Take 2 steps and call me in the morning: Prescribing physical activity through primary care

Objectives: Physical activity guidelines for older adults target high-intensity activities (i.e. increasing exercise), with less attention on low-intensity activities (i.e. reducing/interrupting sedentary behaviours) to improve health. Mobile health (mHealth) holds promise for engaging patients in self-management of chronic diseases. The purpose of this research was to prescribe physical activity of various intensities (i.e. sedentary through exercise) in primary care paired with mHealth for self-management. Methods: 60 older adults (55-75yr) were randomly assigned to four groups: one control, and three receiving mHealth kits plus prescription for a specific intensity of physical activity (exercise, sedentary or both). Clinical measures (anthropometrics, blood pressure, aerobic fitness, glucose, lipid profile) were conducted in a primary care office. During the 12-week intervention, participants remotely submitted measures for physical activity, blood pressure, body weight, and blood glucose. Six-months post-intervention, aerobic fitness was measured and interviews were conducted. Results: Clinical and remotely submitted measures improved (p Conclusions: To our knowledge, this is the first report of sedentary behaviour prescription in primary care. Findings support the ongoing practice of measuring lifestyle-related risk factors (e.g. body weight status, blood pressure, cardiorespiratory fitness) in the primary care setting for chronic disease management and prevention. Novel results demonstrate clinical benefits of prescribing changes to sedentary behaviours among older men and women. Additionally, results support the physiological and behavioural benefits of pairing physical activity prescription with mHealth for self-monitoring among at-risk older adults

Health behaviour change considerations for weight loss and type 2 diabetes: nutrition, physical activity and sedentary behaviour

Good nutrition, regular physical activity and low levels of sedentary behaviour are important in the prevention, management and treatment of obesity and type 2 diabetes mellitus (T2DM). Self-management requires individuals to have the capability to enact, opportunity to enable and motivation to perform relevant health behaviours. These behaviours, and the bio-psycho-social drivers of them, should be considered when working in the area of T2DM. Copyright © 2020 John Wiley & Sons

Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults

abstract: Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors. Despite an explosion of mobile phone applications aimed at physical activity and other health behaviors, few have been based on theoretically derived constructs and empirical evidence. Eighty adults ages 45 years and older who were insufficiently physically active, engaged in prolonged daily sitting, and were new to smartphone technology, participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence. An “analytically” framed custom application focused on personalized goal setting, self-monitoring, and active problem solving around barriers to behavior change. A “socially” framed custom application focused on social comparisons, norms, and support. An “affectively” framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar, whose movements and behaviors reflected the physical activity and sedentary levels of the user. To explore the applications' initial efficacy in changing regular physical activity and leisure-time sitting, behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity questionnaire and the Australian sedentary behavior questionnaire. User acceptability of and satisfaction with the applications was explored via a post-intervention user survey. The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period. Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology. Preliminary data exploring sustained use of the applications across a longer time period yielded promising results. The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors.The article is published at http://journals.plos.org/plosone/article?id=10.1371/journal.pone.006261

Exploring osteoporosis sufferers knowledge on sedentary behaviour in the management of their disease

Objectives: 1) To develop an understanding of the thoughts and opinions of older women diagnosed with osteoporosis regarding sedentary behaviour and 2) Investigate strategies used to reduce sedentary behaviour for future intervention development. Methods: Eleven older women with osteoporosis (mean age=68.2y±6.6(SD)) participated in semi-structured interviews (March-May 2020). They were recruited from the Royal Osteoporosis Society (Scottish) support group networks and the Strathclyde Age-Friendly-Academy. Telephone interviews were recorded, transcribed verbatim and thematically analysed using Braun & Clarke (2006). Results: Three main themes emerged: ‘Older Women’s Knowledge’, ‘Motivators to reduce Sedentary Behaviour’ and ‘Older Adult’s and Technology’. Participants reported an increase/maintenance of physical activity levels after osteoporosis diagnosis, had a good understanding and awareness of sedentary behaviour and how it affects health holistically. Participants identified motivators to interrupt sedentary behaviour (e.g. family/friends) and facilitators of sedentary behaviour (e.g. Television). Technology appeared to be used widely among participants to track movement patterns (e.g. Fitbit) but access and usability were identified as potential barriers when using technology to reduce sedentary behaviour among older adults. Conclusion: Knowledge does not appear to be a factor that needs addressing in relation to sedentary behavior in older women diagnosed with osteoporosis. Identified motivators and barriers could increase awareness of sedentary behaviour among older adults

Mobile Health Interventions for Adult Obesity in the United States: Analysis of Effectiveness and Efficacy

The Unites States continues to struggle with the negative health effects associated with increasing population obesity, a problem which has been historically difficult, if not impossible, to solve. Mobile health applications represent a potential partial solution to this problem. We examine the existing literature on the effects of mobile health applications on body weight, waist circumference, BMI, and lifestyle, examining both physical findings as well as adherence, satisfaction and cost effectiveness. The use of mobile for weight reduction looks promising, but evidence is mixed, which is not surprising given the rapidly evolving nature of the mobile application field

Systematic review of context-aware digital behavior change interventions to improve health

Health risk behaviors are leading contributors to morbidity, premature mortality associated with chronic diseases, and escalating health costs. However, traditional interventions to change health behaviors often have modest effects, and limited applicability and scale. To better support health improvement goals across the care continuum, new approaches incorporating various smart technologies are being utilized to create more individualized digital behavior change interventions (DBCIs). The purpose of this study is to identify context-aware DBCIs that provide individualized interventions to improve health. A systematic review of published literature (2013-2020) was conducted from multiple databases and manual searches. All included DBCIs were context-aware, automated digital health technologies, whereby user input, activity, or location influenced the intervention. Included studies addressed explicit health behaviors and reported data of behavior change outcomes. Data extracted from studies included study design, type of intervention, including its functions and technologies used, behavior change techniques, and target health behavior and outcomes data. Thirty-three articles were included, comprising mobile health (mHealth) applications, Internet of Things wearables/sensors, and internet-based web applications. The most frequently adopted behavior change techniques were in the groupings of feedback and monitoring, shaping knowledge, associations, and goals and planning. Technologies used to apply these in a context-aware, automated fashion included analytic and artificial intelligence (e.g., machine learning and symbolic reasoning) methods requiring various degrees of access to data. Studies demonstrated improvements in physical activity, dietary behaviors, medication adherence, and sun protection practices. Context-aware DBCIs effectively supported behavior change to improve users' health behaviors

Feasibility of MyHealthAvatar mobile phone application for reducing prolonged sedentary behaviour in Type 2 diabetes

A thesis submitted to the University of Bedfordshire, in fulfilment of the requirements for the degree of Masters by Research.Objective: Time spent in a prolonged sedentary state can have detrimental health effects in people with Type 2 diabetes mellitus (T2DM). The aim of this study was to assess the feasibility of a mobile phone app, MyHealthAvatar, for reducing prolonged sedentary behaviour in people with T2DM. Methods: Twelve individuals with recently diagnosed T2DM were randomised to either an intervention or control group for 8 weeks. The intervention group utilised the app for 8 weeks and the control group continued their normal behaviour. Physical activity and sitting were measured at baseline and during the last intervention week. Health measures were taken at baseline and post-intervention. Semi-structured interviews were carried out post-intervention to gain participant feedback on the usability of the app. Results: The intervention group decreased total sedentary time by 50.52 minutes/day and increased number of breaks from sedentary time by 4.08 breaks per day, standing time by 41.76 minutes/day and light physical activity by 5.28 minutes/day from baseline to post-intervention compared to the control group. Conclusion: MyHealthAvatar has the potential to reduce prolonged sedentary behaviour in individuals with T2DM. The effectiveness of this app requires investigation in a fully powered randomised controlled trial

Investigating the use of mobile technology to promote active lifestyles and improved glycaemic control in individuals with type 2 diabetes

The purpose of this thesis was to examine the potential of using mobile technology to promote active lifestyles and improved glycaemic control in individuals with Type 2 diabetes. Chapter 1 introduced the research area, thesis rationale, and the design and structure of the thesis. Five studies were undertaken as part of this thesis. This first (Chapter 2) was a systematic and integrated literature review examining the effectiveness, acceptability and feasibility of using mobile technology to promote active living in adults with Type 2 Diabetes. The second (Chapter 3) presented the challenges and solutions of combining glucose and activity data sets measured continuously using mobile technology. The third (Chapter 4) examined the physical activity, sedentary behaviour and glucose patterns of adults with Type 2 diabetes in a free-living setting using mobile technology. The fourth (Chapter 5) examined the individual glycaemic response in adults with Type 2 Diabetes to interrupting prolonged sedentary behaviour in a controlled setting. Study five (Chapter 6) explored the experiences of, and attitudes towards, using mobile technologies to promote active living in adults with Type 2 diabetes. The final chapter (Chapter 7) discussed the findings of these studies in the wider context of the thesis and how the findings can be used to positively impact diabetes care and future research.The purpose of this thesis was to examine the potential of using mobile technology to promote active lifestyles and improved glycaemic control in individuals with Type 2 diabetes. Chapter 1 introduced the research area, thesis rationale, and the design and structure of the thesis. Five studies were undertaken as part of this thesis. This first (Chapter 2) was a systematic and integrated literature review examining the effectiveness, acceptability and feasibility of using mobile technology to promote active living in adults with Type 2 Diabetes. The second (Chapter 3) presented the challenges and solutions of combining glucose and activity data sets measured continuously using mobile technology. The third (Chapter 4) examined the physical activity, sedentary behaviour and glucose patterns of adults with Type 2 diabetes in a free-living setting using mobile technology. The fourth (Chapter 5) examined the individual glycaemic response in adults with Type 2 Diabetes to interrupting prolonged sedentary behaviour in a controlled setting. Study five (Chapter 6) explored the experiences of, and attitudes towards, using mobile technologies to promote active living in adults with Type 2 diabetes. The final chapter (Chapter 7) discussed the findings of these studies in the wider context of the thesis and how the findings can be used to positively impact diabetes care and future research