Social Mobile Approaches to Reducing Weight (SMART) 2.0: protocol of a randomized controlled trial among young adults in university settings

Background Excess weight gain in young adulthood is associated with future weight gain and increased risk of chronic disease. Although multimodal, technology-based weight-loss interventions have the potential to promote weight loss among young adults, many interventions have limited personalization, and few have been deployed and evaluated for longer than a year. We aim to assess the effects of a highly personalized, 2-year intervention that uses popular mobile and social technologies to promote weight loss among young adults. Methods The Social Mobile Approaches to Reducing Weight (SMART) 2.0 Study is a 24-month parallel-group randomized controlled trial that will include 642 overweight or obese participants, aged 18–35 years, from universities and community colleges in San Diego, CA. All participants receive a wearable activity tracker, connected scale, and corresponding app. Participants randomized to one intervention group receive evidence-based information about weight loss and behavior change techniques via personalized daily text messaging (i.e., SMS/MMS), posts on social media platforms, and online groups. Participants in a second intervention group receive the aforementioned elements in addition to brief, technology-mediated health coaching. Participants in the control group receive a wearable activity tracker, connected scale, and corresponding app alone. The primary outcome is objectively measured weight in kilograms over 24 months. Secondary outcomes include anthropometric measurements; physiological measures; physical activity, diet, sleep, and psychosocial measures; and engagement with intervention modalities. Outcomes are assessed at baseline and 6, 12, 18, and 24 months. Differences between the randomized groups will be analyzed using a mixed model of repeated measures and will be based on the intent-to-treat principle. Discussion We hypothesize that both SMART 2.0 intervention groups will significantly improve weight loss compared to the control group, and the group receiving health coaching will experience the greatest improvement. We further hypothesize that differences in secondary outcomes will favor the intervention groups. There is a critical need to advance understanding of the effectiveness of multimodal, technology-based weight-loss interventions that have the potential for long-term effects and widespread dissemination among young adults. Our findings should inform the implementation of low-cost and scalable interventions for weight loss and risk-reducing health behaviors. Trial registration ClinicalTrials.govNCT03907462. Registered on April 9, 2019

A Wearable Activity Tracker Intervention With and Without Weekly Behavioral Support Emails to Promote Physical Activity Among Women Who Are Overweight or Obese: Randomized Controlled Trial

Background Physical activity (PA) plays a fundamental role in combating the current obesity epidemic; however, most women who are overweight or obese are generally physically inactive. Wearable activity tracker interventions can help increase the PA levels in this population. Supplementing such interventions with behavioral support emails may further improve their effectiveness, but this remains to be confirmed. Objective This study aims to determine if adding behavioral support emails to a wearable activity tracker intervention can further increase PA levels among women who are overweight or obese in comparison to a wearable activity tracker–only intervention and a control condition. Methods Women with a BMI ≥25 kg/m2 who were not meeting the Canadian PA guidelines for aerobic and strength training were randomized into 1 of 3 groups. Group 1 received 6 weekly behavioral support emails, a wearable activity tracker, and a copy of the Canadian PA guidelines. Group 2 received a wearable activity tracker and a copy of the Canadian PA guidelines, and group 3 (control condition) received a copy of the Canadian PA guidelines. Self-reported data for walking and moderate to vigorous intensity PA were collected preintervention (week 0; prerandomization), postintervention (7 weeks postrandomization), and at follow-up (21 weeks postrandomization) and analyzed as metabolic equivalent of task minutes per week. In addition, potential mechanisms of behavior change (ie, basic psychological needs satisfaction and motivational regulations) were assessed for within- and between-group differences at all 3 time points. Data were analyzed using nonparametric statistical tests. Results A total of 49 women were recruited; data from 47 women (mean age 37.57 years, SD 11.78 years; mean BMI 31.69 kg/m2, SD 5.97 kg/m2) were available for analysis. Group 1 reported a significant increase in walking from preintervention to postintervention (χ22=7.5; P=.02) but not in moderate to vigorous intensity PA (P=.24). Group 1 also reported significant increases in perceptions of competence from preintervention to follow-up (χ22=7.6; P=.02) and relatedness from preintervention to follow-up (χ22=8.7; P=.005). Increases in perceived autonomy were observed for group 2 (χ22=7.0) and group 3 (χ22=10.6). There were no significant changes in the motivational regulations within the groups. The difference between the groups was not significant for any outcome variable. Conclusions The results suggest that adding behavioral support emails to a wearable activity tracker intervention may help to increase time spent walking and perceptions of competence and relatedness for PA among women who are overweight or obese. Trial Registration ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663

A personalised smartphone-delivered just-in-time adaptive intervention (JITABug) to increase physical activity in older adults: A feasibility pilot study (Preprint)

BACKGROUND Just-in-time-adaptive-interventions (JITAIs) provide real-time ‘in the moment’ behaviour change support to people when they need it most. JITAIs could be a viable way to provide personalised physical activity support to older adults in the community. However, it is unclear how feasible it is to remotely deliver a physical activity intervention via a smartphone to older adults, or how acceptable older adults would find a JITAI targeting physical activity in everyday life. OBJECTIVE (1) to describe the development of “JITABug”, a personalised smartphone and activity tracker delivered JITAI designed to support older adults to increase or maintain their physical activity level; (2) to explore the acceptability of JITABug in a free-living setting, and (3) to assess the feasibility of conducting an effectiveness trial of the JITABug intervention. METHODS The intervention development process was underpinned by the Behaviour Change Wheel. The intervention consisted of a wearable activity tracker (Fitbit) and a companion smartphone app (JITABug) which delivered goal setting, planning, reminders, and just-in-time adaptive messages to encourage achievement of personalised physical activity goals. Message delivery was tailored based on time of day, real-time physical activity tracker data, and weather conditions. We tested the feasibility of remotely delivering the JITAI with older adults in a 6-week trial using a mixed-methods approach. Data collection involved assessment of physical activity by accelerometery and activity tracker, self-reported mood and mental wellbeing via ecological momentary assessment, and contextual information on physical activity via voice memos. Feasibility and acceptability outcomes included: (1) recruitment capability and adherence to the intervention; (2) intervention delivery ‘in the wild’; (3) appropriateness of data collection methodology; (4) adverse events and; (5) participant satisfaction. RESULTS Of 46 recruited older adults (aged 56-72 years old), 65% completed the intervention. The intervention was successfully delivered as intended; 27 participants completed the intervention independently, 94% of physical activity messages were successfully delivered, and 99% of Fitbit and 100% of weather data calls were successful. Wrist-worn accelerometer data were obtained from 96% at baseline and 96% at follow up. On average, participants recorded 8/16 (50%) voice memos, 3/8 (38%) mood assessments, and 2/4 (50%) wellbeing assessments via the app. Overall acceptability of the intervention was very good (77% satisfaction). Participant feedback suggested that more diverse and tailored physical activity messages, app usage reminders, technical refinements regarding real-time data syncing, and an improved user interface could improve the intervention and make it more appealing. CONCLUSIONS This study suggests that a smartphone delivered JITAI utilizing a wearable activity tracker is an acceptable way to support physical activity in older adults in the community. Overall, the intervention is feasible, however based on user feedback, the JITABug app requires further technical refinements that may enhance usage, engagement, and user satisfaction before moving to effectiveness trials. CLINICALTRIAL Non-Applicable

Daily Physical Activity and Sleep Measured by Wearable Activity Trackers during the Coronavirus Disease 2019 Pandemic: A Lesson for Preventing Physical Inactivity during Future Pandemics

Wearable activity trackers are devices that are comfortably worn on the body and are designed to be effective in monitoring daily physical activity and improving physical fitness of the wearer. This review aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on physical activity measured using wearable activity trackers and discuss future perspectives on wearable activity trackers during pandemics. Daily physical activity was significantly decreased during the COVID-19 pandemic. The implementation of strict public health measures, such as total lockdown, can decrease people’s physical activity by 50% or more of that prior to the lockdown. Physical inactivity is significantly associated with several health problems, including obesity, diabetes, cardiovascular disease, and cancers; therefore, an effective healthcare system to prevent physical inactivity during pandemics should be established. It is essential to create a network between healthcare organizations and wearable activity tracker users to monitor real-time health status and prepare for the future pandemic.

Enhancing the Physical Activity Levels of Frail Older Adults with a Wearable Activity Tracker-Based Exercise Intervention: A Pilot Cluster Randomized Controlled Trial

A wearable activity tracker (WAT) incorporated with behavioral change techniques (BCTs) increases physical activity in younger adults; however, its effectiveness with frail older adults is unknown. The feasibility and preliminary effects of a WAT-based exercise intervention to increase physical activity levels in frail older adults was investigated in this pilot study involving 40 community-dwelling frail older adults. The experimental group received a 14-week WAT-based group exercise intervention and a 3-month follow-up, while the control group only received similar physical training and all BCTs. The recruitment rate was 93%, and the average attendance rate was 85.2% and 82.2% in the WAT and control groups, respectively, establishing feasibility. Adherence to wearing the WAT was 94.2% and 92% during the intervention and follow-up periods, respectively. A significant interaction effect between time and group was found in all physical assessments, possibly lasting for 3 months post-intervention. However, no significant difference between groups was observed in any daily activity level by the ActiGraph measurement. The majority of the WAT group’s ActiGraph measurements reverted to baseline levels at the 1-month follow-up. Thus, the WAT-based exercise program has potential for employment among community-dwelling frail older adults, but sustaining the effects after the intervention remains a major challenge.

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

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

Comparing the Effectiveness of a Wearable Activity Tracker in Addition to Counseling and Counseling Only to Reinforce Leisure-Time Physical Activity among Breast Cancer Patients: A Randomized Controlled Trial

This randomized controlled trial aimed to compare the effectiveness of a wearable activity tracker (WAT) in addition to counseling (WAT+counseling) and counseling only for reinforcing leisure-time physical activity (LTPA) among breast cancer patients during radiotherapy (RT). A total of 152 breast cancer patients who were planning to undergo radiation therapy (RT) after surgery participated in the study. The WAT+counseling group (n = 76) underwent physical activity (PA) self-monitoring using a WAT and participated in counseling. The counseling-only group (n = 76) received telephone counseling once a week during RT and did not receive WAT. The WAT+counseling group had increased relative change in self-reported LTPA (102.8) compared with the counseling-only group (57.8) immediately after RT compared to baseline. Although the relative changes of self-reported LTPA of the WAT+counseling group were higher at three and six months after the end of RT compared to in the counseling-only group, the results were not significant. The mean average daily step count of the WAT+counseling group was 9351.7, which increased to 11,592.2 during RT and 12,240.1 after RT. In the subgroup analysis, patients who did not perform regular PA before cancer diagnosis had significantly increased step counts. This study shows the feasibility of WAT with counseling to reinforce PA among breast cancer patients.