Tailored physical activity behavior change interventions: challenges and opportunities

Perspectives of Australian healthcare professionals towards gamification in practice

AIM

Gamification may be an effective tool in motivating sustained behaviour change. This study aimed to explore perspectives of Australian-based healthcare professionals, including dietitians, towards gamification in their practice when assisting patients/clients to achieve health-related goals.

METHODS

Semi-structured online interviews were conducted with healthcare professionals. Data was audio-recorded, transcribed verbatim, de-identified and thematically analysed to identify key themes and inform the creation of personas.

RESULTS

Six dietitians, two psychologists, two exercise physiologists, one medical specialist, with 1-24 years of work experience, participated. Most participants (n = 7, 64%) were unable to articulate a definition of gamification, however, when offered more context, they could identify examples. Overall, participants were positive towards gamification, regardless of prior experience/exposure. Three themes emerged; (1) Variable familiarity with gamification, (2) Context matters, (3) Barriers hinder engagement/adoption. Stage of career rather than profession influenced participants' views of gamification, as reflected in three characterising personas; 'Joel: Early-Career, Progressive', 'Bella: Mid-Career, Stable' and 'Sam: Advanced-Career, Expert'.

CONCLUSIONS

Findings suggest that gamification is not widely used in health practice in Australia. Concerns about participation costs and data privacy are adoption barriers. Promotion of the effectiveness of gamification as a valuable adjunct tool to encourage behaviour change needs support from peak bodies. Embedding gamification in university curricula could better prepare graduates to engage with gamification in future practice. Further research capturing more diverse healthcare professionals' perspectives is required to fully understand the potential of gamification to change health behaviours, and to design feasible gamified solutions.

The Relationship Between Motivation for Physical Activity, Physical Activity Level, and Body Mass Index for University Students

The object of the study was to identify the relationship between the motivation for physical activity, the physical activity index (PAI), and the body mass index (BMI) for a sample of university students, taking into consideration the gender difference. The study subjects were 813 (340 men and 473 women), and the age range of the participants varied between 18 and 25 years. The RM 4-FM (Motivation for Physical Activity and Exercise) and PAI online questionnaires were applied to measure the motivation and the physical activity level. The study's novelty focused on analyzing how intrinsic and extrinsic motivation interact and correlate BMI and physical activity levels (PAI). Regarding gender, we approached the identification of motivational differences and the level of physical activity of students from non-sports faculties to identify relevant aspects for promoting proactive behaviors. Results revealed significant gender differences: men had a higher PAI (53.48 ± 28.11) than women (36.67 ± 23.92, p < 0.01); BMI (23.25 vs. 21.69, p < 0.01). The Cohen's value of RAI of RM 4-FM, BMI, and PAI were > 0.5, indicating a large effect size. The analysis presents a unique perspective of the interactions between psychological factors, motivation, and physical characteristics, providing insight into developing strategies to improve and promote a proactive lifestyle.

Perceptions and Experiences of Exercise Snacks Among Middle-Aged and Older Adults: A Systematic Review and Meta-Synthesis

BACKGROUND

Physical inactivity in middle-aged and older adults is a major health problem. Exercise snacks are an emerging form of physical activity characterized by shorter single bouts of high-intensity exercise spread out repeatedly throughout the day which can provide more exercise opportunities for middle-aged and older adults.

PURPOSE

To summarize perceptions and experiences of exercise snacks among middle-aged and older adults, and explore the barriers and facilitators of promoting exercise snacks.

METHODS

We followed the PRISMA and systematically searched five databases from the earliest to May 2024. The Critical Appraisal Skills Program tool is used to quality assess and the Capability, Opportunity, and Motivation Model of Behavior (COM-B model) is used to guide thematic synthesis.

RESULTS

Fourteen categories from nine studies were summarized, and 277 findings were identified. Three synthesized findings were: capability of middle-aged and older adults (including health-related exercise disorders, learning and mastery skills, and health literacy), opportunities for exercise snacks (including flexible and free, easy and quick, integration into life, social and family support, and application of mobile health technology), and motivation of exercise snacks (including pleasurable experiences, gaining physical and mental benefits, effective reminders, incentives and feedback, personalized needs, and self-efficacy).

CONCLUSION

Exercise snacks are a promising approach， however, they need to be continuously optimized. Our results can provide evidence for designing and optimizing exercise snack programs. Medical workers should assist middle-aged and older adults in developing appropriate exercise snack strategies.

TRIAL REGISTRATION

PROSPERO (CRD42024544089).

Unveiling the link: exploring muscle oxygen saturation in fibromyalgia and its implications for symptomatology and therapeutic strategies

Fibromyalgia, characterized as a complex chronic pain syndrome, presents with symptoms of pervasive musculoskeletal pain, significant fatigue, and pronounced sensitivity at specific anatomical sites. Despite extensive research efforts, the origins of fibromyalgia remain enigmatic. This narrative review explores the intricate relationship between muscle oxygen saturation and fibromyalgia, positing that disruptions in the oxygenation processes within muscle tissues markedly influence the symptom profile of this disorder. Muscle oxygen saturation, crucial for muscle function, has been meticulously investigated in fibromyalgia patients through non-invasive techniques such as near-infrared spectroscopy and magnetic resonance imaging. The body of evidence consistently indicates substantial alterations in oxygen utilization within muscle fibers, manifesting as reduced efficiency in oxygen uptake during both rest and physical activity. These anomalies play a significant role in fibromyalgia's symptomatology, especially in terms of chronic pain and severe fatigue, potentially creating conditions that heighten pain sensitivity and accumulate metabolic byproducts. Hypothesized mechanisms for these findings encompass dysfunctions in microcirculation, mitochondrial irregularities, and autonomic nervous system disturbances, all meriting further research. Understanding the dynamics of muscle oxygen saturation in fibromyalgia is of paramount clinical importance, offering the potential for tailored therapeutic approaches to alleviate symptoms and improve the quality of life for sufferers. This investigation not only opens new avenues for innovative research but also fosters hope for more effective treatment strategies and improved outcomes for individuals with fibromyalgia.

Physical Inactivity and Cardiovascular Health in Aging Populations: Epidemiological Evidence and Policy Implications from Riyadh, Saudi Arabia

BACKGROUND

Cardiovascular Diseases (CVDs) are the leading cause of morbidity and mortality globally, particularly among older adults. Physical inactivity, a modifiable risk factor, is strongly associated with the development and progression of CVD through its correlation with hypertension, diabetes, obesity, and hyperlipidemia. This study examines the association between physical inactivity and cardiovascular health among older adults in the Riyadh region, Saudi Arabia.

METHODS

A cross-sectional study was conducted on 168 participants aged 60 years and older attending a tertiary hospital in Riyadh. Data were collected using a structured questionnaire, the Physical Activity Scale for the Elderly (PASE), anthropometric measurements, and medical record reviews. Cardiovascular health indicators and risk factors were analyzed using descriptive statistics, chi-square tests, and multivariate logistic regression.

RESULTS

Participants with low physical activity levels had a higher prevalence of hypertension (78.2%), diabetes (64.4%), and obesity (51.3%) compared to those with high activity levels (41.8%, 28.7%, and 22.3%, respectively). Multivariate analysis showed that physical inactivity was significantly associated with an increased likelihood of CVD (adjusted OR: 1.98, p < 0.001), with hypertension and diabetes also being strong predictors.

CONCLUSIONS

Physical inactivity is strongly correlated with adverse cardiovascular outcomes in older adults. Interventions targeting increased physical activity are essential to reducing the CVD burden. Community-based programs and policy-driven initiatives tailored to the Riyadh region's specific environmental and cultural factors are crucial in promoting active lifestyles among aging populations.

Machine Learning Methods to Personalize Persuasive Strategies in mHealth Interventions That Promote Physical Activity: Scoping Review and Categorization Overview

BACKGROUND

Although physical activity (PA) has positive effects on health and well-being, physical inactivity is a worldwide problem. Mobile health interventions have been shown to be effective in promoting PA. Personalizing persuasive strategies improves intervention success and can be conducted using machine learning (ML). For PA, several studies have addressed personalized persuasive strategies without ML, whereas others have included personalization using ML without focusing on persuasive strategies. An overview of studies discussing ML to personalize persuasive strategies in PA-promoting interventions and corresponding categorizations could be helpful for such interventions to be designed in the future but is still missing.

OBJECTIVE

First, we aimed to provide an overview of implemented ML techniques to personalize persuasive strategies in mobile health interventions promoting PA. Moreover, we aimed to present a categorization overview as a starting point for applying ML techniques in this field.

METHODS

A scoping review was conducted based on the framework by Arksey and O'Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) criteria. Scopus, Web of Science, and PubMed were searched for studies that included ML to personalize persuasive strategies in interventions promoting PA. Papers were screened using the ASReview software. From the included papers, categorized by the research project they belonged to, we extracted data regarding general study information, target group, PA intervention, implemented technology, and study details. On the basis of the analysis of these data, a categorization overview was given.

RESULTS

In total, 40 papers belonging to 27 different projects were included. These papers could be categorized in 4 groups based on their dimension of personalization. Then, for each dimension, 1 or 2 persuasive strategy categories were found together with a type of ML. The overview resulted in a categorization consisting of 3 levels: dimension of personalization, persuasive strategy, and type of ML. When personalizing the timing of the messages, most projects implemented reinforcement learning to personalize the timing of reminders and supervised learning (SL) to personalize the timing of feedback, monitoring, and goal-setting messages. Regarding the content of the messages, most projects implemented SL to personalize PA suggestions and feedback or educational messages. For personalizing PA suggestions, SL can be implemented either alone or combined with a recommender system. Finally, reinforcement learning was mostly used to personalize the type of feedback messages.

CONCLUSIONS

The overview of all implemented persuasive strategies and their corresponding ML methods is insightful for this interdisciplinary field. Moreover, it led to a categorization overview that provides insights into the design and development of personalized persuasive strategies to promote PA. In future papers, the categorization overview might be expanded with additional layers to specify ML methods or additional dimensions of personalization and persuasive strategies.

Investigating the causal impact of different types of physical activity on psychiatric disorders across life stages: A Mendelian randomization study

BACKGROUND

Psychiatric disorders, including attention-deficit hyperactivity disorder (ADHD), depression, anxiety disorders, and dementia, manifest differently across life stages, impacting cognitive, emotional, and behavioral health. Understanding the causal relationships between various types of physical activity and these disorders is crucial for developing targeted interventions.

METHODS

The summary level data from GWAS was utilized to conduct a two-sample Mendelian Randomization (MR) analysis. We assessed the potential causal relationships between different types of physical activity including light do it yourself (DIY) activities, heavy DIY activities, strenuous sports, and aerobic exercises/other exercises and the prevalence of psychiatric disorders (ADHD, depression, anxiety disorders, and dementia) across different life stages.

RESULTS

The MR analysis showed no causal relationship between light DIY activities and any of the psychiatric disorders studied. Heavy DIY activities showed a significant negative association with anxiety disorders but no links with ADHD, depression, or dementia. Strenuous sports did not demonstrate any causal relationship with the psychiatric disorders examined. Aerobic exercises were notably correlated with a reduced risk of depression, although no significant associations were found with ADHD, anxiety disorders, or dementia.

CONCLUSIONS

The findings indicate that heavy DIY activities might contribute to reducing anxiety disorders, while aerobic exercises potentially lower the risk of depression. These results emphasize the potential benefits of promoting specific types of physical activity to improve mental health outcomes across different life stages. Future research could further investigate the mechanisms underlying these relationships and consider diverse populations and objective measures of physical activity.

The relationship between implicit motives and physical activity: a scoping review

BACKGROUND

Interventions that leverage implicit motives - affect-based, non-conscious motivational dispositions - may increase physical activity by making physical activity more pleasurable. However, there is no evidence synthesis of the empirical data linking the major implicit motives (achievement, affiliation, and power motives) and physical activity. We aimed to close this research gap.

METHODS

Following a systematic literature search in the PsycInfo, PubMed, and Web of Science databases until August 2024, we performed a scoping review. We included German- or English-language publications in peer-reviewed journals or books that followed an observational or intervention study design. Studies had to link ≥ 1 major implicit motive measured via a well-established method to physical activity behavior. We critically appraised the methodological quality of the included studies using an adaptation of the JBI critical appraisal checklist for analytical cross-sectional studies and synthesized the evidence qualitatively.

RESULTS

Out of 1047 potentially relevant records, five publications (seven studies, N = 550) were included. All eligible studies were observational (six cross-sectional, one prospective longitudinal). The achievement motive was researched the most. The data indicated a relatively consistent positive association between physical activity and the achievement motive, particularly in athletes and in sports-specific settings. The associations with the affiliation and power motives were more mixed. Most studies were conducted in sports-specific settings. All studies elicited methodological concerns, to varying degrees.

CONCLUSIONS

The available data indicate a positive association between achievement motive strength and physical activity. However, important limitations, especially the lack of intervention studies and the use of non-gold standard assessment methods, limit the confidence in the findings. More, methodologically sound research is needed to better understand the link between implicit motives and physical activity, especially in the general population.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023392198.

Workplace active breaks for university workers: the UNIFIT pilot study protocol

Sedentary behaviour (SB) is associated with an increased risk of metabolic issues (negative effects on diabetes, fasting glucose, fasting insulin, triglycerides, high-density lipoprotein cholesterol and waist circumference), cardiovascular diseases, increased risk of all-cause mortality and accelerated ageing of skeletal muscle power. The research on SB is relatively new, with much evidence regarding its negative health effects gathered within the last decade. Office workers exhibit pronounced sedentary habits, with studies indicating they can spend up to 82% of their working day sitting. To address this issue, workplaces are responsible for promoting physical activity and minimising SB among employees. In this context, one potential strategy for reducing SB and its associated risks could be implementing active breaks (ABs). ABs are defined as brief, structured periods of physical activity or exercise. This quasi-experimental pilot study aims to implement workplace ABs programme aimed at interrupting SB among the University of Bologna (Italy) workers, and it will include both intervention and control groups. The intervention group will participate in an 8-week ABs programme. The findings from this study could establish a robust basis for future large-scale research on the effectiveness of ABs interventions in workplace settings.

Theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury

OBJECTIVES

This project used a systematic and integrated knowledge translation (IKT) approach to co-create theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury (SCI).

METHODS

Guided by the IKT Guiding Principles, we meaningfully engaged research users throughout this project. A systematic approach was used. An international, multidisciplinary expert panel (n = 15), including SCI researchers, counselors, and people with SCI, was established. Panel members participated in two online meetings to discuss the best practices by drawing upon new knowledge regarding counselor-client interactions, current evidence, and members' own experiences. We used concepts from key literature on SCI-specific physical activity counseling and health behavior change theories. An external group of experts completed an online survey to test the clarity, usability and appropriateness of the best practices.

RESULTS

The best practices document includes an introduction, the best practices, things to keep in mind, and a glossary. Best practices focused on how to deliver a conversation and what to discuss during a conversation. Examples include: build rapport, use a client-centred approach following the spirit of motivational interviewing, understand your client's physical activity barriers, and share the SCI physical activity guidelines. External experts (n = 25) rated the best practices on average as clear, useful, and appropriate.

CONCLUSION

We present the first systematically co-developed theory- and evidence-based best practices for SCI physical activity counseling. The implementation of the best practices will be supported by developing training modules. These new best practices can contribute to optimizing SCI physical activity counseling services across settings.

Effects of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals living in a refugee camp in Greece: A randomized controlled trial

Background

The metabolic syndrome epidemic, including in forcibly displaced individuals, requires cost-effective prevention and treatment strategies. Yet, the health needs of forcibly displaced individuals often remain underserved. Our study evaluated the effect of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals in a refugee camp in Greece and examined the indirect effect through cardiorespiratory fitness on metabolic syndrome components.

Methods

We conducted a randomized controlled trial involving an intervention and a wait-list control group with n = 142 (52.8 % women) forcibly displaced Southwest Asians and Sub-Saharan Africans. The intervention group participated for 10 weeks in exercise and sport activities. Outcomes were cardiorespiratory fitness and single metabolic syndrome components. Effects were analyzed with structural equation modeling.

Results

In total, 62.7 % of participants presented with low cardiorespiratory fitness levels (<40th percentile), and 24.6 % met the criteria for metabolic syndrome. In the intervention group, 73.5 % attended the exercise and sport sessions at least once a week. There was evidence for a direct intervention effect on cardiorespiratory fitness, ßdirect = 0.12, p = 0.022, but not for any of the metabolic syndrome components (p ≥ 0.192). Cardiorespiratory fitness significantly facilitated the intervention's indirect effect on abdominal obesity, ßindirect = -0.03, p = 0.012, high diastolic blood pressure, ßindirect = -0.04, p = 0.011, and elevated triglycerides, ßindirect = -0.03, p = 0.025.

Conclusion

Implementing exercise and sport activities in a refugee camp in Greece effectively reaches a wider target population and improves cardiorespiratory fitness among forcibly displaced individuals. The intervention contributes to a decrease in abdominal obesity, high diastolic blood pressure and elevated triglycerides indirectly via improved cardiorespiratory fitness.

Effects of an Individualized mHealth-Based Intervention on Health Behavior Change and Cardiovascular Risk Among People With Metabolic Syndrome Based on the Behavior Change Wheel: Quasi-Experimental Study

BACKGROUND

Metabolic syndrome (MetS) is a common public health challenge. Health-promoting behaviors such as diet and physical activity are central to preventing and controlling MetS. However, the adoption of diet and physical activity behaviors has always been challenging. An individualized mobile health (mHealth)-based intervention using the Behavior Change Wheel is promising in promoting health behavior change and reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, the effects of this intervention are not well understood among people with MetS in mainland China.

OBJECTIVE

We aimed to evaluate the effects of the individualized mHealth-based intervention using the Behavior Change Wheel on behavior change and ASCVD risk in people with MetS.

METHODS

We conducted a quasi-experimental, nonrandomized study. Individuals with MetS were recruited from the health promotion center of a tertiary hospital in Zhejiang province, China. The study involved 138 adults with MetS, comprising a control group of 69 participants and an intervention group of 69 participants. All participants received health education regarding diet and physical activity. The intervention group additionally received a 12-week individualized intervention through a WeChat mini program and a telephone follow-up in the sixth week of the intervention. Primary outcomes included diet, physical activity behaviors, and ASCVD risk. Secondary outcomes included diet self-efficacy, physical activity self-efficacy, knowledge of MetS, quality of life, and the quality and efficiency of health management services. The Mann-Whitney U test and Wilcoxon signed rank test were primarily used for data analysis. Data analysis was conducted based on the intention-to-treat principle using SPSS (version 25.0; IBM Corp).

RESULTS

Baseline characteristics did not differ between the 2 groups. Compared with the control group, participants in the intervention group showed statistically significant improvements in diet behavior, physical activity behavior, diet self-efficacy, physical activity self-efficacy, knowledge of MetS, physical health, and mental health after a 12-week intervention (P=.04, P=.001, P=.04, P=.04, P=.001, P=.04, P=.04, and P<.05). The intervention group demonstrated a statistically significant improvement in outcomes from pre- to postintervention evaluations (P<.001, P=.03, P<.001, P=.04, P<.001, P<.001, and P<.001). The intervention also led to enhanced health management services and quality.

CONCLUSIONS

The individualized mHealth-based intervention using the Behavior Change Wheel was effective in promoting diet and physical activity behaviors in patients with MetS. Nurses and other health care professionals may incorporate the intervention into their health promotion programs.

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW)

Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.

Adapting a Clinical Practice Guideline for Management of Patients with Knee and Hip Osteoarthritis by Hong Kong Physiotherapists

Knee and hip osteoarthritis are common disabling conditions globally. Although numerous international clinical practice guidelines exist to guide physiotherapy management, not all recommendations issued from these guidelines can be translated to other contexts without considering the cultural acceptability and clinical implementability of targeted countries. Because the ADAPTE framework provides a robust methodology to adapt guidelines to the local context, this study used its methodology to adapt high-quality guideline recommendations to promote optimal physiotherapy care for knee and hip osteoarthritis in Hong Kong. The ADAPTE framework was used and modified to complete the adaptation process. International clinical practice guidelines were identified from eight guideline clearinghouses and six electronic databases. Two independent reviewers critically appraised the eligible guidelines using the AGREE II tool. We extracted and tabulated recommendations from high-quality guidelines. A voting-based consensus among interdisciplinary experts was conducted to decide on suitable recommendations for the Hong Kong context and whether there was a need to modify them. Pertinent recommendations were then translated into the traditional Chinese language. Our team members suggested modifying four tools and adding one to explore the patient's feedback on the recommendations, to the ADAPTE framework. The adaptation was performed on three high-quality guidelines. We adapted 28 and 20 recommendations for treating knee and hip osteoarthritis, respectively. We recommend a multimodal treatment for managing knee and hip osteoarthritis. Land- and aquatic-based exercises, patient education, and self-management were strongly recommended for patients with knee osteoarthritis. Land- and aquatic-based exercises were strongly recommended for patients with hip osteoarthritis. This is the first adaptation study in Hong Kong. It provides guidance to local physiotherapists on managing patients with knee and hip osteoarthritis. Future studies should test the effectiveness of implementing this adapted guideline to improve local physiotherapy care in Hong Kong.

Relationships between Obesity, Exercise Preferences, and Related Social Cognitive Theory Variables among Breast Cancer Survivors

Breast cancer survivors with obesity have an increased risk of cancer recurrence, second malignancy, and comorbidities. Though physical activity (PA) interventions are needed, investigation of the relationships between obesity and factors influencing PA program aspects among cancer survivors remain understudied. Thus, we conducted a cross-sectional study examining associations amongst baseline body mass index (BMI), PA program preferences, PA, cardiorespiratory fitness, and related social cognitive theory variables (self-efficacy, exercise barriers interference, social support, positive and negative outcome expectations) from a randomized controlled PA trial with 320 post-treatment breast cancer survivors. BMI was significantly correlated with exercise barriers interference (r = 0.131, p = 0.019). Higher BMI was significantly associated with preference to exercise at a facility (p = 0.038), lower cardiorespiratory fitness (p < 0.001), lower walking self-efficacy (p < 0.001), and higher negative outcome expectations (p = 0.024), independent of covariates (comorbidity score, Western Ontario and McMaster Universities osteoarthritis index score, income, race, education). Those with class I/II obesity reported a higher negative outcome expectations score compared with class III. Location, walking self-efficacy, barriers, negative outcome expectations, and fitness should be considered when designing future PA programs among breast cancer survivors with obesity.

Motivational readiness for physical activity and health literacy: results of a cross-sectional survey of the adult population in Germany

BACKGROUND

Health literacy, defined as the knowledge, motivation, and competences to use health information to improve health and well-being, is associated with regular physical activity. However, there is limited evidence on whether health literacy is also related to the motivational readiness for physical activity in a general population. The aim of this study was to investigate whether motivational readiness for leisure-time physical activity is associated with health literacy.

METHODS

Analyses were based on data of 21,895 adults from the cross-sectional German Health Update and European Health Interview Survey 2014/2015 (GEDA 2014/2015-EHIS). Motivational readiness for leisure-time physical activity was assessed with stages of change for physical activity with a set of validated items. It was then classified, according to an established algorithm, into five stages: precontemplation, contemplation, preparation, action, and maintenance. Health literacy was measured with the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and categorised as low, medium, and high. For bivariate and multinomial logistic regression analyses, the stages were categorised in three phases as: (1) no intention (precontemplation), (2) planning (contemplation or preparation), and (3) in activity (action or maintenance). The models were adjusted for sex, age, education, health consciousness, self-efficacy, and self-perceived general health status.

RESULTS

High compared to low health literacy was associated with a 1.65-times (95% CI = 1.39-1.96) greater probability of being in activity than planning. High compared to low health literacy was associated with a reduced risk of having no intention to change physical activity behaviour (relative risk ratio, RRR = 0.84, 95% CI = 0.75-0.95). The associations persisted after adjusting for covariates.

CONCLUSION

High health literacy was positively associated with more advanced phases of motivational readiness for leisure-time physical activity. Therefore, taking health literacy into account in interventions to promote motivational readiness for leisure-time physical activity could be a useful approach.

Preferences of people with mild cognitive impairment for physical activity interventions in China: protocol for a discrete choice experiment study

INTRODUCTION

Exercise interventions are important non-pharmacological interventions for patients with mild cognitive impairment (MCI), but patients with MCI have poor compliance and there is no consistent strategy for exercise interventions. Understanding the needs and preferences of MCI patients allows for the development of effective and acceptable exercise intervention programmes that achieve the goals of patient-centred care. This study uses a discrete choice experiment (DCE) to measure and quantify MCI patients' preferences for exercise interventions, and aims at (1) identifying and exploring which elements of exercise intervention programmes are essential for MCI patients; (2) measuring MCI patients' preferences for exercise interventions and summarising relevant characteristics that may influence preference choices and (3) determining whether these preferences vary by participant characteristics and classifying the population types based on the sociodemographic characteristics of the participants.

METHODS AND ANALYSIS

A DCE will be conducted to explore MCI patients' preferences for exercise interventions. We conducted a systematic literature review and extensive qualitative work to select the best attributes to develop the design of DCE. A partial factorial survey design was generated through an orthogonal experimental design. We will conduct a questionnaire survey in one city each in the eastern (Nanjing), western (Xining), southern (Zhuhai) and northern (Beijing) parts of China and reach the planned sample size (n=278). Final data will be analysed using a mixed logit model and a latent class model.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee of Nanjing Medical University (2021-666). All participants will be required to provide informed consent. Our findings will be disseminated and shared with interested patient groups and the general public through online blogs, policy briefs, national and international conferences and peer-reviewed journals.

Feasibility of a Theory-Based, Online Tailored Message Program to Motivate Healthier Behaviors in College Women

We aimed to test the feasibility of an online survey and tailored message program in young women. Recruited from college campuses, women (n = 189) completed an online survey assessing preference for and behaviors toward diet and physical activity as well as theory-based influencers of these behaviors (knowledge/information, motivation, and confidence). Health messages were tailored to the participant’s survey responses and learning style to address misconceptions and motivate or reinforce healthy physical activity and dietary behaviors. Most women reported the survey as relevant (92%) and useful for reflecting on their health (83%), with survey responses variable in level of nutrition and physical activity knowledge, motivation, and confidence. Each woman received four tailored messages—most reported the messages as relevant (80%) and learning new information (60%). Across all messages, nearly half of the participants (~48%) reported willingness to try or maintain healthier behaviors and confidence in their ability. Body size discrepancy and dietary restraint had small effects message responses of information learned, and the motivation and confidence in trying healthier behaviors. In summary, these data support the feasibility of this online tailored message program. The college women found the tailored message program acceptable and useful to motivate healthier behaviors. The findings provide direction for behaviorally focused interventions to improve dietary and physical activity behaviors.