A Group-Mediated Approach to Precision Medicine-Social Identification, Prevention, and Treatment

Intervention effects on physical activity identity: a systematic review and meta-analysis

Physical activity (PA) identity (i.e., categorisation of oneself in a particular role) has been linked to PA behaviour in observational research, yet experimental research has seen less attention. The purpose of this meta-analysis was to examine the effectiveness of interventions to change identity and subsequent PA. Eligible studies were published in a peer-reviewed journal in English, included an experimental or quasi-experimental design in the PA domain with a measure of identity as the dependent variable, among an adult (>18 yrs.) sample. A literature search was completed in March 2024 using five common databases. The search yielded 40 independent effect sizes, representing 4939 participants. Random-effects meta-analysis showed positive changes in identity favouring the intervention over the control group g = 0.18 (95% CI = 0.11-0.24) and positive changes in a sub-sample (k = 30) of these studies that also measured PA g = 0.61 (95% CI = 0.41-0.81). Changes in identity did not have significant (Q = 43.08, p = 0.30) heterogeneity, yet changes in PA showed heterogeneity (Q = 204.62, p < .001) and follow-up moderator analyses found potential publication bias, and differences by methods (comparison group, length of intervention) and theoretical approach. Overall, PA identity can change as a result of interventions, but the effect may be smaller than changes in behaviour in these interventions.

Effects of older adults' social identification on psychological flourishing and exercise program adherence

BACKGROUND

With the onset of the COVID-19 pandemic, many exercise programs moved online. The purpose of this study was to examine the extent to which older adults' social identification with other exercise program members contributed to their psychological flourishing and exercise program adherence.

METHODS

The study represented a secondary analysis of data derived from the Seniors COVID-19 Pandemic and Exercise (SCOPE) Trial, in which older adults were randomized to a waitlist control condition or one of two online (personal v group) exercise programs. Only data from participants in the trial intervention conditions (N = 162; Mage = 73.52 years; SD = 5.61) were utilized in this secondary analysis. We assessed psychological flourishing and social identification at baseline and every two weeks, as well as program adherence over each 2-week block, for 12 weeks.

RESULTS

Based on stepwise multilevel modeling the results revealed that older adults' social identification with others in their respective exercise program had a direct effect on psychological flourishing (ΔR2Unique Marginal = 0.063, p < .001) and program adherence (ΔR2Unique Marginal = 0.014, p = .03).

CONCLUSIONS

The results highlight the value of bolstering older adults' social identification with others in an online exercise program to support adherence and well-being.

Changes in identity and habit formation during 3 months of sport and physical activity participation among parents with young children

Understanding factors that might contribute to sustained moderate-to-vigorous intensity physical activity (MVPA) after the initial start of participation is important. The purpose of this study was to examine the changes in PA habit and identity, two constructs purported to drive behavioral maintenance, among parents of young (< 13 years of age) children participating in a PA intervention across 3 months. Parents (team sport n = 58; individual PA n = 60; control n = 66) completed measures of PA habit, PA identity, and self-reported MVPA at baseline, and post-randomization at 6 weeks and 3 months. Identity and habit showed an increase across time, and these changes interacted with group condition assignment. Identity increased for participants in the team sport condition and was significantly different from a stable profile among those assigned to the control condition. Participants in the individual PA condition increased identity from 6 weeks to 3 months. Habit had a more attenuated change across time, with participants in the team sport condition showing an increase from 6 weeks to 3 months compared with the other conditions. The findings contribute to our understanding of maintenance processes and represent the first exploration of how involvement in team sport might shape subsequent habit and identity development.

Extending Our Understanding of the Social Determinants of Physical Activity and Sedentary Behaviors in Families: A Systems Mapping Approach

BACKGROUND

The social environment is important to consider for effective promotion of movement behaviors like increased physical activity (PA) and reduced sedentary behavior (SB); yet, it is less often considered than individual and built environments. One way to advance social environment research is to develop system maps, an innovative, participatory, action-oriented research process that actively engages stakeholders to visualize system structures and explore how systems "work." The purpose of this research was to develop PA and SB system maps of the social environment embedded within the core/nuclear family system.

METHODS

The development process began with a 2-day multicountry, 16-researcher, in-person participatory workshop in August 2023, followed by multiple online follow-up consultations. Attendees contributed to the creation of the maps through shared development of critical determinants and their causal pathways. The structure of the final maps was analyzed using network analysis methods to identify indicators of centrality, and key feedback loops and areas for potential intervention were explored.

RESULTS

Key central determinants that were likely critical targets for systems intervention to produce changes in PA and SB and featured prominently in most of the reinforcing and balancing feedback loops included shared family interests, values and priorities, family logistical support, family cohesion/organization, and shared experiences. The maps also highlighted key determinants of the broader social environment external to the family.

CONCLUSIONS

These system maps support current evidence on movement behaviors in family systems and socioecological theories and have the utility to galvanize future research and policy to promote PA and reduce SB.

Development of the social dimensions of health behaviour framework

Despite rapid theoretical expansion in conceptualising individual and environmental processes, the examination of social processes associated with health behaviours has a less cohesive theoretical landscape. The purpose of this mapping review and content analysis was to develop a taxonomy of social dimensions applicable to health behaviours. Michie et al. (2014) 'ABC of Theories of Behaviour Change' text, which includes 83 behaviour change theories, was used as the data-set, whereby an iterative concurrent content analysis was undertaken with respect to all relational/interpersonal psychological dimensions. The analysis resulted in a social dimensions of health behaviour (SDHB) framework of 10 dimensions, including seven sub-types of social appraisal dimensions and three-sub-types of social identification dimensions. The SDHB revealed that specific dimensions, such as descriptive norm, are prevalent in behavioural theories, while other dimensions have seen less attention. Further, while most social constructs in behavioural theories are represented by only one social dimension in the SDHB, other constructs have complex representation. This version 1.0 of the SDHB framework should assist in specifying the core social dimensions in health behaviour, provide a common lexicon to discuss relational constructs in psychological theories, amalgamate the disparate social constructs literature and identify opportunities for further research to advance theory development and interventions.

"You are either sporty or you are not" a qualitative exploration of pre-teen girls of low-socioeconomic position experiences of being physically active

BACKGROUND

Eighty one percent of adolescents do not meet the recommended physical activity (PA) guidelines with levels of physical activity declining steadily with age and more pronounced in girls of low socioeconomic position (SEP). Furthermore, early adolescence is a time when the rate of decline in PA is most severe amongst girls, placing them at an increased likelihood of developing negative health outcomes associated with physical inactivity. In response, the aim of this study was to explore low-SEP pre-teen girls' experiences of being physically active and to understand their perceptions of the individual, social and environmental factors that influence these experiences.

METHODS

Focus groups were conducted with 107 girls aged 10-12 years from four urban and three rural primary schools. Reflexive thematic analysis was used to analyse the data, with themes mapped to the relevant domains of the Theoretical Domains Framework (TDF).

RESULTS

Themes highlighted how skills and confidence underpin girls' self-identity for PA. Girls described how their social network (i.e., peers, family, coaches and teachers) shaped their experiences of being active. Girls recognised how being active was impacted by the challenges and opportunities in their local community (e.g., lack of facilities and anti-social behaviour).

CONCLUSION

This study provides insight into low-SEP pre-teen girls' experiences of being physically active in both rural and urban locations, while highlighting the complex interplay of individual, social and environmental factors. Additionally, the use of the TDF presents an in-depth behavioural diagnosis which can be used to inform future theory-based interventions to promote low-SEP pre-teen girls PA.

Translating Physical Activity Intentions into Behavior: Reflective, Regulatory, and Reflexive Processes

The purpose of this article was to review predictors of the physical activity (PA) intention-behavior relationship. The review provides evidence for the hypothesis that reflective (consciously deliberated expectations of PA), regulatory (tactics used to enact intentions), and reflexive (stimulus-based associative motivation) processes represent independent determinants of translating PA intentions into action, yet differ in relative contribution across time and circumstance.

MAN v FAT Soccer: Feasibility Study and Preliminary Efficacy of a Sport-Based Weight-Loss Intervention for Overweight and Obese Men in Australia

MAN v FAT Soccer is a sport-based weight-loss program for overweight and obese men that originated in the United Kingdom (i.e., as MAN v FAT Football) and appears to successfully engage men with weight loss. We sought to explore whether the program would work in an Australian context by (a) establishing a foundation for the implementation of the program on a larger scale and (b) determining how large-scale implementation is most feasible. We conducted a nonrandomized, single intervention group feasibility trial of MAN v FAT Soccer in Australia with 418 male participants with a body mass index greater than 27.50 kg/m2. Results indicate that the program is acceptable, with participants reporting positive perceptions of the various components of the program and a high proportion reporting intentions to recommend the program to others (95.9%). Furthermore, preliminary effectiveness results indicate positive changes in weight (4.6% reduction) and physical activity (88.5% increase) and improvements in psychological outcomes such as depression (17.6% decrease), stress (19.0% decrease), and body appreciation (19.1% increase). Our findings provide general support for the feasibility of MAN v FAT Soccer and the notion that leveraging competition and masculinity may help drive men's health behavior change.

Digital intervention promoting physical activity among obese people (DIPPAO) randomised controlled trial: study protocol

INTRODUCTION

Physical inactivity and excessive sedentary behaviours are major preventable causes in both the development and the treatment of obesity and type 2 diabetes mellitus (T2DM). Nevertheless, current programmes struggle to engage and sustain physical activity (PA) of patients over long periods of time. To overcome these limitations, the Digital Intervention Promoting Physical Activity among Obese people randomised controlled trial (RCT) aims to evaluate the effectiveness of a group-based digital intervention grounded on gamification strategies, enhanced by social features and informed by the tenets of the self-determination theory and the social identity approach.

METHODS AND ANALYSIS

This trial is a two-arm parallel RCT testing the effectiveness of the Kiplin digital intervention on obese and patients with T2DM in comparison to the usual supervised PA programme of the University Hospital of Clermont-Ferrand, France. A total of 50 patients will be randomised to one of the two interventions and will follow a 3-month programme with a 6-month follow-up postintervention. The primary outcome of the study is the daily step count change between the baseline assessment and the end of the intervention. Accelerometer data, self-reported PA, body composition and physical capacities will also be evaluated. To advance our understanding of complex interventions like gamified and group-based ones, we will explore several psychological mediators relative to motivation, enjoyment, in-group identification or perceived weight stigma. Finally, to assess a potential superior economic efficiency compared with the current treatment, we will conduct a cost-utility analysis between the two conditions. A mixed-model approach will be used to analyse the change in outcomes over time.

ETHICS AND DISSEMINATION

The research protocol has been reviewed and approved by the Local Human Protection Committee (CPP Ile de France XI, No 21 004-65219). Results will inform the Kiplin app development, be published in scientific journals and disseminated in international conferences.

TRIAL REGISTRATION NUMBER

NCT04887077.

Couple-Based Physical Activity Planning for New Parents: A Randomized Trial

INTRODUCTION

The demands of parenthood may limit the pursuit of moderate-to-vigorous intensity physical activity (MVPA), establish inactivity patterns into middle age, and lead to long-term poorer health and well-being. The purpose of this study was to examine the efficacy of a couple-based planning skills intervention to support MVPA from baseline (~2 months after birth) up to 6 months later in first-time parents.

STUDY DESIGN

Randomized trial.

PARTICIPANTS

264 parents (132 couples) at the 2-month point of parenting their first child.

INTERVENTION

Couples were randomized to either an education control (n=58 couples) or an education plus planning condition (n=74 couples).

MAIN OUTCOME MEASURES

MVPA was assessed via accelerometry and self-report at baseline, 6 weeks, 3 months, and 6 months. Health-related fitness (aerobic fitness, muscular strength, flexibility) and BMI tests were conducted at baseline and 6 months. Rolling recruitment was between 2014 and 2017.

RESULTS

The accelerometry results had large amounts of missing data that were not missing at random, so only self-reported MVPA was analyzed. Dyadic multilevel modeling conducted in 2020 showed that mothers' MVPA had a significant quadratic pattern over time that was similar for both conditions, and BMI decreased while strength and flexibility increased. Fathers did not have significant outcomes. Participants who were not meeting MVPA guidelines at baseline responded to the education plus planning condition with increased MVPA (father B=1.31, mother B=1.14, p<0.05) compared with those who initially met those guidelines.

CONCLUSIONS

Mothers may be more responsive than fathers to MVPA interventions in early parenthood. Already active parents likely have little to be gained from additional intervention. Future research is needed to effectively promote MVPA during fatherhood and identify novel ways to sustain PA past the early response to an intervention.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02290808.

Online-Delivered Group and Personal Exercise Programs to Support Low Active Older Adults' Mental Health During the COVID-19 Pandemic: Randomized Controlled Trial

BACKGROUND

In response to the COVID-19 pandemic, experts in mental health science emphasized the importance of developing and evaluating approaches to support and maintain the mental health of older adults.

OBJECTIVE

The aim of this study was to assess whether a group-based exercise program relative to a personal exercise program (both delivered online) and waitlist control (WLC) can improve the psychological health of previously low active older adults during the early stages of the COVID-19 pandemic.

METHODS

The Seniors COVID-19 Pandemic and Exercise (SCOPE) trial was a 3-arm, parallel randomized controlled trial conducted between May and September 2020 in which low active older adults (aged ≥65 years) were recruited via media outlets and social media. After baseline assessments, consented participants were randomized to one of two 12-week exercise programs (delivered online by older adult instructors) or a WLC condition. A total of 241 older adults (n=187 women) provided baseline measures (via online questionnaires), were randomized (ngroup=80, npersonal=82, ncontrol=79), and completed measures every 2 weeks for the duration of the trial. The trial's primary outcome was psychological flourishing. Secondary outcomes included global measures of mental and physical health, life satisfaction, and depression symptoms.

RESULTS

The results of latent growth modeling revealed no intervention effects for flourishing, life satisfaction, or depression symptoms (P>.05 for all). Participants in the group condition displayed improved mental health relative to WLC participants over the first 10 weeks (effect size [ES]=0.288-0.601), and although the week 12 effect (ES=0.375) was in the same direction the difference was not statistically significant (P=.089). Participants in the personal condition displayed improved mental health, when compared with WLC participants, in the same medium ES range (ES=0.293-0.565) over the first 8 weeks, and while the effects were of a similar magnitude at weeks 10 (ES=0.455, P=.069) and 12 (ES=0.258, P=.353), they were not statistically significant. In addition, participants in the group condition displayed improvements in physical health when compared with the WLC (ES=0.079-0.496) across all 12 weeks of the study following baseline. No differences were observed between the personal exercise condition and WLC for physical health (slope P=.271).

CONCLUSIONS

There were no intervention effects for the trial's primary outcome (ie, psychological flourishing). It is possible that the high levels of psychological flourishing at baseline may have limited the extent to which those indicators could continue to improve further through intervention (ie, potential ceiling effects). However, the intervention effects for mental and physical health point to the potential capacity of low-cost and scalable at-home programs to support the mental and physical health of previously inactive adults in the COVID-19 pandemic.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04412343; https://clinicaltrials.gov/ct2/show/NCT04412343.