Direct and Indirect Causal Effects of an Individual Randomized Physical Activity-Promoting Intervention: A Substantive-Methodological Synergy

Physical activity (PA) promotion is an ideal intervention target for public health because it has the potential to help individuals feel better, sleep better, and perform daily tasks more easily, in addition to providing disease prevention benefits. There is strong evidence that individual-level theory-based behavioral interventions are effective for increasing PA in adult populations but causal inference for potential specific pathways by which (i.e., how) these interventions exert total effects (i.e., direct and indirect) often is unclearly articulated - though frequently attempted to be estimated. Thus, the three objectives of this tutorial were to demonstrate: (1) common cause confounding assumptions required for identification of direct and indirect causal effects; (2) how to estimate identified direct and indirect causal effects of an individual-level theory-based PA-promoting intervention; (3) how to perform sensitivity to violation of common cause confounding assumption(s) analyses. The demonstration was based on the Well-Being and Physical Activity study (ClinicalTrials.gov, identifier:NCT03194854).

Baseline self-efficacy predicts subsequent engagement behavior in an online physical activity intervention

Background

The purported benefits of online physical activity interventions, in terms of reduced costs, high reach, and easy access, may not be fully realized if participants do not engage with the programs. However, there is a lack of research on modifiable predictors (e.g., beliefs) of engagement with online physical activity interventions. The objective of this brief report was to investigate if self-efficacy to engage at baseline predicted subsequent engagement behavior in an online physical activity intervention at post-baseline.

Methods

Data (N = 331) from the 2018 Fun For Wellness effectiveness trial (ClinicalTrials.gov, identifier: NCT03194854) were analyzed in this brief report. Multiple logistic regression was fit in Mplus 8 using maximum-likelihood estimation.

Results

There was evidence that self-efficacy to engage beliefs at baseline positively predicted subsequent engagement behavior in the Fun For Wellness intervention at 30 days post-baseline.

Conclusions

Some recommendations to increase self-efficacy to engage in future online physical activity intervention studies were provided consistent with self-efficacy theory.

The "STAR WARS: The First Jedi" Program-Effects of Gamification on Psychological Well-Being of College Students

Background: College students are particularly susceptible to developing mental health problems. Gamification can be a powerful teaching strategy to favor motivation and behavioral changes for the improvement of psychological well-being. Purpose: To analyze the effect of a 14-week gamification-based physical education teaching program on psychological well-being of college students. Materials and Methods: A total of 112 college students (21.22 ± 2.55 years) were recruited and assigned to a gamification-based group or a control group. The intervention group participated in a gamification-based program under the framework of "STAR WARS" science fiction sage. Participants from this group used a mobile app with a countdown timer and the way for them to gain lifetime was by doing physical activity (PA) and formative challenges. The control group did not experience the gamification approach itself as their classes were based on traditional methodology. They were asked to maintain their usual lifestyle and were not required to do PA. Emotional intelligence, personal initiative, entrepreneurial attitude, resilience, and self-efficacy were self-reported. Results: The gamification-based group showed a significantly higher improvement of emotional intelligence (P ≤ 0.006), personal initiative (P ≤ 0.033), entrepreneurial attitude (P < 0.001), resilience (P = 0.002), and self-efficacy (P < 0.001), compared with the control group. Overall effect sizes were of medium magnitude for emotional intelligence and personal initiative, large magnitude for entrepreneurial attitude, and small magnitude for resilience and self-efficacy. Conclusion: Gamification and the use of mobile apps may become powerful teaching strategies to motivate college students toward healthier lifestyle behaviors that have psychological well-being benefits.

Physical activity self-efficacy online intervention for adults with obesity: protocol for a feasibility study

BACKGROUND

Even without weight loss, adults with obesity can greatly benefit from regular physical activity. The Physical Activity Self-efficacy (PAS) intervention is an online behavioral intervention newly developed to promote physical activity in adults with obesity by providing capability-enhancing learning opportunities. The objective of this manuscript is to describe the protocol for a feasibility study designed to investigate the feasibility and acceptability of implementing the PAS online intervention for adults with obesity recruited from a local weight management center in the United States of America (USA).

METHODS

The study design is a prospective, double-blind, parallel-group individual randomized pilot trial. Thirty participants will be randomly assigned to the PAS group or usual care group to achieve a 1:1 group assignment. Recruitment of participants is scheduled to begin on 1 March 2024 at a local weight management center within a private healthcare system in the USA. There are six eligibility criteria for participation in this study (e.g., a body mass index ≥ 25.00 kg/m2). Eligibility verification and data collection will be conducted online. Three waves of data collection will take up to 14 weeks depending on participants' progress in the study. The primary feasibility outcomes in the study will be: (a) participation rate, (b) engagement behavior, and (c) a preliminary effect size estimate for the effect of the PAS intervention on physical activity. Instruments designed to measure demographic information, anthropometric characteristics, self-efficacy, and acceptability will be included in the survey battery. A research-grade accelerometer will be used to measure free-living physical activity objectively. Data will be analyzed using descriptive statistics and inferential statistical models under an intention-to-treat approach.

DISCUSSION

Results are intended to inform the preparation of a future definitive randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05935111, registered 7 July 2023.

Using Directed Acyclic Graphs (DAGs) to Determine if the Total Causal Effect of an Individual Randomized Physical Activity-Promoting Intervention is Identifiable

Physical activity promotion is a best buy for public health because it has the potential to help individuals feel better, sleep better, and perform daily tasks more easily, in addition to providing disease prevention benefits. There is strong evidence that individual-level theory-based behavioral interventions are effective for increasing physical activity levels in adult populations but causal inference from these interventions often is unclearly articulated. A directed acyclic graph (DAG) can be, but rarely is, used to determine if the causal effect of an individual-level theory-based physical activity-promoting intervention is identifiable (e.g. stripped of any spurious association). The primary objective of the current study was to demonstrate how a DAG can be used to determine if the total causal effect of an individual randomized physical activity-promoting intervention is identifiable. The demonstration was based on the Well-Being and Physical Activity study (ClinicalTrials.gov, identifier: NCT03194854). Annotated files from DAGitty and Mplus are provided.

The Relationship between Gamified Physical Exercise and Mental Health in Adolescence: An Example of Open Innovation in Gamified Learning

Interest in gamified physical activity has been driven by its potential to benefit student mental health. Integrating gamified practices for mental health improvement represents a significant innovation within multidisciplinary approaches to enhancing mental well-being. This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was conducted using the Scopus and Web of Science (WOS) databases, primary sources for education-related studies. Thirteen papers were analyzed, yielding important insights into the relationship between gamified physical activity and mental health. The findings indicate that gamified physical activity positively influences adolescents' mental health and well-being. Additionally, there is a need for improved application and game design to enhance learning within school contexts. Tailoring exergames to fit specific disciplines and school-related characteristics can promote healthier mobile application usage and offer significant benefits for the mental health of young individuals. The difference between this study and previous ones is that it focuses on mobile applications for encouraging active living to improve quality of life and mental health.

Measurement of Physical Activity Self-Efficacy in Adults With Obesity: A Latent Variable Approach to Explore Dimensionality, Temporal Invariance, and External Validity

The objective of this study was to improve the measurement of physical activity self-efficacy (PASE) in adults with obesity. To accomplish this objective, a latent variable approach was used to explore dimensionality, temporal invariance, and external validity of responses to a newly developed battery of PASE scales. Data (Nbaseline = 461 and N30 days postbaseline = 427) from the Well-Being and Physical Activity Study (ClinicalTrials.gov, identifier: NCT03194854), which deployed the Fun For Wellness intervention, were analyzed. A two-dimensional factor structure explained responses to each PASE scale at baseline. There was strong evidence for at least partial temporal measurement invariance for this two-dimensional structure in each PASE scale. There was mixed evidence that the effectiveness of the Fun For Wellness intervention exerted a direct effect on latent PASE in adults with obesity at 30 days postbaseline (i.e., external validity) of this two-dimensional structure.