individuals with stable CVD based on the self-reported measures of activity (Figure). Adjusted logistic models were created to evaluate the association of perceived walkability and safety with the odds of achieving PA goals. Results: In the study population, 36.8% met the overall PA guideline, of whom 7% met only strength activity, 19.5% met only aerobic activity, and 10.3% met both. Men were more likely to meet PA guidelines (42.5% vs. 29.2%) than women. In adjusted weighted analysis, having roads for a walk (OR 1.70, 95%CI 1.23-2.36), fun places such as parks, theatres, and libraries to walk near the living area (OR 1.43, 95%CI 1.08-1.89), and places to walk for relaxing and reducing stress (OR 1.46, 95%CI 1.10-1.95) were strongly associated with meeting PA recommendations. Conclusions: In adults with CVD, the neighborhood environment characteristics strongly associated with adherence to PA recommendations were the presence of places to walk for fun and relaxation. Although residual confounding is a possibility, our findings suggest that investing in social determinants by developing communities with amenities such as parks might help encourage physical activity for cardiovascular health.

Exploring Opportunities to Improve Physical Activity in Individuals with Spinal Cord Injury Using Context-Aware Messaging

Spinal cord injury (SCI) affects the mobility of 250,000 people per year worldwide. Physical activity (PA) in individuals with SCI is positively associated with improved mental and physical health outcomes. Mobile technologies have been developed to motivate individuals with SCI to increase PA using activity tracking and real-time feedback. We conducted semi-structured interviews and participatory design sessions with 15 manual wheelchair users with SCI and eight of their family members/friends to investigate user impressions of future technologies that might use computer-mediated, sensor-triggered communication to motivate PA. We assessed barriers to PA and how context-aware communication could help overcome them. Participants with SCI expressed that PA tracking and communication technologies must be tailored to their specific needs. Further analysis revealed that context-aware messaging could help participants with SCI connect with others to initiate timely conversations about overcoming PA barriers, and to provide encouragement to meet their PA goals. We discuss opportunities to empower individuals with SCI with regards to PA using tailored, context-aware communication.

Better Understanding Wearable Activity Monitor Use and Non-Use Among Older Adults: A Qualitative Study.

We used qualitative methods to better understand wearable activity monitor (WAM) use and its relationship with physical activity (PA) among older adults. Four focus groups, stratified by current/past ("ever") WAM users and "never" WAM users, were conducted with 57 participants aged ≥60 years. Data were coded with deductive and inductive approaches. Among ever WAM users, those with low pre-WAM PA levels reported higher PA related to WAM use while those with high pre-WAM PA levels reported they used WAM for tracking and monitoring their activity. Ever WAM users were motivated to increase PA through rewards and social support. Many never WAM users reported that WAM was unnecessary. WAM may be helpful for some older adults to increase their PA, particularly those who are motivated by setting and achieving PA goals. The results could help develop strategies to overcome barriers to WAM adoption and promote WAM use among older adults.

A Smartphone Physical Activity App for Patients in Alcohol Treatment: Single-Arm Feasibility Trial.

Alcohol use disorder (AUD) is a significant public health concern worldwide. Alcohol consumption is a leading cause of death in the United States and has a significant negative impact on individuals and society. Relapse following treatment is common, and adjunct intervention approaches to improve alcohol outcomes during early recovery continue to be critical. Interventions focused on increasing physical activity (PA) may improve AUD treatment outcomes. Given the ubiquity of smartphones and activity trackers, integrating this technology into a mobile app may be a feasible, acceptable, and scalable approach for increasing PA in individuals with AUD. This study aims to test the Fit&Sober app developed for patients with AUD. The goals of the app were to facilitate self-monitoring of PA engagement and daily mood and alcohol cravings, increase awareness of immediate benefits of PA on mood and cravings, encourage setting and adjusting PA goals, provide resources and increase knowledge for increasing PA, and serve as a resource for alcohol relapse prevention strategies. To preliminarily test the Fit&Sober app, we conducted an open pilot trial of patients with AUD in early recovery (N=22; 13/22, 59% women; mean age 43.6, SD 11.6 years). At the time of hospital admission, participants drank 72% of the days in the last 3 months, averaging 9 drinks per drinking day. The extent to which the Fit&Sober app was feasible and acceptable among patients with AUD during early recovery was examined. Changes in alcohol consumption, PA, anxiety, depression, alcohol craving, and quality of life were also examined after 12 weeks of app use. Participants reported high levels of satisfaction with the Fit&Sober app. App metadata suggested that participants were still using the app approximately 2.5 days per week by the end of the intervention. Pre-post analyses revealed small-to-moderate effects on increase in PA, from a mean of 5784 (SD 2511) steps per day at baseline to 7236 (SD 3130) steps per day at 12 weeks (Cohen d=0.35). Moderate-to-large effects were observed for increases in percentage of abstinent days (Cohen d=2.17) and quality of life (Cohen d=0.58) as well as decreases in anxiety (Cohen d=-0.71) and depression symptoms (Cohen d=-0.58). The Fit&Sober app is an acceptable and feasible approach for increasing PA in patients with AUD during early recovery. A future randomized controlled trial is necessary to determine the efficacy of the Fit&Sober app for long-term maintenance of PA, ancillary mental health, and alcohol outcomes. If the efficacy of the Fit&Sober app could be established, patients with AUD would have a valuable adjunct to traditional alcohol treatment that can be delivered in any setting and at any time, thereby improving the overall health and well-being of this population. ClinicalTrials.gov NCT02958280; https://www.clinicaltrials.gov/ct2/show/NCT02958280.

Informing a healthy eating and physical activity program to decrease postnatal weight retention: What are women experiencing and what type of program do they want?

Retention of weight gained during pregnancy contributes to overweight and obesity and consequent chronic disease risk. Early programs have been successful in improving diet quality, physical activity levels and reducing postnatal weight retention. However, barriers to program engagement remain. This study aimed to investigate women's healthy eating, physical activity and weight experiences and explore their views regarding digital health interventions to assist meeting their lifestyle goals. This qualitative descriptive study utilised semi-structured interviews with women who had recently become mothers who had gestational diabetes or a body mass index above 25 kg/m2 . Themes were then identified through thematic analysis of interview transcripts. Nine women were interviewed (average age 33.4 ± 4.2 years). The two distinct areas of questioning resulted in two overarching topics: (i) Enablers and barriers to maintaining regular physical activity and a healthy dietary pattern; and (ii) characteristics of a postpartum program to enable meeting of diet, physical activity and weight loss goals. These topics each had their own descriptive themes and sub-themes. Understanding women's needs and viewpoints for a postnatal diet, physical activity and weight program allows researchers to design a program to maximise engagement and outcomes. SO WHAT?: Any further postnatal program must leverage off existing infrastructure, integrate learnings from published formative work and harnesses the impact of digital delivery. This will improve program accessibility and provide ongoing contact for sustained behaviour change through text messaging and providing digital resources in a dynamic format women can engage with in their own time.

Investigating Rewards and Deposit Contract Financial Incentives for Physical Activity Behavior Change Using a Smartphone App: Randomized Controlled Trial.

Financial incentive interventions for improving physical activity have proven to be effective but costly. Deposit contracts (in which participants pledge their own money) could be an affordable alternative. In addition, deposit contracts may have superior effects by exploiting the power of loss aversion. Previous research has often operationalized deposit contracts through loss framing a financial reward (without requiring a deposit) to mimic the feelings of loss involved in a deposit contract. This study aimed to disentangle the effects of incurring actual losses (through self-funding a deposit contract) and loss framing. We investigated whether incentive conditions are more effective than a no-incentive control condition, whether deposit contracts have a lower uptake than financial rewards, whether deposit contracts are more effective than financial rewards, and whether loss frames are more effective than gain frames. Healthy participants (N=126) with an average age of 22.7 (SD 2.84) years participated in a 20-day physical activity intervention. They downloaded a smartphone app that provided them with a personalized physical activity goal and either required a €10 (at the time of writing: €1=US $0.98) deposit up front (which could be lost) or provided €10 as a reward, contingent on performance. Daily feedback on incentive earnings was provided and framed as either a loss or gain. We used a 2 (incentive type: deposit or reward) × 2 (feedback frame: gain or loss) between-subjects factorial design with a no-incentive control condition. Our primary outcome was the number of days participants achieved their goals. The uptake of the intervention was a secondary outcome. Overall, financial incentive conditions (mean 13.10, SD 6.33 days goal achieved) had higher effectiveness than the control condition (mean 8.00, SD 5.65 days goal achieved; P=.002; ηp2=0.147). Deposit contracts had lower uptake (29/47, 62%) than rewards (50/50, 100%; P<.001; Cramer V=0.492). Furthermore, 2-way analysis of covariance showed that deposit contracts (mean 14.88, SD 6.40 days goal achieved) were not significantly more effective than rewards (mean 12.13, SD 6.17 days goal achieved; P=.17). Unexpectedly, loss frames (mean 10.50, SD 6.22 days goal achieved) were significantly less effective than gain frames (mean 14.67, SD 5.95 days goal achieved; P=.007; ηp2=0.155). Financial incentives help increase physical activity, but deposit contracts were not more effective than rewards. Although self-funded deposit contracts can be offered at low cost, low uptake is an important obstacle to large-scale implementation. Unexpectedly, loss framing was less effective than gain framing. Therefore, we urge further research on their boundary conditions before using loss-framed incentives in practice. Because of limited statistical power regarding some research questions, the results of this study should be interpreted with caution, and future work should be done to confirm these findings. Open Science Framework Registries osf.io/34ygt; https://osf.io/34ygt.

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.

Effects of meeting steps-based and minutes-based physical activity goals on weight loss in online behavioral weight control: seemingly unrelated regression analysis

ABSTRACT Background Behavioral weight loss programs often prescribe physical activity (PA) goals in terms of minutes/week of moderate-to-vigorous PA (MVPA) and steps/day. However, the impact of meeting each type of goal prescription on weight loss is unclear, particularly in digitally-based (eHealth/mHealth) programs. This secondary analysis of a randomized trial examined the effects of meeting steps-based and minutes-based goals on weight loss in an eHealth behavioral weight control program. Methods Adults in the control arm received a 6-month online behavioral weight loss intervention with prescribed weekly goals for daily steps and minutes of MVPA. The number of weeks steps-based and minutes-based goals were met (≥100% and ≥75% thresholds) based on self-reported PA were examined as predictors of 6-month weight loss among those providing weight outcomes (n = 172; 81% of control arm) using a systems regression approach. Results Participants (BMI 35.6 kg/m2; 90.1% female; 48.7 years of age) met weekly goals for MVPA (7.1 ± 6.4 weeks) more often than steps (3.5 ± 5.5 weeks, P < .001). Meeting the steps goals (β = .24, P < .001) and MVPA goals (β = .20, P < .001) were each statistically significant predictors of weight loss at the 100% threshold; their total effects were not statistically different from one another (χ 2 = 1.12, P = .29). Similarly, at the 75% threshold for steps goals (β = .19, P < .001) and MVPA goals (β = .19, P < .001), each independently predicted weight loss; no differences were detected in their total effects (χ2 = .01, P = .92). The probability of reaching ≥5% weight loss was comparable between meeting the steps goals and MVPA goals at both adherence thresholds. Conclusions Greater attainment of PA goals prescribed as steps and minutes of MVPA independently contribute to similar weight loss outcomes in a 6-month online behavioral weight loss intervention. Future research should determine whether promoting adherence to combined steps-based and minutes-based goals produces better weight loss than utilizing either goal alone and identify strategies that improve adherence.

Maintenance effects of a gamification intervention on motivation and physical activity in patients with coronary heart disease: intermediate results of a randomized controlled trial

Abstract Background Despite the benefits of cardiac rehabilitation and secondary prevention, patients with coronary heart disease frequently fail to meet their daily physical activity goals. When one is stuck in a cycle of bad habits, changing one's behavior can be very challenging. One of the difficulties to maintaining a healthy lifestyle may be a lack of motivation. The use of game design elements (such as points, leaderboards, progress bars, and badges) in non-game contexts to promote motivation and engagement is known as gamification. It could be a powerful tool for encouraging patients to engage in physical activity. However, solid ideas that utilize the fundamental experience and psychological impacts of gaming mechanics must be built upon. Purpose The aim of this study is to look into the impact of a smartphone-based gamification intervention on physical activity engagement and other related psychological outcomes in patients with coronary heart disease, as well as the 24-week maintenance of effects beyond the 12-week intervention. Methods Participants with coronary heart disease were randomly assigned to three groups (control group, individual group and team group). The individual and team groups received gamified behavior intervention based on behavioral economic principles. Based on the Individual group, the team earned social incentives (collaboration). The intervention lasted 12 weeks, with another 12 weeks of follow-up. The primary outcomes included the change in daily steps and the proportion of patient-days that step goals achieved. The secondary outcomes included competence, autonomous, relatedness and autonomous motivation. Results The follow-up period has now been completed by 65 participants (mean age 52.8+10.3, 18.2% female) completed the follow-up period. Compared with the control group (n=17), participants in the individual group (n=25) had a significantly greater increase in mean daily steps from baseline during the intervention group (difference 956; 95% CI, 243–1623; P&amp;lt;0.01), and had a significantly greater proportion of patient-days that step goals achieved (difference 0.35; 95% CI, 0.03–0.12; P&amp;lt;0.001), competence (difference 0.5, 95% CI, 0.3–0.7; P&amp;lt;0.001), autonomous motivation (difference 3.2; 95% CI, 2.0–4.0; P&amp;lt;0.001). However, no significant difference of change in step counts was found between team group (n=23) and control group. During the follow-up period, mean daily steps and autonomous motivation in the individual declined but remained significantly greater than that in the control arm compared with baseline (steps: difference 452; 95% CI, 138–818; P&amp;lt;0.05) (motivation: difference 1.2; 95% CI, 0.3–1.8; P&amp;lt;0.05). Conclusions A smartphone-based gamification intervention was found to be an effective strategy to enhance motivation and physical activity engagement, as well as having a great maintenance effect. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work is financially supported by a Construction Programme of Independent Innovation Ability of Community Health Nursing Engineering Laboratory in Jilin Province (Study code: 2020C038-8) awarded to FL.

The Influence of Easing COVID-19 Restrictions on the Physical Activity Intentions and Perceived Barriers to Physical Activity in UK Older Adults.

COVID-19 has had profound effects on physical activity behaviours of older adults, and understanding this impact is essential to driving public health policies to promote healthy ageing. The present study aimed to determine; (1) intended physical activity behaviours of older adults following the easing of UK COVID-19 restrictions; (2) the relationship between self-reported physical activity and intended physical activity behaviour; (3) perceived barriers to achieving the intended physical activity goal. Ninety-six participants (74.8 ± 4.4 years; 52 female) from a longitudinal study examining the impact of COVID-19 on physical activity were recruited. Participants outlined their future physical activity intentions and completed the COM-B Self Evaluation Questionnaire. Participants were split into groups based on their intention to ‘Maintain’ (n = 29), ‘Increase’ (n = 38) or ‘Return’ (n = 29) to pre-COVID-19 physical activity. Self-reported physical activity undulated over the pandemic but was mostly equivalent between groups. Intended physical activity behaviour was independent of self-report physical activity. Capability and motivation factors were the most frequently cited barriers to the intended physical activity behaviour, with a greater number of capability barriers in the ‘Return’ group. Such barriers should be considered in the COVID-19 recovery public health physical activity strategy for promoting healthy ageing.

Educational level differences in the primary and secondary prevention of stroke

The aim of this study is to estimate the educational level differences in the primary and secondary prevention of stroke among the Chinese population. Data were obtained from the China Kadoorie Biobank (CKB) survey of 512,891 people aged 30–79 years in 10 geographic regions of China, which was conducted from 2002 to 2008. The Prediction for Atherosclerotic Cardiovascular Disease Risk in China model was used to identify individuals with a high estimated 10-year stroke risk. A total of 8884 participants (1.7%) had established stroke and 218,972 (42.7%) had a high stroke risk. In both primary and secondary prevention, the participants' educational level was positively associated with the control of smoking, blood pressure, consuming a healthy diet, and the use of antiplatelet, BP-lowering medications but negatively associated with higher physical activity levels (all Ptrend < 0.001). In addition, the positive associations were observed with the control of drinking and use of anti-hyperglycaemia medication for primary prevention (all Ptrend < 0.001) and with the use of lipid-lowering medication for secondary prevention (Ptrend = 0.019). The results of the interaction between education level and prevention level showed that, compared with participants in primary prevention, educational level disparities in those with secondary prevention had significantly higher use of antiplatelets and lipid-lowering drugs, achieving the physical activity goal and non-current drinker (all Pfor interaction < 0.05). A higher education level was associated with an increased acceptance of primary and secondary prevention strategies (not smoking or drinking, consuming a healthier diet) except for engaging in a suitable level of physical activity.

The effects of a cluster-randomized control trial manipulating exercise goal content and planning on physical activity among low-active adolescents.

The purpose of the present two studies was to investigate whether in framing messages that target salient beliefs of youth, the type of goal framed matter to promote physical activity (PA) participation among low-active adolescents (i.e., participating in less than 1 h/day of moderate-to-vigorous PA). More specifically, the main trial (study 2) compared the effect of intrinsic and extrinsic-goal framing messages alongside planning (IMC + P and EMC + P) to a control condition (CC) on low-active adolescents’ physical activity (PA), intention, attitude, and exercise goals, and examined the potential meditational effect of these variables between condition and PA. Low-active students (n = 193; M age = 16.89) from fifteen classes were assigned to one of these three conditions. PA was assessed using an accelerometer, and the socio-cognitive mediators were measured at baseline (i.e., 2 weeks before the intervention) and post-test, and the intention was measured again at follow-up (i.e., 2 weeks after the intervention). Results showed that compared to adolescents in the CC group, those in the experimental conditions did not do more moderate PA, but carried out more light PA, and yielded an increase in attitude and intention. Mediational analysis revealed no significant effect of the potential mediators.

Self-Assessment of Physical Fitness and Health versus Motivational Value of Physical Activity Goals in People Practicing Fitness, Football, Martial Arts and Wheelchair Rugby.

The aim of the study was to determine the relationship between self-assessment of physical fitness and health, and the motivational role of physical activity goals in people, depending on their sports discipline. The study included 470 men and 218 women, aged 18–45, from western and southern Poland. The respondents practiced sports recreationally (fitness—F), competitively (football—FB, martial arts—MA), and for rehabilitation and sports purposes (wheelchair rugby—R). The standardized questionnaire for the motivational role of physical activity goals (Inventory of Physical Activity Objectives, IPAO) by Lipowski and Zaleski and the authors’ questionnaire on lifestyle were used. In the statistical analyses, non-parametric statistics were used. Individuals with very high and high self-assessment of their physical fitness and very good self-assessment of health achieved higher scores on the motivational value scale, time management, motivational conflict and multidimensionality of physical activity goals (p < 0.05). Respondents who assessed their health as very good achieved lower results on the perseverance scale, compared to those who assessed their health as good or poor. Self-assessment of physical fitness had a positive, high and moderate correlation with the self-assessment of health in people practicing wheelchair rugby, fitness, football and martial arts (r = 0.61; r = 0.52; r = 0.41; r = 0.40, respectively). Correlations were found between the motivational role and time management in people practicing fitness (r = 0.81), football (r = 0.66) and martial arts (r = 0.45), and multidimensionality of goals in those practicing fitness (r = 0.65) and martial arts (r = 0.42) Wheelchair rugby players scored the highest on all KCAF scales (except for motivational conflict). Self-assessment of physical fitness of wheelchair rugby players and fitness practitioners was negatively correlated with time management (r = −0.68; r = −0.49), multidimensionality of goals (r = −0.51; r = −0.49) and motivational values (r = −0.43; r = −0.43). The demonstrated relationships indicated that there was a need to strengthen the self-esteem and motivation for physical activity, promoting perseverance, the ability to focus on the implementation of one’s goals and prioritizing the goals among people practicing various sports disciplines.