Technology-based Physical Activity Intervention Research Articles

Physical activity interventions: an update on advancing sedentary time, technology, and dissemination and implementation research.

Approximately 28% of American adults meet both the physical activity (PA) and strength training guidelines despite the numerous health benefits associated with a physically active lifestyle. The purpose of this paper is to provide an update of the 2017 Society of Behavioral Medicine PA Special Interest Group article that outlined future directions in sedentary time reduction interventions, technology-based PA interventions, and the dissemination and implementation of PA interventions. Since the prior review, there has been significant progress on effective interventions for reducing sedentary time. However, there has been less progress for improving the specificity of sedentary time guidelines. There has been a dramatic increase in the number of studies examining PA mHealth interventions and support for mHealth intervention has generally been positive, though sustaining engagement in mHealth interventions remains a challenge. Promising newer technologies that have been explored more extensively since the prior review including artificial intelligence (AI). Knowledge of how to implement and scale-up effective PA interventions has also increased. Several current trends in PA intervention research that continue to advance the field include examining the moderating effect of the built environment on the effectiveness of behavioral interventions, cultural tailoring of interventions, Just in Time Adaptive Interventions (JITAIs), and exercise snacks (vigorous intensity PA sessions that are less than one minute). Overall, there has been significant progress in the PA intervention field but significant work remains for creating effective interventions that can be readily implemented into real world settings.

Effectiveness of wearable technology-based physical activity interventions for adults with type 2 diabetes mellitus: A systematic review and meta-regression.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder with the increasing prevalence of a modern sedentary lifestyle. Wearable technology-based physical activity interventions (WT-BPAI) might provide a channel to improve diabetic self-management. The study aimed to (1) evaluate the effectiveness of WT-BPAI on PA levels, glycemic levels, and other outcomes (blood pressure [BP], body mass index [BMI], and serum lipid profile) in adults with T2DM, and (2) investigate the potential covariates affecting aforementioned outcomes. Eight databases were searched thoroughly using three steps from inception until January 16, 2024. The quality of the studies and overall evidence were evaluated. The package meta of the R software program version 4.3.1. was utilized for meta-analyses, subgroup analyses, and meta-regression analyses. A total of 19 randomized controlled trials (RCTs) were found. Meta-analyses revealed that WT-BPAI significantly increased 1583 steps per day and decreased systolic BP (SBP) by 2.46 mmHg. Subgroup and meta-regression analyses found that function, duration of intervention, and age were significant covariates. According to the risk of bias version 2, more than half of the trials raised some concerns about the randomization process, deviations from the intended intervention, and missing outcome data. The certainty of the evidence was very low for all outcomes based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. WT-BPAI can be considered a supplementary intervention to increase the steps per day and decrease SBP, especially when used for short periods in young adults with T2DM. However, we need more well-designed research with long-term outcomes.

Does a person's body size and the application type influence healthcare students' perceptions of technologies to promote physical activity? Findings from a cross-sectional study

BackgroundRecent evidence suggests that weight bias may be pervasive, even among health professionals specialized in obesity, including healthcare students. Technology-based physical activity interventions are promising for people with obesity, specifically when they are theory-driven (e.g., autonomy-supportive as described by self-determination theory). However, perceptions of these technologies have been understudied among healthcare students and professionals. ObjectiveThe purpose of this study was to examine the influence of a person's body size based on body mass index and technology type on healthcare students' perceptions. DesignThis is a cross-sectional, experimental study. Participants and methodsFive hundred and two healthcare students (360 females, 142 males; mean age = 23.3, SD = 5.0) were randomly exposed to one of four scenarios that manipulated a hypothetical person's body mass index (22 kg/m2 vs. 42 kg/m2) and a technology-based physical activity type based on self-determination theory (autonomy-supportive app vs. controlling app). They then completed measures of their perceptions of the person's app acceptability and self-efficacy and of their intention to recommend the app. Multivariate and univariate analyses of covariance were performed. ResultsStudents exposed to the larger-bodied people (42 kg/m2) versus the smaller-bodied people (22 kg/m2) perceived a lower level of person's app acceptability (i.e., higher social influence and less enjoyment in using the app), as well as a lower level of self-efficacy to use the technology. Students exposed to the controlling app were more likely to recommend it compared to those exposed to the autonomy-supportive app. ConclusionsThese results suggest that healthcare students' attitudes may be negatively influenced by explicit weight bias. Also, in contrast to self-determination theory precepts, a controlling app may be more frequently recommended. Further study of healthcare students' implicit attitudes toward technology is needed.

Stakeholder Perceptions of a Web-Based Physical Activity Intervention for COPD: A Mixed-Methods Study.

Technology-based physical activity interventions have been shown to be efficacious in chronic obstructive pulmonary disease (COPD), though their potential impact has not been fully realized due to ineffective implementation. We used a convergent, parallel mixed-methods design to identify patient- and provider-facing barriers and facilitators to implementing a rigorously studied web-based physical activity intervention for COPD. Quantitative surveys (based on the unified theory of acceptance and use of technology; range 1 (poor usability)-5 (high usability)) and semi-structured interviews (guided by the practical robust implementation and sustainability model) assessed the perspectives of 15 patients and 15 health care providers. The patients and providers rated the usability of the intervention as high (median = 5.0, IQR = 1.0). For both patients and providers, the main facilitators included: the potential high impact of the intervention on patient health, the usefulness of the intervention for unmet clinical needs, and the perceived ease of use of the intervention. The main barriers identified were digital literacy and its fit with current clinical workflows. Implementation efforts may benefit from supporting patients' use of the website and developing strategies to integrate referrals to the intervention and the monitoring of patients into current clinical infrastructures.

Physical activity virtual intervention for improving mental health among university students during the COVID-19 pandemic: A Co-creation process and evaluation using the Behavior Change Wheel

BackgroundDuring the COVID-19 pandemic, there were reductions in university students' physical activity, which further increased their mental distress, calling for technology-based physical activity interventions to address the challenges in delivering in-person interventions. This study aimed to develop a technology-based physical activity intervention and pilot test it. MethodsWe developed a virtually-delivered team-based physical activity challenge using the Behavior Change Wheel and Co-creation Framework based on Self-determination Theory. A pilot study was conducted in the evaluation phase to measure the recruitment rate, dropout rate, change in physical activity, and mental distress while identifying problems and collecting participants' opinions regarding the challenge. Wilcoxon signed-rank tests were conducted to assess the change in physical activity and mental distress. Qualitative data were analyzed using thematic analysis. ResultsA three-week physical activity challenge comprising five identified intervention functions was held with 480 participants. The recruitment rate was 84.8% resulting from 407 virtual challenge participants who were conveniently joined as research participants. The dropout rate for the pilot study was 10.96% resulting from the incompatibility problems with the application. Among sample participants who lacked physical activity, participation in this challenge improved their physical activity by 52.5 min of moderate-intensity physical activity per week and reduced their mental distress by three points of self-reporting questionnaire-20 score. Issues regarding the virtual application and the influence of participation in the challenge on basic psychological needs emerged. Participants' opinions identified lack of time as the main barrier to physical activity. ConclusionA co-created physical activity intervention developed using the Behavioral Change Wheel Framework inspired high interest from university students and may increase their physical activity and improve their mental health. Several suggestions were discussed to address the identified problems and improve the internal and external validity of the evaluation phase. Trial registrationTCTR20220720004 (retrospectively registered on July 19, 2022).

Preliminary efficacy of a technology-based physical activity intervention for older Korean adults during the COVID-19 pandemic

ABSTRACT Physical activity (PA) interventions deployed using eHealth technologies have been shown to improve cardiovascular health (CVH) and physical function in older adults. This study tested the preliminary efficacy of a 12-week hybrid (web-based and center-based) PA intervention combining the use of a smartwatch and mobile application. Our intervention was concurrently implemented in-person at the local senior welfare center and at-home through a web-based modality. Participants (n = 120) had an average age of 72.7 year and were largely female (75%). Health status was categorized as low-risk (26.7%), middle-risk (43.3%), and high-risk (30%). Overall, increases were evident in diastolic blood pressure (t = −3.55, p < .01), and high-density-lipoprotein (t = −3.02, p < .01), with decreases seen for triglyceride levels (t = 2.42, p < .05) at posttest. Participants showed improvements in muscular function (t = −3.75, p < .001) and cardiopulmonary endurance (t = −2.34, p < .05). Moreover, while controlling for covariate, participants in the middle-risk health category showed lower diastolic blood pressure (b = −4.54, p < .05) and greater triglyceride levels (b = 37.74, p < .001) and cardiopulmonary endurance (b = 6.98, p < .05) than those within the low-risk health group. Participants with high-risk health showed greater triglyceride levels than those with low-risk group (b = 40.57, p < .001). Further studies should test a PA intervention using a randomized controlled trial design, with the expansion of the surveyed covariates and possible important mechanistic confounders.

The Acceptability of Technology-Based Physical Activity Interventions in Postbariatric Surgery Women: Insights From Qualitative Analysis Using the Unified Theory of Acceptance and Use of Technology 2 Model.

Bariatric surgery offers an opportunity for physical activity (PA) promotion due to patients' increased ability to engage in PA. Technology-based PA interventions are promising tools for promoting PA to support patients in this key period. The Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model is a recognized theoretical model for examining technology acceptability. Although a previous study reported that 92% of women with obesity have high acceptability of at least one technology-based PA intervention, little is known about the factors that lead to different levels of acceptability between technologies and therefore the reasons for choosing a preferred intervention. The purpose of this study was to (1) characterize the acceptability of 3 technology-based PA interventions (ie, telehealth, active video game, mobile app) in the context of bariatric surgery, and (2) explore patients' preference motives. This study, using a qualitative design, examined the suitability of the UTAUT2 model in this specific context. Participants (n=26) read written French descriptions of the technology-based PA interventions with illustrations and chose their preferred intervention. Semidirective interviews were conducted to explore the reasons for their choice of the preferred intervention, notably using the UTAUT2 framework. Data were analyzed based on inductive and deductive approaches. All participants who preferred a technology-based PA intervention (ie, active video game, n=10; mobile app, n=10; telehealth, n=6) expressed a behavioral intention to use it. In addition, some of them expressed a high behavioral intention to use another technology (ie, active video game, n=4; mobile app, n=1; telehealth, n=7). All the constructs of the UTAUT2 emerged during the qualitative interviews and were specified through subcategories. Additional constructs also emerged, especially other motivational factors. This study showed that, in the context of technology-based PA interventions for postbariatric patients, the UTAUT2 is suitable, although additional motivational factors (which were not considered by the UTAUT2 model) should be considered.

P10-09 Acceptability of technology-based physical activity interventions in obese females: a qualitative study

BackgroundThe effectiveness of technology-based physical activity interventions (TbPAI) has recently been shown for obese women (Cotie et al., 2018). However, the acceptability of TbPAI has often been considered through the measure of satisfaction, and not through the theoretical concepts of acceptability. To our knowledge, TbPAI acceptability has never been explored in bariatric surgery. The purpose of this study was to explore in-depth the facilitators of and barriers to TbPAI acceptability according to the theoretical concepts of the UTAUT2 model (Venkatesh et al., 2012).MethodsTwenty-six women with a mean age of 32.9 (SD=5.5) and a BMI of 30.1 (SD=6.5) were interviewed at least 6 months after bariatric surgery. Participants were selected in a panel of obese women who completed measures of acceptability (Hayotte et al., 2020) for each TbPAI, and expressed preference in using at least one of the technologies (10 active video games, 10 mobile application, 6 videoconferencing). Interviews were audio-recorded, transcribed verbatim, and analysed using thematic content analysis. Ethical approval was gained by local committee, and informed consent were obtained from the participants before data collection.ResultsAutonomy, monitoring and feedback were identified as facilitators of mobile application acceptability. Lack of external regulation was perceived as a barrier. Regarding the acceptability of active video games, the playful dimension was perceived as a facilitator, despite several participants showing resistance to any game experience. For videoconferencing, individualization of practice was perceived as a facilitator, whereas appointment constraints were seen as a barrier.ConclusionsThese preliminary results highlighted areas to be considered for the dissemination of these TbPAI in a healthcare setting. These results will also help to better individualize TbPAI counselling according to the barriers and facilitators identified.

O5-4 Technology-based physical activity interventions acceptability in obese females: a latent profile transition analysis

BackgroundTechnology-based physical activity interventions (TbPAI) have recently been shown to be effective for care of obese women (Cotie et al., 2018). Therefore, it is necessary to assess the acceptability of TbPAI to ensure dissemination and usage in the treatment of obesity (Venkatesh et al., 2012).As such, the purpose of this study was to: (1) identify acceptability profiles of three TbPAI in obesity care (e.g., active video games, mobile applications, videoconferencing); (2) examine the issues of consistency or change of acceptability profiles for the same individual across the three technology; and (3) explore whether technology acceptability profiles were associated with motivation for physical activity (PA), general causality orientations for PA and sociodemographic data.MethodsThree hundred and twelve women with a mean age of 30.7 (SD=7.1) years, and a mean BMI of 34.9 (SD=9.2) kg/m2 were recruited from health services that provide obesity management. Enrolled participants completed an online survey including the following measures: motivation for PA, general causality orientations for PA, TbPAI acceptability for the three selected technologies based on the UTAUT2 model (Venkatesh et al., 2012), and sociodemographic data. Ethical approval was gained by local committee, and informed consent were obtained from the participants before data collected. We used a Latent Profile Transition Analysis (LPTA) approach.ResultsA 2-class model (high and low acceptability) best described latent classes for each technology. Acceptability profiles changed over the technologies. Among our sample, only 8.0% (n = 25) of women have low acceptability of all technologies, and 57.7% (n = 180) have high acceptability of all technologies. The covariate effect estimates showed significant effects of: (a) age and control causality orientation on video games acceptability profiles, (b) intrinsic motivation and impersonal causality orientation on videoconferencing profiles, and (c) control and impersonal causality orientations on mobile applications profiles.ConclusionsA LPTA approach may prove usefulness in understanding TbPAI acceptability in the obesity treatment and have implications for implementation and dissemination of such technologies.

Effects and Acceptability of Technology-Based Physical Activity Interventions in Bariatric Surgery: a Scoping Review.

The aim of this scoping review is to highlight current trends in the emerging field of technology-based physical activity interventions (TbPAI) in pre- and post-bariatric surgery. Original articles published between 2000 and 2020 on eHealth, bariatric surgery, and physical activity were identified through electronic searches of eight databases. Screening, data extraction, and charting were performed independently by two authors and disagreements were resolved by consensus. Nine full-text articles were included in this review. The studies reported that the physical activity outcomes had improved and the interventions were positively perceived by the target population. We highlight some consistent findings, as well as knowledge gaps, and suggest how future studies could be improved.

A multiple technology-based physical activity intervention for Latina adolescents in the USA: randomized controlled trial study protocol for Chicas Fuertes

BackgroundLatina adolescents in the USA report some of the lowest rates of physical activity of any demographic subgroup; this is paralleled by a markedly higher lifetime risk of obesity, type 2 diabetes, and other conditions related to inactivity. Despite this, to date, no fully powered clinical trials have tested physical activity interventions specifically for this population. High use of mobile technologies (including text messages, smartphone apps, and social media) suggests this could be an appropriate intervention channel, while also having potential for broad reach. This paper describes the protocol for Chicas Fuertes, a fully powered randomized trial of a mobile technology-based physical activity intervention for Latina adolescents.MethodsWe plan to recruit 200 Latina teens (age 13–18) in San Diego, CA, currently engaging in ≤ 150 min/week of moderate-to-vigorous physical activity (MVPA) to be assigned 1:1 to the intervention or control groups. Those randomly assigned to the intervention group receive a one-on-one goal setting session followed by 6 months of mobile technology-based intervention, including a personalized website, Fitbit activity tracker and app, individually tailored text messages based on Fitbit data, and daily intervention content on Instagram. Those randomized to the control group receive only a Fitbit activity tracker. The main outcome is change in weekly minutes of MVPA from baseline to 6 months, measured both objectively (ActiGraph accelerometers and Fitbit Inspire HR) and subjectively (7-Day Physical Activity Recall Interview). Additional outcomes are maintenance of activity change at 12 months and changes in psychosocial constructs, including social support and self-efficacy, engagement with mobile technology channels, and costs of intervention delivery. We are also examining the potential mediators and moderators of the intervention. The efficacy of the intervention is analyzed using a mixed effects regression model, adjusting for any potential confounders not balanced by randomization. All analyses of accelerometer measured MVPA are also adjusted for wear time.DiscussionThe Chicas Fuertes trial uses widely available mobile technologies to target critical health behavior, physical activity, in Latina teens, a population with a high lifetime risk of lifestyle-related diseases. The results will speak to the efficacy and acceptability of the intervention, which has the potential for broad dissemination.Trial registrationClinicalTrials.govNCT04190225. Registered on November 20, 2019

Effect of Wearable Technology-Based Physical Activity Interventions on Breast Cancer Survivors' Physiological, Cognitive, and Emotional Outcomes: A Systematic Review.

This systematic review synthesized all randomized controlled trials (RCTs) and controlled trials examining the effects of wearable health technology-based physical activity interventions on physiological, cognitive, and emotional outcomes in breast cancer survivors (BCS). We searched NCBI, Academic Search Premier, EMBASE, Web of Science, PubMed, and Medline from inception to March 2021. We included studies which: (1) were RCTs or controlled trials ≥8 weeks in duration; (2) were peer-reviewed and published in English; (3) sampled BCS in full remission and had not received treatment for at least six months; (4) utilized wearable health technology (e.g., Fitbit, Garmin xGC30); and (5) examined physiological, emotional, and/or cognitive outcomes. Sixty-six studies were identified and 14 were included in the review. Most of the observed effects were statistically significant and those which employed multi-component interventions generally yielded greater effects. Overall, the use of wearable health technology reduced sedentary behavior and increased moderate-to-vigorous intensity physical activity. Further, increased moderate-to-vigorous intensity physical activity was observed to be associated with increased perceived cognition and higher cognitive performance. Multiple studies also observed significant improvements in attitude, worry, and anxiety. Overall, findings suggested wearable health technology-based physical activity interventions to be effective for improving physical activity, attitude, and cognitive functions and for reducing sedentary behavior, anxiety, and worry in BCS.

Acceptability of technology-based physical activity intervention profiles and their motivational factors in obesity care: a latent profile transition analysis.

This study aimed to: (a) identify the acceptability profiles for three technology-based physical activity interventions (TbPAI) in obesity treatment (active video games, mobile applications, telehealth), (b) examine the issues of consistency or change in these profiles for the same individual across technologies, and (c) determine whether acceptability profiles are related to motivational factors. Three hundred and twelve women (Mage = 30.7, SD = 7.1 years; MBMI = 34.5, SD = 7.8 kg/m²) using obesity services were recruited for this cross-sectional survey. They completed an online survey including sociodemographic data and measures related to physical activity: level, stage of change, motivation, and general causality orientations. The women read descriptions of the three technologies and rated their acceptability. We used a latent profile transition analysis (LPTA) approach. A 2-class model (high and low acceptability) best described the profiles for each technology. Intra-individual analysis revealed that the profiles exhibited both changes and stability across TbPAI. Women with high scores on impersonal orientation were more likely to be in the high acceptability telehealth profile, whereas those reporting high scores on control orientation were more likely to be in the high acceptability active video games profile. Women with high scores on control orientation and low scores on impersonal orientation were more likely to be in the high acceptability mobile applications profile. Results showed that the causality orientations were factors related to the TbPAI acceptability profiles, suggesting that clinicians should consider these psychological characteristics in TbPAI counseling.

A Technology-Based Physical Activity Intervention for Patients With Metastatic Breast Cancer (Fit2ThriveMB): Protocol for a Randomized Controlled Trial.

BackgroundIncreased incidence and life expectancy have resulted in a growing population of patients with metastatic breast cancer, and these patients experience high rates of morbidity and premature mortality. Increased physical activity (PA) is consistently associated with improved health and disease outcomes among early-stage survivors. However, there is a paucity of research on PA in patients with metastatic breast cancer, and existing PA interventions have exhibited low feasibility because of their focus on intense PA and/or requirement of on-site visits. Mobile health (mHealth)–based PA interventions may be particularly useful for patients with metastatic breast cancer because they allow for remote monitoring, which facilitates individual tailoring of PA recommendations to patients’ abilities and may minimize participant burden. However, no studies have examined mHealth PA interventions in patients with metastatic breast cancer.ObjectiveWe aim to address these critical research gaps by testing a highly tailored technology-based intervention to promote PA of any intensity (ie, light, moderate, or vigorous) by increasing daily steps in patients with metastatic breast cancer. The primary aim of this study is to test the feasibility and acceptability of the Fit2ThriveMB intervention. We will also examine outcome patterns suggesting the efficacy of Fit2ThriveMB on symptom burden, quality of life, and functional performance.MethodsThe Fit2ThriveMB trial is a two-arm pilot randomized controlled trial that will compare the effects of a smartphone-delivered, home-based PA intervention and an attention-control education condition on PA and quality of life in low-active female patients with metastatic breast cancer. A subsample (n=25) will also complete functional performance measures. This innovative trial will recruit 50 participants who will be randomized into the study’s intervention or control arm. The intervention will last 12 weeks. The Fit2ThriveMB intervention consists of a Fitbit, coaching calls, and the Fit2ThriveMB smartphone app that provides self-monitoring, a tailored goal-setting tool, real-time tailored feedback, app notifications, and a group message board. Assessments will occur at baseline and post intervention.ResultsThe Fit2ThriveMB study is ongoing. Data collection ended in February 2021.ConclusionsData from this study will provide the preliminary effect sizes needed to assemble an intervention that is to be evaluated in a fully powered trial. In addition, these data will provide essential evidence to support the feasibility and acceptability of using a technology-based PA promotion intervention, a scalable strategy that could be easily integrated into care, among patients with metastatic breast cancer.Trial RegistrationClinicalTrials.gov NCT04129346; https://clinicaltrials.gov/ct2/show/NCT04129346International Registered Report Identifier (IRRID)DERR1-10.2196/24254

A survey of technology literacy and use in cancer survivors from the Alberta Cancer Exercise program.

BackgroundSupervised physical activity interventions can improve cancer survivor quality of life. However, they are resource intensive and may not support physical activity maintenance. Therefore, most cancer survivors remain inactive. Electronic health is a promising tool to support physical activity maintenance, yet technology-based physical activity interventions in oncology have shown mixed effectiveness. We surveyed cancer participants in the Alberta Cancer Exercise program to better understand their experience with technology.MethodsAlberta Cancer Exercise participants were invited to complete a survey on technology literacy, usage, and perceived usefulness. Summary statistics were calculated for all variables. Multiple regression examined demographic prediction of technology usage and literacy.ResultsThe response rate was 52.6% (n = 627/1191), with 93.3% survey completion (n = 585/627). Respondents were 60.6 ± 11.0 years old, 96.2% Caucasian, and of high socioeconomic status (83.3% with post-secondary education, 65.5% with income >$60,000). While electronic health literacy was low (mean 1.73 ± 0.73/4), computer (87.6%) and smartphone (87.5%) use was widespread, with 94.6% of smartphone users reporting daily use. One in two respondents used mobile applications or wearable trackers for physical activity, which were perceived as useful by >80% of users. Age and income were significant predictors of technology use and literacy.ConclusionsTechnology is part of the lives of cancer survivors who engaged in a physical activity program, with mobile devices perceived as useful to support physical activity. However, the present findings highlight a need to increase electronic health literacy via education and tailoring of digital tools. These survey findings are being used to build our patient-centered, technology-supported physical activity interventions.

Perspectives of older adults with chronic disease on the use of wearable technology and video games for physical activity.

BackgroundThere is increasing interest in technology to deliver physical rehabilitation and allow clinicians to monitor progress. Examples include wearable activity trackers and active video games (AVGs), where physical activity is required to play the game. However, few studies have explored what may influence the effectiveness of these as technology-based physical activity interventions in older adults with chronic diseases.ObjectiveThis study aimed to explore: 1) perceptions about wearable physical activity trackers; 2) perceptions about using technology to share physical activity information with clinicians; 3) barriers and motivators to playing games, including AVGs for rehabilitation.MethodsQualitative study based on semi-structured interviews with older adults (n = 19) with chronic obstructive pulmonary disease (COPD).ResultsWearable activity trackers were perceived as useful to quantify activity, facilitate goal-setting, visualize long-term improvements and provide reminders. Participants generally wished to share data with their clinicians to gain greater accountability, receive useful feedback and improve the quality of clinical care. Participants were motivated to play games (including AVGs) by seeking fun, social interaction and health benefits. Some felt that AVGs were of no benefit or were too difficult. Competition was both a motivator and a barrier.ConclusionsThe findings of the present study seek to inform the design of technology to encourage physical activity in older adults with chronic diseases.

Cancer Survivor Perspectives on Text Messages in a Technology-Based Physical Activity Intervention

Messaging through mobile apps and texts are a common feature of technology-based physical activity interventions. We aimed to examine perspectives of mid-life and older cancer survivors on message content, timing, and two-way communication. We conducted qualitative interviews with 14 participants (Mean 59.9 years, Range 52-79) who completed a remotely delivered intervention that included text messages to support physical activity. After transcription, the interviews were coded and analyzed thematically using inductive, directed content analysis. Themes related to content preferences included personalization, accountability, perspective on the ‘bigger picture,’ and acknowledgement of PA-related achievements. Random timing for receipt was considered acceptable whereas interest in responding to messages was highly variable. Older cancer survivors’ preferences for highly personalized messages are an important consideration in designing technology-based physical activity interventions. A combination of accountability, relation to personal factors, and acknowledgement of goal attainment need to be considered in efforts to scale interventions. Part of a symposium sponsored by the Cancer and Aging Interest Group.

Web-Based Physical Activity Intervention for COPD: Differences Between Rural and Urban Veterans

Physical activity is recommended for all patients with chronic obstructive pulmonary disease (COPD), a disease prevalent among older adults. Rural Veterans often lack access to in-person services to support behavior change. Technology can be used to overcome these barriers. This secondary analysis of a randomized controlled trial compared engagement (weekly website-logons) and efficacy (step-count change) measures of a 4-month technology-based physical activity intervention between rural and urban Veterans with COPD. Rural-urban commuting codes (RUCA) were used to classify participants (N=239; mean age=66.7±8.84 years) as ‘rural’ or ‘urban’. Participants were randomized 2:1 to a pedometer and website with iterative, individualized step-count feedback and goals, motivational and informational messages, and an online community (intervention group, n=155, 45.8% rural) or to receive a pedometer-alone (waitlist-control group, n=84, 44% rural). General linear modeling estimated the adjusted effect of rurality on intervention response. There was no significant rural-urban difference in weekly website-logons (3.33 vs. 3.17; p=.364). There was a significant interaction between rurality and group on step-count change (p=.045). Among rural participants, both intervention and controls increased their step counts (567.32 vs. 732.30; p=.769). Among urban participants, the intervention group demonstrated a significantly higher change in step-counts compared to controls (1052.67 vs. -313.57; p=.008). Results suggest that rural participants increased their step-counts similarly whether they received a pedometer alone or used the intervention, whereas only urban participants who used the intervention increased their step counts. It is possible that simply receiving the pedometer alone was sufficient for behavior change in the rural participants.

Effect of a technology-supported physical activity intervention on health-related quality of life, sleep, and processes of behavior change in cancer survivors: A randomized controlled trial.

This pilot trial tested the effect of adding a multi-level, technology-based physical activity intervention module to a standard survivorship care plan for breast and colorectal cancer survivors. The objective of this analysis was to determine whether the physical activity module improved health-related quality of life, sleep, and factors key to lasting behavior change (eg, social support, self-efficacy). Breast and colorectal cancer survivors (n = 50) were enrolled alongside a support partner. Survivors were assigned to receive a standard survivorship care plan either alone or augmented by a 12-week multi-component physical activity module. The module included a Fitbit tracker (with the physical activity data integrated into the electronic health record for clinician review) and customized email feedback. Physical activity was measured using the ActiGraph GT3X+. Psychosocial outcomes included the SF-36, FACT, ISEL, PROMIS sleep measures, and physical activity beliefs. Data were analyzed using linear mixed modeling. Cancer survivors were aged 54.4 ± 11.2 years and were 2.0 ± 1.5 years from diagnosis. Relative to comparison, the intervention was associated with moderate-to-large improvements in physical health (effect size: d = 0.39, 95% CI = 0.0, 0.78), mental health (d = 0.59, 95% CI = 0.19, 0.99), sleep impairment (d = 0.62, 95% CI = -1.02, -0.22), and exercise self-efficacy (d = 0.60, 95% CI = 0.20, 1.0). The intervention delivered meaningful improvements in survivors' quality of life, social support, and sleep impairment. If replicated in a larger sample, adding a technology-supported physical activity module to survivorship care plans may be a practical strategy for supporting healthy survivorship. ClinicalTrials.gov#: NCT02677389.

Effects of a wearable technology-based physical activity intervention on sleep quality in breast cancer survivors: the ACTIVATE Trial.

Physical activity interventions can improve sleep quality in breast cancer survivors. This paper examines the effects of the ACTIVATE Trial, a wearable-based physical activity intervention (Garmin Vivofit2® coupled with behavioral feedback, goal setting, and health coaching) on sleep outcomes. Post-primary treatment, inactive, postmenopausal breast cancer survivors were recruited and randomized to primary intervention or waitlist. Wrist-worn actigraphy (sleep onset latency, SOL; total sleep time, TST; sleep efficiency, SE; wake after sleep onset, WASO; and number of awakenings, NWAKE) and questionnaire-derived sleep measures (Pittsburgh Sleep Quality Index) were assessed at baseline (T1), 12weeks (end of primary intervention and start of waitlist intervention, T2), and at 24weeks (T3). Eighty-three women (mean age = 62years) were randomized; trial retention was 94% at T2 and 87% at T3. At T2, primary intervention participants had greater improvements in WASO (- 5.7min, 95% CI - 11.7 to - 0.2) and NWAKE compared with the waitlist arm (- 2.0, 95% CI - 3.6 to - 0.4). At T3, within-group improvements were observed for SE (both groups), WASO (both groups), NWAKE (primary intervention group only), total PSQI score (primary intervention group), and sleep efficacy (primary intervention group). The intervention reduced actigraphy-measured sleep disturbances. Within-group analyses suggest that improvements in sleep quality are sustained over a longer duration, and there may be similar benefits from an abridged intervention (wearable device only). Actigraphy-measured effects appeared stronger in participants who were poor sleepers at study entry. Wearable technology can increase physical activity and improve sleep for breast cancer survivors.