Wearable fitness trackers in physical activity research: accuracy assessment and effects on motivation and engagement

2021 Spring.Includes bibliographical references.To view the abstract, please see the full text of the document

Motivational Profiles and Associations With Physical Activity Before, During, and After the COVID-19 Pandemic: Retrospective Study

BackgroundIn March 2020, the World Health Organization declared the worldwide COVID-19 outbreak a pandemic, triggering many countries, including Canada, to issue stay-at-home orders to their citizens. Research indicates that these stay-at-home orders are associated with a decline in physical activity (PA), a behavior that can reduce disease risk and improve the quality of life. Many behavioral change theories, such as the self-determination theory (SDT) of motivation, state that PA engagement is mediated by psychological constructs, such as motivation. According to the SDT, motivation exists on a continuum from more controlled (external or coerced) to more autonomous (volitional) regulatory forms. Individuals move along the continuum from more controlled to more autonomous forms through the fulfillment of 3 psychological needs: autonomy, competence, and relatedness. Research indicates that moderate-to-vigorous physical activity (MVPA) is positively associated with the autonomous regulatory form of motivation. Recently, researchers have speculated that a better method to describe motivation than movement along the continuum is to generate motivational profiles, which represent combinations of differing levels of controlled and autonomous regulation existing simultaneously. ObjectiveWe aimed to identify distinct motivational profiles and determine their association with MVPA before, during, and after the COVID-19 pandemic. MethodsUsing a cross-sectional, retrospective design, we surveyed 977 Canadian adults. We assessed motivation for PA using the Behavioral Regulations in Exercise Questionnaire-3 (BREQ-3). We assessed PA pre–, during, and post–COVID-19 stay-at-home orders in Canada using the International Physical Activity Questionnaire (IPAQ). We derived motivational profiles using latent profile analysis (LPA). Using motivational profiles as an independent variable, we assessed their effect on PA at all 3 time points with multilevel models that included the participant ID as a random variable. ResultsWe identified 4 profiles: high controlled and high autonomous (HCHA), low overall motivation (LOM), high autonomous and introjected (HAI), and high amotivation and external (HAE). The HCHA profile had the highest levels of weekly MVPA minutes at all 3 time points, followed by the HAI profile. ConclusionsOur results suggest that a combination of both autonomous and controlled regulatory forms may be more effective in influencing MVPA than the controlled or autonomous forms alone, particularly during times of high stress, such as a worldwide pandemic. Although the odds of another global pandemic are low, these results may also be applied to other times of stress, such as job transitions, relationship changes (eg, change in marital status), or the death of a loved one. We suggest that clinicians and practitioners consider developing PA interventions that seek to increase both controlled and autonomous regulatory forms instead of aiming to reduce controlled forms

Type 2 Diabetes Management Intervention Using a blended in-person and Mobile Application: A Feasibility Study

Background: The prevalence and incidence of T2DM have been disproportionately high among South Asians. Gini Health recently developed a 12-week T2DM management program (Gin Health 360 Approach) that uses a combination of tailored in-person lifestyle coaching and mobile health self-monitoring and check-ins. Currently, the feasibility of delivering such program in India remains unclear. Objectives: To evaluate the feasibility and preliminary efficacy of the 12-week program in changing blood glucose (HBA1c), low-density lipoproteins (LDL), blood pressure (BP), body weight, body mass index (BMI), and waist circumference. Methods: This study used a single-arm pre-post design. The Gini Health care team delivered the 12-week intervention in India and collected intervention outcome. The intervention is a comprehensive lifestyle program focusing on a healthy diet and regular physical activity (e.g., emphasis on 10,000 steps per day). The program is free for participants to join during the evaluation period. Participants were aged 21 to 70 years living in India, with a diagnosis of T2DM. Anonymous data were provided to researchers for secondary analysis. Paired t-tests were used to evaluate changes in study outcomes. Results: Fifty participants were recruited. The mean age of participants was 53.45 (SD 12.38) years old. HbA1c, LDL, SBP, DBP, BMI, and waist circumference were all significantly lower following the intervention relative to baseline (p<.05). Conclusion: This study showed preliminary evidence that Gini Health 360 Approach may improve HbA1c, LDL, SBP, DBP, BMI, and waist circumference for T2DM patients after 12 weeks. This intervention offered a blended in-person and mhealth intervention delivery approach to manage T2DM. This kind of delivery model has the potential to be scaled across South Asian communities

Type 2 Diabetes Management Intervention Using a blended in-person and Mobile Application: A Feasibility Study

ABSTRACT Background: The prevalence and incidence of T2DM have been disproportionately high among South Asians. Gini Health recently developed a 12-week T2DM management program that uses a combination of tailored in-person and mobile health interventions delivery. Currently, the feasibility of this 12-week intervention remains unclear. Objectives: To evaluate the feasibility and preliminary efficacy of the 12-week program in changing blood glucose (HBA1c), low-density lipoproteins (LDL), blood pressure (BP), body weight, body mass index (BMI), and waist circumference. Methods: This study used a single-arm pre-post design. The Gini Health care team delivered the 12-week intervention in India and collected intervention outcome. The intervention is a comprehensive lifestyle program focusing on dietary and physical activity (e.g., emphasis on 10,000 steps per day). The program is free for participants to join during the evaluation period. Participants were aged 21 to 70 years living in India, with a diagnosis of T2DM. Anonymous data were provided to researchers for secondary analysis. Paired t-tests were used to evaluate changes in study outcomes. Results: Fifty participants were recruited for the study. The mean age of participants was 53.45 (SD 12.38) years old. HbA1c, LDL, SBP, DBP, BMI, and waist circumference were all significantly lower following the intervention relative to baseline (p<.05). Conclusion: This study showed preliminary evidence that the program developed by Gini Health could improve health-related outcomes for T2DM management after 12 weeks. This intervention offered a blended in-person and mhealth intervention delivery approach to manage T2DM. This kind of delivery model has the potential to be scaled across South Asian communities

Evaluating the Effectiveness of a Family-Based Virtual Childhood Obesity Management Program Delivered During the COVID-19 Pandemic in Canada: Prospective Study

BackgroundGeneration Health (GH) is a 10-week family-based lifestyle program designed to promote a healthy lifestyle for families with children who are off the healthy weight trajectory in British Columbia, Canada. GH uses a blended delivery format that involves 10 weekly in-person sessions, and self-guided lessons and activities on a web portal. The blended program was adapted to be delivered virtually due to the COVID-19 pandemic. Currently, the effectiveness of the virtual GH program compared with that of the blended GH program remains unclear. ObjectiveWe aimed to (1) compare the effectiveness of the virtual GH program delivered during the COVID-19 pandemic with that of the blended GH program delivered prior to the pandemic for changing child physical activity, sedentary and dietary behaviors, screen time, and parental support–related behaviors for child physical activity and healthy eating, and (2) explore virtual GH program engagement and satisfaction. MethodsThis study used a single-arm pre-post design. The blended GH program (n=102) was delivered from January 2019 to February 2020, and the virtual GH program (n=90) was delivered during the COVID-19 pandemic from April 2020 to March 2021. Families with children aged 8-12 years and considered overweight or obese (BMI ≥85th percentile according to age and sex) were recruited. Participants completed preintervention and postintervention questionnaires to assess the children’s physical activity, dietary and sedentary behaviors, and screen time, and the parent’s support behaviors. Intervention feedback was obtained by interviews. Repeated measures ANOVA was used to evaluate the difference between the virtual and blended GH programs over time. Qualitative interviews were analyzed using thematic analyses. ResultsBoth the virtual and blended GH programs improved children’s moderate-to-vigorous physical activity (F1,380=18.37; P<.001; ηp2=0.07) and reduced screen time (F1,380=9.17; P=.003; ηp2=0.06). However, vegetable intake was significantly greater in the virtual GH group than in the blended GH group at the 10-week follow-up (F1,380=15.19; P<.001; ηp2=0.004). Parents in both groups showed significant improvements in support behaviors for children’s physical activity (F1,380=5.55; P=.02; ηp2=0.002) and healthy eating (F1,380=3.91; P<.001; ηp2=0.01), as well as self-regulation of parental support for children’s physical activity (F1,380=49.20; P<.001; ηp2=0.16) and healthy eating (F1,380=91.13; P<.001; ηp2=0.28). Families in both groups were satisfied with program delivery. There were no significant differences in attendance for the weekly in-person or group video chat sessions; however, portal usage was significantly greater in the virtual GH group (mean 50, SD 55.82 minutes) than in the blended GH group (mean 17, SD 15.3 minutes; P<.001). ConclusionsThe study findings suggested that the virtual GH program was as effective as the blended program for improving child lifestyle behaviors and parental support–related behaviors. The virtual program has the potential to improve the flexibility and scalability of family-based childhood obesity management interventions

Motivational Profile as a Predictor for Physical Activity Among U.S. Adults During the Early Months of the COVID-19 Pandemic: A Daily Diary Study

Objective: This study used a daily diary approach to examine associations between day-level physical activity (PA) behavior, PA-specific motivational profile, and days since the COVID-19 national emergency declaration during the early months (April-June 2020) of the pandemic. Method: A total of 475 U.S. adults (Mage=34.9 years, 78% female) participated in a 28-day smartphone-based daily diary study assessing PA. A baseline survey assessed PA and motivation for PA using the Behavioral Regulation for Exercise Questionnaire. Multi-level linear regression models examined the main effects and interactions of motivational profile and time (days since the March 13, 2020 COVID-19 national emergency declaration) on daily PA minutes. Results: Latent Profile Analysis identified four distinct motivational profile classes for PA among this sample: Class 1) high amotivation (n=102, 21%); Class 2) low controlled motivation (n=55, 12%); Class 3) high external regulation (n=47, 10%); and Class 4) moderate autonomous motivation (n=271, 57%). After controlling for baseline PA, there were significant interactions between class and time on daily PA (-0.16, p&lt;.01). Class 2 showed greater decreases in daily PA minutes over time than Classes 1 and 3 (b=-0.28, p&lt;.01 and b=-0.17, p=.02, respectively). Conclusions: Contrary to previous research, individuals with lower controlled or moderate autonomous motivation demonstrated the largest decreases in PA over time, whereas individuals with higher amotivation or external regulation demonstrated smaller decreases over time. These findings suggest that external motivation may have provided short-term protection against declines in PA observed during early months of the COVID-19 pandemic

Heart rate validity for the Fitbit Charge and Apple Watch

Background: This study assessed the validity of heart rate (HR) and energy expenditure (EE) measurements for the Fitbit Charge and Apple Watch. Methods: Thirty young adults (15 females, 15 males, age 23.5±3.0) completed the Bruce Protocol. HR measurements were recorded from the electrocardiogram (ECG) and each device every minute. EE measurements were recorded from the devices at the conclusion of exercise and calculated from the PARVO data. Results: For heart rate, the Apple Watch showed lower RER (2.4%-5.1%) compared with the Fitbit (3.9%-13.5%) for all exercise intensities. For both devices, the strongest relationship with ECG-measured HR was found for very light PA with very high CCC (rc>.90). The strength of the relationship declined with increases in exercise intensity for Apple Watch and Fitbit. For energy expenditure, the Apple Watch relative error was 24.25% for overall, 18.58% for males, and 29.93% for females. For the Fitbit, the relative error was 20.07% for overall, 24.17% for males, and 16.72% for females. Conclusions: Both the Fitbit Charge and the Apple Watch are inaccurate when measuring heart rate and energy expenditure. These results indicate a need for the consumer to use them with caution

#4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial

BackgroundMany emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas. ObjectiveThis pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah. MethodsWe will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics’ research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants’ engagement with the social media campaign. ResultsThe trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management. ConclusionsSocial media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors. Trial RegistrationClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158 International Registered Report Identifier (IRRID)PRR1-10.2196/5039