Effects of behavioral performance, intrinsic reward value, and context stability on the formation of a higher-order nutrition habit: an intensive longitudinal diary study

Background: Habits drive many of our health behaviors in our daily lives. However, little is known about the relative contribution of different key factors for habit formation in real-world contexts. We examined the effects of behavioral performance, intrinsic reward value (operationalized as tastiness), and context stability on the formation of a higher-order nutrition habit. Methods: Participants were recruited via mailing lists and posts on social media platforms. N = 199 participants (Mage = 37.10 years, SD = 13.00, 86.93% female) received an online intervention for building the higher-order habit of filling half of their plates with vegetables at dinner and completed one daily online survey for up to 56 days, including the assessment of habit strength, behavioral performance, intrinsic reward value, and context stability, providing a total of N = 6352 daily measurements. N = 189 participants (N = 4175 measurements) could be included in the primary analysis. Utilizing multilevel modeling, we analyzed the impact of behavioral performance, intrinsic reward value, and context stability, as well as their interaction effects, on habit strength on the next day. Results: Habit strength significantly increased over time. This effect was strengthened in persons with high mean levels of behavioral performance. Furthermore, mean levels of behavioral performance, intrinsic reward value, and context stability were all positively related to mean levels of habit strength. There were no positive effects of daily intraindividual variations in the three examined factors on habit strength at the next day. There was an unexpected negative effect of daily behavioral performance on habit strength at the next day. We found little to no evidence for our expected and pre-registered interaction effects. In an additional exploratory analysis, there were positive effects of daily intraindividual variations in the three factors on habit strength at the same day. Conclusions: We found that behavioral performance, intrinsic reward value, and context stability were all independent predictors of habit strength of a higher-order habit at the between-person level. However, we did not find the expected associations at the within-person level. Habit interventions should promote the consistent performance of the target behaviors in stable contexts

Comparison of a group-delivered and individually delivered lifestyle-integrated functional exercise (LiFE) program in older persons: a randomized noninferiority trial

Background: The Lifestyle-Integrated Functional Exercise (LiFE) program is effective in improving strength, balance, and physical activity (PA) while simultaneously reducing falls in older people by incorporating exercise activities in recurring daily tasks. However, implementing the original LiFE program includes substantial resource requirements. Therefore, as part of the LiFE-is-LiFE project, a group format (gLiFE) of the LiFE program has been developed, which will be tested regarding its noninferiority to the individually delivered LiFE in terms of PA-adjusted fall incidence and overall cost-effectiveness. Methods: In a multi-centre, single-blinded noninferiority trial, an envisaged sample of N = 300 participants (> 70 years; faller and/or confirmed falls risk; community-dwelling) will be randomized in either LiFE or gLiFE. Both groups will undergo the same strength and balance activities as well as PA promotion activities and habitualization strategies as described in the LiFE programme, however, based on different approaches of delivery: During the 6-month intervention phase, LiFE participants will receive seven home visits and two telephone calls; in gLiFE, the program will be delivered in seven group sessions and also two telephone calls. Main outcomes are a) fall incidence per PA and b) incremental cost-effectiveness ratio comparing costs and quality-adjusted life years between the two interventions. Secondary outcomes include PA behaviour, motor performance, health status, psychosocial status, program evaluation, and adherence. Measurements will be conducted at baseline, 6-month and 12-month follow-up; evaluation of intervention sessions and assessment of psychosocial variables related to execution and habitualization of LiFE activities will be made during the intervention period as well. Discussion: Compared to LiFE, we expect gLiFE to (a) reduce falls per PA by a similar rate; (b) be more cost-effective; (c) comparably enhance physical performance in terms of strength and balance as well as PA. By investigating the economic and societal benefit, this study will be of high practical relevance as noninferiority of gLiFE would facilitate large-scale implementation due to lower resource usage. This would result in better reach and increased accessibility, which is important for subjects with a history of falls and/or being at risk of falls. Trial registration ClinicalTrials.gov NCT03462654. Registered on March 12, 2018

The Group-Based Lifestyle-Integrated Functional Exercise Intervention for Older Adults: Theory- and Evidence Based Intervention Development and Evaluation From a Health Behavior Change Perspective

The promotion of healthy aging becomes increasingly important against the background of a growing aging population around the world. The aging process is associated with a loss of physical function and an increased prevalence of falls, which can be effectively prevented by multi-component physical activity such as balance and strength training. However, older adults rarely meet the recommended amount of physical activity or oftentimes withdraw shortly after engagement in interventions. The Lifestyle-integrated Functional Exercise (LiFE) intervention provides an innovative, habit-based approach to fall prevention and physical activity promotion in older adults by linking functional balance and strength activities to daily routines. This dissertation project is embed-ded in the LiFE-is-LiFE trial, a randomized non-inferiority trial with the aim to make LiFE suit-able for large-scale implementation by developing and testing a group-based LiFE (gLiFE) format. The aims of the presented work are to enrich the LiFE-is-LiFE project and differentiate it from the health behavior change perspective. gLiFE was developed and evaluated alongside the MRC guidelines for the development and evaluation of complex interventions with a focus on psychological determinants of behavior change. In the development process of gLiFE, empir-ically established health psychological theories such as the health action process approach (HAPA), the self-determination theory, and habit formation theory as well as the behavior change technique (BCT) taxonomy were applied. To better understand how gLiFE promotes physical activity and prevents falls, gLiFE was evaluated in comparison to LiFE with regard to multiple outcomes, such as effectiveness (e.g., activity-adjusted falls), the participants’ per-ceptions, and changes in psychological determinants of health behavior change (e.g., motiva-tional and volitional constructs or habit strength). Community-dwelling older adults aged 70 years and older at risk of falling were eligible for participation in the LiFE-is-LiFE trial. LiFE and gLiFE were both delivered in seven intervention sessions over the course of 11 weeks, followed by two booster phone calls. The baseline sample comprised N = 309 individuals who were 78.8 (range 70-94) years old on average, with the majority of participants being female (73.5%). Follow-up assessments took place 6 and 12 months after intervention start. This dissertation project includes six publications which are based on data from the LiFE-is-LiFE trial. The first publication was preparatory research to examine the relationship between theory-based psychological determinants derived from the HAPA and self-determination the-ory with older adults’ sensor-measured daily walking duration as a specific marker for physi-cal function. Findings indicate that intrinsic motivation, but not HAPA-based social-cognitive determinants were related to older adults’ walking duration. The second publication presented the conceptual gLiFE framework and its initial feasibility testing. My contribution was the modification and extension of the original conceptual LiFE model regarding behavior change theory. The development process resulted in a gLiFE train-er’s manual. The results of the initial feasibility testing suggest that gLiFE is feasible, accepted by the target group, and is associated with positive changes in psychological determinants of behavior change such as action and coping planning or habit strength. In the third publication, the evaluation of LiFE and gLiFE from the participants’ perspective was reported with a focus on acceptability. Results of qualitative analyses based on focus group interviews with a subsample of participants (n = 30) who completed the 6-month follow-up suggest that participants accept gLiFE and LiFE equally. Regarding behavior change, LiFE and gLiFE participants reported successful habit formation. The latter three publications were based on data from the full sample assessed at 6- and 12-month follow-up. In the fourth publication, the new gLiFE intervention underwent a non-inferiority testing regarding activity-adjusted falls, which revealed inconclusive results. Alt-hough gLiFE participants did not show a similar reduction of activity-adjusted falls as LiFE participants, they significantly increased their daily step count compared to LiFE participants. In the fifth publication, a quantitative evaluation of participants’ perspective on LiFE and gLiFE regarding general and more specific contents such as behavior change strategies like action planning was conducted using data from the 6- and 12-month follow-up. Overall, gLiFE par-ticipants rated the overall satisfaction, program-specific aspects, and perceived effectiveness as good and stable over time. Compared to the ratings of LiFE participants, only marginal differences arose, e.g., regarding the perceived helpfulness of planning. In the sixth and final publication, the changes in psychological determinants of behavior change (i.e., self-efficacy, outcome expectancies, risk perception, intention, action planning, coping planning, action control, habit strength, autonomy, competence, relatedness, and in-trinsic motivation) through LiFE and gLiFE were reported. Results showed that LiFE and gLiFE mainly induced long-term changes in volitional determinants such as action control. Both LiFE and gLiFE participants still showed above mid-scale levels of habit strength of the LiFE activities at 12-month follow-up. Taken together, the current work provides evidence for gLiFE to be a valuable theory-based fall prevention and physical activity promotion intervention for older adults aged 70 years and older. The discussion lays out similarities and differences between LiFE and gLiFE. My re-search suggests implications for research, referring to both the behavior change process and to the delivery of LiFE and gLiFE. Additionally, implications for gLiFE trainers and potential stakeholders are provided. The dissemination of gLiFE has already been initiated, paving the way for a larger number of older adults to be supported in aging healthily and actively

Factors affecting the gender difference in dream sharing frequency

Numerous studies have shown that women tend to share dreams more often than men. However, research looking at factors that might explain this gender difference is scarce. The present online study ( N = 1,808) clearly showed that gender differences in frequency of sharing emotional experiences and sex role orientation (femininity/expressivity) did affect the gender difference in dream sharing whereas dream-related variables such as dream recall frequency and attitude towards dreams did not. Many of the factors associated with dream sharing indicate that the socialization processes might have an effect on dream variables in adulthood. To pursue this line of research, it would be fruitful to study dream sharing within the family. </jats:p

Development of a conceptual framework for a group-based format of the Lifestyle-integrated Functional Exercise (gLiFE) programme and its initial feasibility testing

Background:The Lifestyle-integrated Functional Exercise (LiFE) programme is a fall prevention programme originally taught in a resource-intensive one-to-one format with limited feasibility for large-scale implementation. The aim of this paper is to present the conceptual framework and initial feasibility evaluation of a group-based LiFE (gLiFE) format developed for large-scale implementation.Methods:The conceptual gLiFE framework (part I) is based on three pillars, LiFE Activities and Principles, Theory of Behaviour Change and Behaviour Change Techniques, and Instruction. The feasibility of gLiFE was tested (part II) within a multimodal approach including quantitative questionnaires measuring safety, acceptability (1 = best to 7 = insufficient), and adherence to the LiFE activities (range = 0–14) as well as a focus group interview. Exploratory self-reported measures on behaviour change including self-determined motivation (range = 1–5), intention, planning, action control, and habit strength (range = 1–6) were assessed pre and post intervention. Data analyses were performed using descriptive statistics and qualitative content analysis.Results:The development process resulted in a manualised gLiFE concept containing standardised information on gLiFE’s content and structure. Feasibility testing: Six older adults (median = 72.8 years, 5 female) completed the feasibility study and rated safety (median = 7.0, IQR = 0.3) and acceptability as high (median = 1, IQR = 1). Participants implemented 9.5 LiFE activities (IQR = 4.0) into their daily routines. No adverse events occurred during the study. In the focus group, the group format and LiFE activities were perceived as positive and important for maintaining strength and balance capacity. Self-determined motivation intention, planning, and habit strength were rated higher post intervention.Conclusion:The developed conceptual gLiFE framework represents the basis for a gLiFE format with potential for standardised large-scale implementation. Proof-of-concept could be demonstrated in a group of community-dwelling older adults at risk of falling. The public health potential of gLiFE in terms of (cost-)effectiveness is currently being evaluated in a large trial.Trial registration:ClinicalTrials.gov NCT03412123. Registered on January 26, 2018publishe

Group-Based and Individually Delivered LiFE : Content Evaluation and Predictors of Training Response : A Dose-Response Analysis

Introduction: Lifestyle-integrated Functional Exercise (LiFE) is an effective, individually delivered fall prevention program but comes with substantial resource requirements; hence, a group-format was developed (gLiFE). This study 1) evaluates the program content of two different LiFE formats (group vs individual) and 2) examines the relationship between predictors of training response (dose) and improvements in balance, strength, and physical activity (PA) (response).Material and Methods: The analysis included n = 252 (gLiFE = 126, LiFE = 126) community-dwelling older adults (78.6± 5.2 years). LiFE was administered in seven sessions either in a group (gLiFE: 8– 12 participants) or individually at home (LiFE). Questionnaire-based, descriptive content evaluation (frequency distributions) included reported frequency of practice (days/week, number of activities), activity preferences, safety, intensity, integrability of activities, and acceptance after 6 months of LiFE practice. Predictors (ie, dose [reported frequency and intensity], safety, and integrability of activities) for improvements in balance, strength, and PA were analyzed using radar charts.Results: In both formats, 11.2 activities were practiced on average. Strength activities were more frequently selected than balance. Content evaluation showed some marginal advantages for the LiFE participants for selected aspects. The effects on balance, strength, and PA were nearly similar in both groups. Participants who performed balance activities more frequently (≥ 4 days/week) scored better in the balance and PA domain. Those who performed strength activities more frequently (≥ 4 days/week) performed better in all three outcomes. Higher perceived safety was associated with better performance. Those who reported activities as “not physically exhausting” performed better in all three outcomes. Those who found activities easily integrable into daily routines scored higher in the balance and strength domain.Discussion and Conclusion: Overall, both program formats are comparable with respect to content evaluation and effects. Participants need to perceive the activities as safe, not exhausting, and should practice ≥ 4 days/week to generate a high benefit from the intervention.Trial Registration: ClinicalTrials.gov, NCT03462654. Registered on 12 March 2018.publishe

Association between everyday walking activity, objective and perceived risk of falling in older adults

Background:older persons can be grouped according to their objective risk of falling (ORF) and perceived risk of falling (PRF) into ‘vigorous’ (low ORF/PRF), ‘anxious’ (low ORF/high PRF), ‘stoic’ (high ORF/low PRF) and ‘aware’ (high ORF/PRF). Sensor-assessed daily walking activity of these four groups has not been investigated, yet.Objective:we examined everyday walking activity in those four groups and its association with ORF and PRF.Design:cross-sectionalSetting:communitySubjects:N = 294 participants aged 70 years and older.Methods:ORF was determined based on multiple independent risk factors; PRF was determined based on the Short Falls Efficacy Scale-International. Subjects were allocated to the four groups accordingly. Linear regression was used to quantify the associations of these groups with the mean number of accelerometer-assessed steps per day over 1 week as the dependent variable. ‘Vigorous’ was used as the reference group.Results:average number of steps per day in the four groups were 6,339 (‘vigorous’), 5,781 (‘anxious’), 4,555 (‘stoic’) and 4,528 (‘aware’). Compared with the ‘vigorous’, ‘stoic’ (−1,482; confidence interval (CI): −2,473; −491) and ‘aware’ (−1,481; CI: −2,504; −458) participants took significantly less steps, but not the ‘anxious’ (−580 steps; CI: −1,440; 280).Conclusion:we have integrated a digital mobility outcome into a fall risk categorisation based on ORF and PRF. Steps per day in this sample of community-dwelling older persons were in accordance with their ORF rather than their PRF. Whether this grouping approach can be used for the specification of participants’ needs when taking part in programmes to prevent falls and simultaneously promote physical activity remains to be answered in intervention studies.publishe

Group or individual lifestyle-integrated functional exercise (LiFE)? : A qualitative analysis of acceptability

Background:The Lifestyle-integrated Functional Exercise (LiFE) program is an effective but resource-intensive fall prevention program delivered one-to-one in participants’ homes. A recently developed group-based LiFE (gLiFE) could enhance large-scale implementability and decrease resource intensity. The aim of this qualitative focus group study is to compare participants’ experiences regarding acceptability of gLiFE vs LiFE.Methods:Programs were delivered in seven group sessions (gLiFE) or seven individual home visits (LiFE) within a multi-center, randomized non-inferiority trial. Four structured focus group discussions (90–100 min duration; one per format and study site) on content, structure, and subjective effects of gLiFE and LiFE were conducted. Qualitative content analysis using the method of inductive category formation by Mayring was applied for data analysis. Coding was managed using NVivo.Results:In both formats, participants (N = 30, 22 women, ngLiFE = 15, nLiFE = 15, mean age 78.8 ± 6.6 years) were positive about content, structure, and support received by trainers. Participants reflected on advantages of both formats: the social aspects of learning the program in a peer group (gLiFE), and benefits of learning the program at home (LiFE). In gLiFE, some difficulties with the implementation of activities were reported. In both formats, the majority of participants reported positive outcomes and successful implementation of new movement habits.Conclusion:This is the first study to examine participants’ views on and experiences with gLiFE and LiFE, revealing strengths and limitations of both formats that can be used for program refinement. Both formats were highly acceptable to participants, suggesting that gLiFE may have similar potential to be adopted by adults aged 70 years and older compared to LiFE.publishe

The Lifestyle-integrated Functional Exercise (LiFE) program and its modifications : a narrative review

Lifestyle-integrated exercise is a promising approach to increase adherence levels of older adults compared to structured exercise programs as it saves time and effort and supports older adults in preventing falls and functional decline. The Lifestyle-integrated Functional Exercise (LiFE) program embodies this approach by integrating physical activity, balance, and strength activities into daily tasks of community-dwelling older adults aged 70+. A randomized controlled trial shows strong effectiveness of the original, resource-intensive one-on-one format of the LiFE program in terms of reducing falls, improving motor performance, and increasing physical activity. The positive effects of the original LiFE program have yet stimulated adaptions to group-based and information and communications technology-based formats, to younger seniors, for multicomponent interventions, and to populations with disabilities which resulted in 16 known studies about LiFE modifications. Evidence for the effectiveness of specific LiFE modifications exists for four programs, while seven adaptions are in the feasibility stage and one is still in the early development phase. A decade of existing LiFE research is summarized in this narrative review that, to the best of our knowledge, does not exist until now. The aim of this article is (1) to provide an overview of the number of LiFE modifications and their specifications, (2) to describe the current evidence regarding feasibility and effectiveness, and (3) to present challenges and potential of the different LiFE modifications. All adaptions of the LiFE program embody the benefits of the lifestyle-integrated approach and enable an enhancement of the successful LiFE concept.publishe