1
|
McMahon SK, Lewis BA, Guan W, Wang Q, Hayes SM, Wyman JF, Rothman AJ. Effect of Intrapersonal and Interpersonal Behavior Change Strategies on Physical Activity Among Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240298. [PMID: 38421648 PMCID: PMC10905305 DOI: 10.1001/jamanetworkopen.2024.0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024] Open
Abstract
Importance Despite guidelines that recommend physical activity (PA), little is known about which types of behavior change strategies (BCSs) effectively promote sustained increases in PA in older adults who are insufficiently active. Objective To determine whether intrapersonal BCSs (eg, goal setting) or interpersonal BCSs (eg, peer-to-peer sharing or learning) combined with the Otago Exercise Program (17 strength and balance exercises and a walking program that are learned and individually tailored, with instruction to perform 3 times per week at home or location of choice) and a wearable PA monitor help older adults sustain increases in their PA. Design, Setting, and Participants This 2 × 2 factorial randomized clinical trial (Community-Based Intervention Effects on Older Adults' Physical Activity) of community-dwelling older adults 70 years or older with PA levels below minimum national PA guidelines was conducted in urban community centers. Dates of enrollment were from November 17, 2017, to June 15, 2021, with final follow-up assessments completed on September 2, 2022. Interventions Participants were randomized to intrapersonal (eg, goal setting) BCSs, interpersonal (eg, problem-solving with peer-to-peer sharing and learning) BCSs, intrapersonal and interpersonal BCSs, or an attention control group. All interventions included a PA monitor and 8 weekly small-group meetings with discussion, practice, and instructions to implement the exercise program and relevant BCSs independently between meetings and after the intervention. Main Outcomes and Measures The primary outcome was daily minutes of objectively measured total PA (light, moderate, or vigorous intensities) averaged over 7 to 10 days, measured at baseline and after the intervention at 1 week, 6 months, and 12 months. Results Among 309 participants (mean [SD] age, 77.4 [5.0] years; 240 women [77.7%]), 305 (98.7%) completed the intervention, and 302 (97.7%) had complete data. Participants receiving PA interventions with interpersonal BCS components exhibited greater increases in total PA than did those who did not at 1 week (204 vs 177 PA minutes per day; adjusted difference, 27.1 [95% CI, 17.2-37.0]; P < .001), 6 months (195 vs 175 PA minutes per day; adjusted difference, 20.8 [95% CI, 10.0-31.6]; P < .001), and 12 months (195 vs 168 PA minutes per day; adjusted difference, 27.5 [95% CI, 16.2-38.8]; P < .001) after the intervention. Compared with participants who did not receive interventions with intrapersonal BCS components, participants who received intrapersonal BCSs exhibited no significant changes in total PA at 1 week (192 vs 190 PA minutes per day; adjusted difference, 1.8 [95% CI, -8.6 to 12.2]; P = .73), 6 months (183 vs 187 PA minutes per day; adjusted difference, -3.9 [95% CI, -15.0 to 7.1]; P = .49), or 12 months (177 vs 186 PA minutes per day; adjusted difference, -8.8 [95% CI, -20.5 to 2.9]; P = .14) after the intervention. Interactions between intrapersonal and interpersonal BCSs were not significant. Conclusions and Relevance In this randomized clinical trial, older adults with low levels of PA who received interpersonal BCSs, the exercise program, and a PA monitor exhibited significant increases in their PA for up to 12 months after the intervention. Intrapersonal BCSs elicited no significant PA changes and did not interact with interpersonal BCSs. Our findings suggest that because effects of a PA intervention on sustained increases in older adults' PA were augmented with interpersonal but not intrapersonal BCSs, approaches to disseminating and implementing the intervention should be considered. Trial Registration ClinicalTrials.gov Identifier: NCT03326141.
Collapse
Affiliation(s)
| | - Beth A. Lewis
- School of Kinesiology, University of Minnesota, Minneapolis
| | - Weihua Guan
- School of Public Health, University of Minnesota, Minneapolis
| | - Qi Wang
- School of Public Health, University of Minnesota, Minneapolis
| | | | - Jean F. Wyman
- School of Nursing, University of Minnesota, Minneapolis
| | | |
Collapse
|
2
|
Choma EA, Hayes S, Lewis BA, Rothman AJ, Wyman JF, Guan W, McMahon SK. Technical Assistance Received by Older Adults to Use Commercially Available Physical Activity Monitors (Ready Steady 3.0 Trial): Ad-Hoc Descriptive Longitudinal Study. JMIR Mhealth Uhealth 2023; 11:e47891. [PMID: 37997772 PMCID: PMC10690145 DOI: 10.2196/47891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023] Open
Abstract
Background Despite evidence that regular physical activity (PA) among older adults confers numerous health and functional benefits, PA participation rates are low. Using commercially available wearable PA monitors (PAMs) is one way to augment PA promotion efforts. However, while expert recommendations exist for the specific information needed at the beginning of PAM ownership and the general ongoing need for structures that support as-needed technical troubleshooting, information is lacking about the type, frequency, and modes of assistance needed during initial and long-term ownership. Objective This paper describes problems reported and technical assistance received by older adults who used PAMs during the 18 months they participated in a community-based PA trial: Ready Steady 3.0 (RS3). Methods This was an ad-hoc longitudinal analysis of process variables representing technical problems reported and assistance received by 113 RS3 study participants in the 18 months after their orientation to PAMs. Variables included date of contact, problem(s) reported, mode of technical assistance, and whether the equipment was replaced. The descriptive analysis included frequencies and incidence rates of distinct contacts, types of problems, and technical assistance modes. Results On average, participants were aged 77 (SD 5.2) years. Most identified as female (n=87, 77%), reported experience using smartphones (n=92, 81.4%), and used the PAM between 2 and 18 months. Eighty-two participants (72.6%) reported between 1 to 9 problems with using PAMs, resulting in a total of 150 technical assistance contacts with a mean of 1.3 (SD 1.3) contacts. The incidence rate of new, distinct contacts for technical assistance was 99 per 100 persons per year from 2018 to 2021. The most common problems were wearing the PAM (n=43, 28.7%), reading its display (n=23, 15.3%), logging into its app (n=20, 13.3%), charging it (n=18, 12%), and synchronizing it to the app (n=16, 10.7%). The modalities of technical assistance were in person (n=53, 35.3%), by telephone (n=51, 34%), by email (n=25, 16.7%), and by postal mail (n=21, 14%). Conclusions In general, the results of this study show that after receiving orientation to PAMs, problems such as uncomfortable wristbands, difficulty using the PAM or its related app, and obtaining or interpreting relevant personal data were occasionally reported by participants in RS3. Trained staff helped participants troubleshoot and solve these technical problems primarily in person or by phone. Results also underscore the importance of involving older adults in the design, usability testing, and supportive material development processes to prevent technical problems for the initial and ongoing use of PAMs. Clinicians and researchers should further assess technical assistance needed by older adults, accounting for variations in PAM models and wear time, while investigating additional assistance strategies, such as proactive support, short GIF videos, and video calls.
Collapse
Affiliation(s)
- Elizabeth A Choma
- Department of Physical Therapy, Whitworth University, SpokaneWA, United States
| | - Shannon Hayes
- School of Nursing, University of Minnesota, MinneapolisMN, United States
| | - Beth A Lewis
- School of Kinesiology, University of Minnesota, MinneapolisMN, United States
| | - Alexander J Rothman
- Department of Psychology, University of Minnesota, MinneapolisMN, United States
| | - Jean F Wyman
- School of Nursing, University of Minnesota, MinneapolisMN, United States
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, MinneapolisMN, United States
| | - Siobhan K McMahon
- School of Nursing, University of Minnesota, MinneapolisMN, United States
| |
Collapse
|
3
|
Onyekwere AO, Okobi OE, Ifiora FC, Akinboro MK, Akueme NT, Iroro J, Dan-Eleberi AO, Onyeaka FC, Ghansah AA. Association Between Wearable Device Use and Levels of Physical Activity Among Older Adults in the US: Evidence From the 2019-2020 Health Information National Trends Survey. Cureus 2023; 15:e44289. [PMID: 37779789 PMCID: PMC10533366 DOI: 10.7759/cureus.44289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Objective To examine the relationship between electronic wearable device (WD) use and physical activity (PA) levels among older adults in the US. Methods Data were pooled from 3310 older adults from the 2019 and 2020 Health Information National Trends Survey. The explanatory variable was WD use, and the outcomes were weekly PA levels, resistance training, and sedentary time. Logistic regression was conducted to investigate the association between WD use and the reported outcome variables. Separate logistic models were also fitted to explore the relationship between WD use and physical activity outcomes among a subgroup of older adults with chronic conditions. Results A total of 14.4% of older adults reported WD use. Older adults who use WD were more likely to meet national guidelines for weekly levels of PA (odds ratio (OR) 1.60, 95% confidence intervals (CI) (1.10, 2.32); p = 0.015) and resistance strength training (OR 1.54, 95% CI (1.14, 2.09); p = 0.005) when compared with their counterparts not using WD. After restricting the analysis to those with chronic conditions only, WD use was only associated with a higher level of weekly strength training (OR 1.68, 95% CI 1.19, 2.38; p = 0.004). Conclusion WD use may be associated with increased physical activity among older adults, including those with chronic health conditions. Further studies are needed to examine the factors influencing the adoption and sustained use of WD in older adults.
Collapse
Affiliation(s)
| | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Francis C Ifiora
- Pharmacy, University of Texas Health Science Center at Houston, Houston, USA
| | - Micheal K Akinboro
- Epidemiology and Biostatistics, Texas A&M Health School of Public Health, College Station, USA
| | - Ngozi T Akueme
- Dermatology, University of Medical Sciences (UNIMED), Ondo, NGA
| | - Joy Iroro
- Internal Medicine, All Saints University School of Medicine, Roseau, DMA
| | | | - Faith C Onyeaka
- Haematology/Blood Transfusion Science, Madonna University, Calabar, NGA
| | | |
Collapse
|
4
|
Zytnick D, Folta SC, Reid KF, Chomitz VR. Better Understanding Wearable Activity Monitor Use and Non-Use Among Older Adults: A Qualitative Study. J Appl Gerontol 2023; 42:447-455. [PMID: 36314597 DOI: 10.1177/07334648221137057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
We used qualitative methods to better understand wearable activity monitor (WAM) use and its relationship with physical activity (PA) among older adults. Four focus groups, stratified by current/past ("ever") WAM users and "never" WAM users, were conducted with 57 participants aged ≥60 years. Data were coded with deductive and inductive approaches. Among ever WAM users, those with low pre-WAM PA levels reported higher PA related to WAM use while those with high pre-WAM PA levels reported they used WAM for tracking and monitoring their activity. Ever WAM users were motivated to increase PA through rewards and social support. Many never WAM users reported that WAM was unnecessary. WAM may be helpful for some older adults to increase their PA, particularly those who are motivated by setting and achieving PA goals. The results could help develop strategies to overcome barriers to WAM adoption and promote WAM use among older adults.
Collapse
Affiliation(s)
- Deena Zytnick
- Department of Public Health and Community Medicine, School of Medicine, 1810Tufts University, Boston, MA, USA
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, 1810Tufts University, Boston, MA, USA
| | - Kieran F Reid
- Laboratory of Exercise Physiology and Physical Performance, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Virginia R Chomitz
- Department of Public Health and Community Medicine, School of Medicine, 1810Tufts University, Boston, MA, USA
| |
Collapse
|
5
|
Smart MH, Nabulsi NA, Gerber BS, Gupta I, Di Eugenio B, Ziebart B, Sharp LK. A Remote Health Coaching, Text-Based Walking Program in Ethnic Minority Primary Care Patients With Overweight and Obesity: Feasibility and Acceptability Pilot Study. JMIR Form Res 2022; 6:e31989. [PMID: 35044308 PMCID: PMC8811699 DOI: 10.2196/31989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/08/2021] [Accepted: 11/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Over half of US adults have at least one chronic disease, including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended physical activity goals. Individuals who identify as racial and ethnic minorities are disproportionally affected by chronic diseases and physical inactivity. Interventions using consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain, such as minorities, have been poorly represented to date. Objective This study aims to assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed at increasing the number of steps in a predominantly overweight ethnic minority population. Methods Overweight patients (BMI >25 kg/m2) were recruited from an internal medicine clinic located in an inner-city academic medical center. Fitbit devices were provided. Using 2-way SMS text messaging, health coaches (HCs) guided patients to establish weekly step goals that were specific, measurable, attainable, realistic, and time-bound. SMS text messaging and Fitbit activities were managed using a custom-designed app. Program feasibility was assessed via the recruitment rate, retention rate (the proportion of eligible participants completing the 8-week program), and patient engagement (based on the number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed using a qualitative, summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared with week 8 using a paired t test (2-tailed) and modeling daily steps over time using a linear mixed model. Results Of the 33 patients initially screened; 30 (91%) patients were enrolled in the study. At baseline, the average BMI was 39.3 (SD 9.3) kg/m2, with 70% (23/33) of participants presenting as obese. A total of 30% (9/30) of participants self-rated their health as either fair or poor, and 73% (22/30) of participants set up ≥6 weekly goals across the 8-week program. In total, 93% (28/30) of participants completed a qualitative summative evaluation, and 10 themes emerged from the evaluation: patient motivation, convenient SMS text messaging experience, social support, supportive accountability, technology support, self-determined goals, achievable goals, feedback from Fitbit, challenges, and habit formation. There was no significant group change in the average weekly steps for week 1 compared with week 8 (mean difference 7.26, SD 6209.3; P=.99). However, 17% (5/30) of participants showed a significant increase in their daily steps. Conclusions Overall, the results demonstrate the feasibility and acceptability of a remotely delivered walking study that included an HC; SMS text messaging; a wearable device (Fitbit); and specific, measurable, attainable, realistic, and time-bound goals within an ethnic minority patient population. Results support further development and testing in larger samples to explore efficacy.
Collapse
Affiliation(s)
- Mary H Smart
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, United States
| | - Nadia A Nabulsi
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, United States
| | - Ben S Gerber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Itika Gupta
- Department of Computer Science, College of Engineering, University of Illinois Chicago, Chicago, IL, United States
| | - Barbara Di Eugenio
- Department of Computer Science, College of Engineering, University of Illinois Chicago, Chicago, IL, United States
| | - Brian Ziebart
- Department of Computer Science, College of Engineering, University of Illinois Chicago, Chicago, IL, United States
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, United States
| |
Collapse
|
6
|
Rha JY, Nam Y, Ahn SY, Kim J, Chang Y, Jang J, Kurita K, Park JY, Eom K, Moon H, Jung MH, Kim YJ, Hwang JE, Choo H. What drives the use of wearable healthcare devices? A cross-country comparison between the US and Korea. Digit Health 2022; 8:20552076221120319. [PMID: 36003315 PMCID: PMC9393678 DOI: 10.1177/20552076221120319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/29/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Given the rapid growth of the wearable healthcare device market, we examined
the associations among health-related and technology-related characteristics
of using wearable healthcare devices and demonstrated how the associations
differ between the US and Korean users. Methods Online self-administered surveys were conducted with 4098 participants (3035
in the US and 1063 in Korea) who were recruited through two online survey
service providers based on quota sampling. The primary outcome was the use
of wearable healthcare devices. Seven health-related, two
technology-related, and five socio-demographic factors were included as
explanatory variables. Binary logistic regression analyses and a Chow test
were conducted. Results The health-related characteristics that were significantly associated with
using wearable healthcare devices included disease-related worries
(β = 0.11**), health information seeking (β = 0.26***), physical activity
(β = 0.62***), and health-related expenditures ($50–$199, β = 0.38***; $200
or more, β = 0.56***). Hedonic (β = 0.33***), social (β = 0.31***), and
cognitive innovativeness (β = 0.14*) also exhibited positive relationships.
Younger, higher earner, and individuals with a child were more likely to use
wearable healthcare devices. However, for Korean users, several associations
disappeared including health information seeking, hedonic and social
innovativeness, age, and household income. Conclusions Key drivers of using wearable healthcare devices include greater concern
about a specific illness, active engagement in health-promoting behaviors,
and hedonic and social motivation to adopt new technologies. However, more
country-specific considerations are needed in future studies to identify the
main benefits for target markets.
Collapse
Affiliation(s)
- Jong-Youn Rha
- Department of Consumer Science, Seoul National University, Seoul, Gwanak-gu, Korea
- Research Institute of Human Ecology, Seoul National University, Seoul, Gwanak-gu, Korea
| | - Youngwon Nam
- Department of Consumer Science, Seoul National University, Seoul, Gwanak-gu, Korea
- Research Institute of Human Ecology, Seoul National University, Seoul, Gwanak-gu, Korea
| | - Sun Young Ahn
- School of Business and Leadership, University of Puget Sound, Tacoma, WA, USA
| | - Jihye Kim
- Research Institute of Human Ecology, Seoul National University, Seoul, Gwanak-gu, Korea
| | - Youchung Chang
- Department of Consumer Science, Seoul National University, Seoul, Gwanak-gu, Korea
| | - Jisu Jang
- Department of Consumer Science, Seoul National University, Seoul, Gwanak-gu, Korea
| | - Keiko Kurita
- Samsung Research America, Mountain View, CA, USA
| | - Jin-Young Park
- Advanced Sensor Lab, Device Research Center, SAIT, Samsung Electronics, Suwon-si, Gyeonggi, Korea
| | - Kunsun Eom
- Advanced Sensor Lab, Device Research Center, SAIT, Samsung Electronics, Suwon-si, Gyeonggi, Korea
| | - Hyunseok Moon
- Advanced Sensor Lab, Device Research Center, SAIT, Samsung Electronics, Suwon-si, Gyeonggi, Korea
| | - Myoung Hoon Jung
- Advanced Sensor Lab, Device Research Center, SAIT, Samsung Electronics, Suwon-si, Gyeonggi, Korea
| | - Yoon Jae Kim
- Advanced Sensor Lab, Device Research Center, SAIT, Samsung Electronics, Suwon-si, Gyeonggi, Korea
| | - Jeong-Eun Hwang
- Advanced Sensor Lab, Device Research Center, SAIT, Samsung Electronics, Suwon-si, Gyeonggi, Korea
| | - HyucK Choo
- Advanced Sensor Lab, Device Research Center, SAIT, Samsung Electronics, Suwon-si, Gyeonggi, Korea
| |
Collapse
|
7
|
McCarthy MM, Fletcher J, Heffron S, Szerencsy A, Mann D, Vorderstrasse A. Implementing the physical activity vital sign in an academic preventive cardiology clinic. Prev Med Rep 2021; 23:101435. [PMID: 34150483 PMCID: PMC8193127 DOI: 10.1016/j.pmedr.2021.101435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/27/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
The aims were to implement physical activity (PA) screening as part of the electronic kiosk check-in process in an adult preventive cardiology clinic and assess factors related to patients' self-reported PA. The 3-question physical activity vital sign (PAVS) was embedded in the Epic electronic medical record and included how many days, minutes and intensity (light, moderate, vigorous) of PA patients conducted on average. This is a data analysis of PAVS data over a 60-day period. We conducted multivariable logistic regression to identify factors associated with not meeting current PA recommendations. Over 60 days, a total of 1322 patients checked into the clinic using the kiosk and 72% (n = 951) completed the PAVS at the kiosk. The majority of those patients were male (58%) and White (71%) with a mean age of 64 ± 15 years. Of the 951 patients completing the PAVS, 10% reported no PA, 55% reported some PA, and 35% reported achieving at least 150 min moderate or 75 min vigorous PA/week. In the logistic model, females (AOR = 1.4, 95%CI: 1.002-1.8, p = .049) vs. males, being Black (AOR = 2.0, 95%CI: 1.04-3.7, p = .038) or 'Other' race (AOR = 1.5, 95%CI: 1.02-2.3, p = .035) vs. White, unknown or other types of relationships (AOR = 0.0.26, 95%CI: 0.10-0.68, p = .006) vs. being married/partnered, and those who were retired (AOR = 1.9, 95% CI: 1.4-2.8, p < .001) or unemployed (AOR = 2.2, 95%CI: 1.3-3.7, p = .002) vs. full-time workers were associated with not achieving recommended levels of PA. The PAVS is a feasible electronic tool for quickly assessing PA and may prompt providers to counsel on this CVD risk factor.
Collapse
Affiliation(s)
- Margaret M. McCarthy
- NYU Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, United States
| | - Jason Fletcher
- NYU Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, United States
| | - Sean Heffron
- NYU Langone Health, 550 First Avenue, New York, NY 10016, United States
| | - Adam Szerencsy
- NYU Langone Health, 550 First Avenue, New York, NY 10016, United States
| | - Devin Mann
- NYU Langone Health, 550 First Avenue, New York, NY 10016, United States
| | | |
Collapse
|