Feasibility of promoting physical activity using mHEALTH technology in rural women: the step-2-it study

Abstract Background Rural women are more likely to be obese and have a higher risk for chronic disease than their non-rural counterparts. Inadequate physical activity (PA) at least in part contributes to this increased risk. Rural women face personal, social and environmental barriers to PA engagement. Interventions promoting walking among rural women have demonstrated success; however, few of these studies use text messaging to promote PA. Methods Step-2-It was a pilot study to assess the feasibility, acceptability, and effectiveness of text-messaging combined with a pedometer to promote PA, specifically walking among English-speaking women, aged 40 and older, living in a rural, northwest Illinois county. Enrolled participants completed baseline assessments, received pedometers and two types of automated text messages: motivational messages to encourage walking, and accountability messages to report pedometer steps. Participants engaged in 3, 6, 9, and 12-week follow-ups to download pedometer data, and completed post-intervention assessments at 12 weeks. Results Of the 44 enrolled participants, 35 participants (79.5%) completed the intervention. Among completers, the proportion meeting PA guidelines increased from 31.4% (11/35) at baseline to 48.6% (17/35) at post-intervention, those with no PA decreased from 20% (7/35) to 17.1% (6/35). During weeks 1-12, when participants received motivational text messages, average participant daily step count was 5926 ± 3590, and remained stable during the intervention. Pedometer readings were highly correlated with self-reported steps (r = 0.9703; p < 0.001). Conclusion Step-2-It was a feasible and acceptable walking intervention for older rural women. Technology, including text messaging, should be investigated further as an enhancement to interventions for rural women. Trial Registration on Clinicaltrials.gov: NCT04812756, registered on March 22, 2021

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Feasibility of a Culturally Tailored Smartphone-delivered Physical Activity Intervention among Midlife African American Women (Preprint)

10.2196/preprints.27383 ◽

2021 ◽

Author(s):

Rodney P Joseph ◽

Barbara E Ainsworth ◽

Kevin Hollingshead ◽

Michael Todd ◽

Colleen Keller

Keyword(s):

Physical Activity ◽

Social Support ◽

African American ◽

Self Regulation ◽

Text Messages ◽

Discussion Board ◽

Feasibility Trial ◽

Post Intervention ◽

Culturally Tailored ◽

Increased Risk

BACKGROUND Performing regular aerobic physical activity (PA) is an important component for healthy aging. Yet, only 27-40% of African American (AA) women achieve national PA guidelines. Available data also show clear decline in PA as AA women transition from young adulthood (i.e., 25-44 years) into midlife. This decline of PA among during midlife coincides with increased risk for AA women developing cardiometabolic disease conditions, including obesity, type 2 diabetes, and cardiovascular disease. Thus, effective efforts are needed to promote PA among sedentary AA women during midlife. OBJECTIVE To examine the acceptability and feasibility of a culturally tailored, smartphone-delivered PA intervention, originally developed to increase PA among AA women aged 24-49, among a slightly older sample of midlife AA women aged 50-65. METHODS A single-arm pre-posttest study design was implemented. Twenty insufficiently active AA (i.e., >60 minutes/week of PA) women between the ages of 50 and 65 years participated in the 4-month feasibility trial. The intervention, entitled Smart Walk, was delivered through the study Smart Walk smartphone application and text messages. Features available on the Smart Walk app include: personal profile pages, multi-media PA promotion modules, discussion board forums, and an activity tracking feature that integrates with Fitbit activity monitors. Self-reported PA and Social Cognitive Theory (SCT) mediators targeted by the intervention (i.e., self-regulation, behavioral capability, outcome expectations, self-efficacy, social support) were assessed at baseline and 4-months. Feasibility and acceptability were assessed using a post-intervention intervention satisfaction survey that included multiple choice and open-ended questions evaluating participant perceptions of the intervention and suggestions for intervention improvement. Wilcoxon signed-rank tests were used to examine pre-post intervention changes in PA and SCT variables. Effect size estimates were calculated using the Pearson r test statistic. RESULTS Participants increased in moderate-to-vigorous PA (median 30 minutes/week increase, r =1.0, p=.002) and reported improvements in two theoretical mediators (self-regulation, r=.397, p=.012; behavioral capability, r=.440, p=.006). Nearly all participants (93%) indicated they would recommend intervention to a friend. Participant suggestions for improving the intervention included enhancing the intervention’s provisions of social support for PA. CONCLUSIONS Results provide preliminary support for feasibility of the smartphone-based approach to increase PA among middle-aged AA women. However, prior to larger scale implementation among midlife AA women, enhancements to the social support components of the intervention are warranted.

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

Annals of Behavioral Medicine ◽

10.1093/abm/kaab028 ◽

2021 ◽

Author(s):

Caroline A Figueroa ◽

Nina Deliu ◽

Bibhas Chakraborty ◽

Arghavan Modiri ◽

Jing Xu ◽

...

Keyword(s):

Physical Activity ◽

Text Messaging ◽

Text Message ◽

Text Messages ◽

Cognitive Behavioral ◽

Motivational Messages ◽

Physical Activity Interventions ◽

Generalized Estimation Equation ◽

To Receive ◽

Positive Effect

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

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Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18031011 ◽

2021 ◽

Vol 18 (3) ◽

pp. 1011

Author(s):

Andrea A. Joyce ◽

Grace M. Styklunas ◽

Nancy A. Rigotti ◽

Jordan M. Neil ◽

Elyse R. Park ◽

...

Keyword(s):

Primary Care ◽

Text Messaging ◽

Risk Perceptions ◽

Environmental Changes ◽

Age Groups ◽

Text Messages ◽

Increased Risk ◽

Primary Care Patients ◽

The Impact ◽

At Home

The impact of the COVID-19 pandemic on US adults’ smoking and quitting behaviors is unclear. We explored the impact of COVID-19 on smoking behaviors, risk perceptions, and reactions to text messages during a statewide stay-at-home advisory among primary care patients who were trying to quit. From May–June 2020, we interviewed smokers enrolled in a 12-week, pilot cessation trial providing text messaging and mailed nicotine replacement medication (NCT04020718). Twenty-two individuals (82% white, mean age 55 years), representing 88% of trial participants during the stay-at-home advisory, completed exit interviews; four (18%) of them reported abstinence. Interviews were thematically analyzed by two coders. COVID-19-induced environmental changes had mixed effects, facilitating quitting for some and impeding quitting for others. While stress increased for many, those who quit found ways to cope with stress. Generally, participants felt at risk for COVID-19 complications but not at increased risk of becoming infected. Reactions to COVID-19 and quitting behaviors differed across age groups, older participants reported difficulties coping with isolation (e.g., feeling disappointed when a text message came from the study and not a live person). Findings suggest that cessation interventions addressing stress and boredom are needed during COVID-19, while smokers experiencing isolation may benefit from live-person supports.

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Long-Term and Transfer Effects of an Action Control Intervention in Overweight Couples: A Randomized Controlled Trial Using Text Messages

Frontiers in Psychology ◽

10.3389/fpsyg.2021.754488 ◽

2021 ◽

Vol 12 ◽

Author(s):

Corina Berli ◽

Urte Scholz

Keyword(s):

Physical Activity ◽

Physical Fitness ◽

Text Messaging ◽

Vigorous Physical Activity ◽

Action Control ◽

Text Messages ◽

Control Group ◽

Transfer Effects ◽

Control Intervention

Keeping a physically active lifestyle requires consistent self-regulatory effort such as action control (e.g., continuously monitoring and evaluating a behavior in terms of one’s goals). Involving the romantic partner in interventions might be particularly effective in the long run. The present study examined the long-term and transfer effects of an action control intervention in couples using text messaging for promoting target persons’ and partners’ physical activity, anthropometric measures and physical fitness 6 months post baseline. A total of 121 overweight and obese romantic couples, randomly allocated to an intervention (n = 60; information + action control text messages) or a control group (n = 61; information only) and to participating as target person or partner, completed baseline assessments (T1). 100 couples (82.6%) completed the 6-month follow-up (T3) assessment. Primary outcomes included self-reported moderate-to-vigorous physical activity (MVPA) and objective MVPA and MVPA adherence using triaxial accelerometers across a diary period of 14 days after T3. Secondary outcomes included BMI, waist-to-hip circumference and physical fitness (target persons only) using a submaximal aerobic cycle test. At T3, there were no significant between-group differences between target persons and partners with regard to their objective MVPA, self-reported MVPA, BMI, waist-hip ratio or physical fitness. No significant changes in outcomes were observed from T1 to T3; however, changes in BMI from T1 to T3 between target persons and partners in the intervention group were associated. Overall, the brief 14-days action control intervention was not effective in improving target person’s physical activity, body measures and physical fitness in the long-term. Moreover, no long-term benefits for partners emerged. While brief ecological momentary interventions might be a promising tool for short-term effects, future studies are needed to test features enhancing long-term effectiveness. Associations in romantic partners’ changes suggest that dyadic interventions can be a promising approach, as changes induced in one partner may then transfer over to the other (controlled-trials.com ISRCTN15705531).

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Iterative development of a multiple technology-based physical activity intervention for Latina adolescents: The Chicas Fuertes Study (Preprint)

10.2196/preprints.26195 ◽

2020 ◽

Author(s):

Britta Larsen ◽

Emily D. Greenstadt ◽

Brittany L. Olesen ◽

Bess H. Marcus ◽

Job Godino ◽

...

Keyword(s):

Physical Activity ◽

Social Media ◽

Focus Group ◽

Focus Groups ◽

Text Messaging ◽

Physical Activity Intervention ◽

Target Population ◽

Text Messages ◽

Study Objective ◽

Latina Adolescents

BACKGROUND Adolescent girls report the lowest levels of physical activity (PA) of any demographic group, with rates especially low for racial/ethnic minority girls. Only 3% of Latina teens meet national PA guidelines, and these habits appear to persist into adulthood. Developing effective interventions to increase PA in Latina teens is necessary for preventing disease and reducing disparities. OBJECTIVE The study objective was to develop a mHealth PA intervention for Latina adolescents using a multi-stage iterative process based on an adaptation of the IDEAS (Integrate, DEsign, Assess, Share) framework. METHODS Development of the intervention was accomplished through three iterations: 1) feedback from a previous web-based pilot study, Niñas Saludables; 2) conducting focus groups with the target population; and, 3) vetting the final materials with a youth advisory board (YAB) comprising Latina adolescents. Based on feedback from participants in the Niñas Saludables study, plans to improve the intervention included incorporating visual social media posts and text messaging, adding a commercial wearable tracker, and revising the existing website to be primarily visual; proposed procedures and material were then refined through focus groups. Participants for focus groups (N=50) were girls age 13-18 who could speak and read in English who were recruited from local high schools and after school programs serving a high proportion of Latinos. Facilitated discussions focused on experience with PA and social media apps, and specific feedback on intervention material prototypes and possible names and logos. Materials were refined based on their feedback, then were beta tested by the YAB. YAB members (N=4) were Latinas age 13-18 who were not regularly active and were recruited via word of mouth and selected through an application process. RESULTS The focus group discussions yielded the following findings: PA preferences included walking, running and group fitness classes, while the least popular activities were running, swimming, and biking. Most participants used some form of social media, with Instagram being the most favored. Participants preferred text messages be sent no more than once a day, be personalized, and be positively worded. Focus group participants preferred an intervention directly targeting Latinas, and social media posts that were brightly colored, included girls of all body types, and provided specific tips and information. Modified intervention materials were generally perceived favorably by the YAB members, who provided suggestions for further refinements including incorporation of some Spanish phrases. CONCLUSIONS Latina teens were generally enthusiastic about an mHealth PA intervention, provided the materials were targeted specifically to them and their preferences. Through multiple iterations of development and feedback with the target population, we gained insight into the needs of Latina teens and joined with industry partners to build a viable final product.

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Is a Low Intensity Walking Intervention Successful in Reducing Depression Symptoms in Middle to Older Age Women?

Innovation in Aging ◽

10.1093/geroni/igab046.2882 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 787-787

Author(s):

Jingchuan Wu

Keyword(s):

Physical Activity ◽

Depressive Disorders ◽

Negative Impact ◽

Activity Level ◽

Older Age ◽

Depression Symptoms ◽

Post Intervention ◽

Walking Program ◽

Walking Intervention ◽

Over Time

Abstract Depression is a common syndrome that has a strong negative impact on people’s quality of life. Women, especially in middle age, are facing a greater risk for depressive disorders. Increasing one’s physical activity level has shown great effects on reducing depression symptoms. The study evaluated the effect of a 12-week goal-directed walking intervention on walking engagement and depression symptoms among middle-aged women. A total of 55 middle to older age female participants (age range: 50–74) were included in the analysis. The 12-week intervention instructed participants to increase 15% of baseline steps every other week. Depression levels were measured pre-and post-intervention by the Center for Epidemiologic Studies Depression Revised Scale (CESD-R). A baseline measure-time structure- was considered as a possible mediator of association between walking and depression. Although no intervention effects were found in steps promotion and depression reduction in this walking program, we found that more depressed or younger participants had lower walking consistency It suggested that people with higher depression level or younger age require more instruction over time when engaging in physical activity interventions. Additionally, adherence of participants showed a over-time decreasing trend in this self-paced walking program. This inspired us to give timelier adjusts goals and exercise performance feedback to bolster participants' adherence in the future.

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Perceived Facilitators and Barriers in Response to a Walking Intervention in Rural Cancer Survivors: A Qualitative Exploration

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15122824 ◽

2018 ◽

Vol 15 (12) ◽

pp. 2824 ◽

Cited By ~ 3

Author(s):

Lauren Frensham ◽

Gaynor Parfitt ◽

Rebecca Stanley ◽

James Dollman

Keyword(s):

Physical Activity ◽

Cancer Survivors ◽

Rural Areas ◽

Perceived Exertion ◽

South Australia ◽

Physical Activity Behavior ◽

Structured Interviews ◽

Post Intervention ◽

Walking Behavior ◽

Walking Intervention

Physical activity has numerous associated benefits for cancer survivors. Compared to their urban counterparts, rural and remote Australians experience a health disadvantage, including poorer survival rate after the diagnosis of cancer. The purpose of this qualitative study was to (a) investigate factors that motivated or inhibited walking in rural participants during a 12-week intervention and (b) to investigate factors that motivated or inhibited physical activity behavior change three months post-intervention. Ten cancer survivors living in rural areas of South Australia participated in a 12-week computer-delivered walking-based intervention during which they reported daily steps, daily affect, and ratings of perceived exertion. Based on this information, individualized daily step goals were sent to them to increase walking. Following the intervention, participants engaged in face-to-face semi-structured interviews. Interviews were recorded, transcribed and coded using thematic analysis. Participants identified a range of physical, psychological, social, environmental, and organizational motivators and barriers. Participants appreciated the monitoring and support from the research team, but some voiced a need for better transition to post-program and many desired ongoing support to maintain their motivation. Future studies should incorporate strategies to help walking behavior to become more intrinsically motivated and therefore sustained.

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Understanding preferences for lifestyle-focused visual text messages in patients with cardiovascular and chronic respiratory disease: a discrete choice experiment (Preprint)

10.2196/preprints.26224 ◽

2020 ◽

Author(s):

Michael Choi ◽

Rebecca Raeside ◽

Karice Hyun ◽

Stephanie Ruth Partridge ◽

Aravinda Thiagalingam ◽

...

Keyword(s):

Physical Activity ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Pulmonary Rehabilitation ◽

Choice Experiment ◽

Text Messaging ◽

Text Messages ◽

Choice Sets ◽

Visual Text

BACKGROUND Supporting healthy lifestyle change is a key aim of cardiovascular and pulmonary rehabilitation programs. Text messaging programs have demonstrated effectiveness in cardiovascular disease risk reduction, weight loss, increasing physical activity and smoking cessation. Optimisation of text message programs may deliver greater population benefits as mobile phone usage becomes ubiquitous. Visual messaging (i.e. image-based messages) has the potential to communicate health messages via digital technology with enhanced engagement. OBJECTIVE To determine and understand patient preferences for lifestyle-focused visual text messages that support cardiovascular and pulmonary rehabilitation METHODS A discrete choice experiment was conducted in a four-stage iterative process to elicit patient preferences for features of visual messages. Attribute and level development yielded three attributes: purpose, image type and web address and 16 choice sets were subsequently constructed according to a full factorial design. Patients participating in cardiovascular and pulmonary rehabilitation were surveyed (online) for their preferences regarding the visual message choice sets. Respondents were asked to choose between 16 pairs of visual messages regarding key lifestyle behaviours, namely, physical activity and nutrition. Data were analysed by using a conditional logit model. RESULTS There was a total of 1728 observations from 54 unique respondents. Two factors that were associated with the patient preference were gain-framed purpose compared to no purpose (OR 1.93, 95% CI 1.40 – 2.65) and real images compared to cartoon images (OR 1.26, 95% CI 1.04 – 1.54). A loss-framed purpose was less preferred than no purpose (OR 0.55, 95% CI 0.42 - 0.74). Overall, patients preferred positive images that were colourful and engaging with text that supported the image with a preference for images of real people rather than cartoons. CONCLUSIONS A discrete choice experiment is a scientific method to elicit patient preferences for a visual messaging intervention designed to support change to lifestyle behaviours. Text messaging programs which utilise visual aids may find greater patient satisfaction by employing a gain-frame, using real images and avoiding a loss-frame. Further research is needed to explore feasibility of implementation and health and behavioural outcomes associated with such visual messaging programs.

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Abstract 260: Pedometer-assessed Workplace Walking Program Improves Cardio-Metabolic Profile Among the University’s Workforce

Hypertension ◽

10.1161/hyp.62.suppl_1.a260 ◽

2013 ◽

Vol 62 (suppl_1) ◽

Author(s):

Praveen Veerabhadrappa ◽

Sushma Bhat ◽

Heather Weiss ◽

Chelsey Michael

Keyword(s):

Physical Activity ◽

Blood Glucose ◽

Lipid Profile ◽

Fasting Blood Glucose ◽

Post Intervention ◽

Glucose Levels ◽

Walking Intervention ◽

Metabolic Outcomes ◽

Before And After ◽

The University

Introduction- The cost of physical inactivity in the workplace setting is significant. The purpose of this study was to evaluate the association between pedometer-assessed physical activity with cardio-metabolic outcomes such as, body weight, blood glucose levels, lipid profile among the University’s academic faculty and staff. Methods- Twenty nine (9M/20F, 50±6yrs; BMI 28.4±4.2 kg/m 2 ) apparently healthy participants who were sedentary, non-smoking, non-diabetic, free of cardiovascular disease, not on antihypertensive or cholesterol medications were recruited from the University workforce. Fasting blood glucose and lipid profile were analyzed using Cholestech LDX analyzer, before and after intervention. Pedometer settings were personalized and participants were instructed to maintain their regular diet during the study period. Participants completed a pedometer-based walking intervention (step-goal: 10,000-steps/day, 5-days/week, 4-weeks). Results- Baseline vs. post-intervention (Mean±SD) for total cholesterol (202.2±40.1 vs. 193.1±42.1 mg/dl; p≤0.05), blood glucose (101.2±8.7 vs. 97.8±8.9; g/dl; p=0.032), systolic blood pressure (BP; 120.7±11.1 vs. 115.1±11.1 mmHg; p=0.003) and diastolic BP (78.6±6.6 vs. 73.8±5.5 mmHg; p<0.0001) were statistically significant. Step-counts significantly increased from baseline to post-intervention (9057.7±3588.9 vs.10319.2±3177; p=0.021). Change in step-count (wk 1 to wk 4) were associated with changes in blood glucose (r=-0.39; p=0.048); diastolic BP (r=-0.43; p=0.029) and BMI (r=-0.45; p=0.022). Conclusion- Our preliminary study modestly increased workday walking by ~12% over four weeks, and significantly improved the cardio-metabolic outcomes among the University workforce. This suggests that, workplace physical activity programs could contribute to the achievement of 10,000 steps/day, which might maximize physical activity participation.

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‘You started something … then I continued by myself’: a qualitative study of physical activity maintenance

Primary Health Care Research & Development ◽

10.1017/s1463423617000433 ◽

2017 ◽

Vol 18 (06) ◽

pp. 574-590 ◽

Cited By ~ 7

Author(s):

Charlotte Wahlich ◽

Carole Beighton ◽

Christina Victor ◽

Rebecca Normansell ◽

Derek Cook ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Good Health ◽

Text Messages ◽

Telephone Interviews ◽

Walking Intervention ◽

Effective Interventions ◽

Bad Weather

Background Most mid-life and older adults are not achieving recommended physical activity (PA) targets and effective interventions are needed to increase and maintain PA long-term for health benefits. The Pedometer And Consultation Evaluation (PACE-UP) trial, a three-armed primary care pedometer-based walking intervention in those aged 45–75 years, demonstrated increased PA levels at 12 months. A three-year follow-up was conducted to evaluate long-term PA maintenance, including a qualitative component. Aim To examine facilitators and barriers to PA maintenance in mid-life and older adults previously involved in a PA trial. Method Semi-structured telephone interviews were conducted with 60 PACE-UP participants across all study arms. Interviews were audio-recorded, transcribed verbatim and coded independently by researchers, prior to thematic analysis. Findings Two-thirds of participants felt since the PACE-UP trial they had an awareness of PA, with the pedometer reported as ‘kick-starting’ regular activity, and then helped them to maintain regular activity. PA facilitators included: maintaining good health, self-motivation, social support and good weather. Lack of time was the most frequently cited barrier. Other barriers were often the inverse of the facilitators; for example, poor health and bad weather. Participants described the type of ‘top-up’ intervention they would find beneficial to aid PA maintenance (eg, text messages, online resources and walking groups). Conclusion A challenge for future PA interventions is to transform barriers into facilitators; for example, educating trial participants about the value of PA for many chronic health conditions to change this from inhibiting to promoting PA. Participants provided ideas for encouraging PA maintenance which could be incorporated into future interventions.

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