Which behaviour change techniques are most effective at increasing older adults' self-efficacy and physical activity behaviour? A systematic review.

Self-efficacy is an important determinant of physical activity but it is unclear how best to increase self-efficacy for physical activity and to maintain these changes. This systematic review aimed to identify which specific behavior change techniques (BCTs), BCT clusters, and number of BCTs were associated with changes in postintervention and maintained changes in self-efficacy for physical activity across all adult populations. A systematic search yielded 180 randomized trials (204 comparisons) which reported changes in self-efficacy. BCTs were coded using the BCT Taxonomy v1. Hierarchical cluster analysis explored the clustering of BCTs. Meta-analyses and moderator analyses examined whether the presence and absence of individual BCTs in interventions were associated with effect-size changes for self-efficacy. Small intervention effects were found for postintervention self-efficacy for physical activity (d = 0.26; 95% CI: [0.21, 0.31]; I2 = 75.8 per cent). "Information about social, environmental, and emotional consequences" was associated with higher effect sizes, whereas "social support (practical)" was associated with lower effect sizes. Small and nonsignificant effects were found for maintained changes in self-efficacy for physical activity (d = 0.08; CI: [-0.05, 0.21]; I2 = 83.8 per cent). Lack of meaningful clustering of BCTs was found. A significant positive relationship was found between number of BCTs and effect sizes for maintained changes in self-efficacy for physical activity. There does not appear to be a single effective approach to change self-efficacy for physical activity in all adults: different approaches are required for different populations. Interventions with more BCTs seem more effective at maintaining changes in self-efficacy for physical activity.

BackgroundGiven disparities in diabetes prevalence, receipt of diabetes education, diabetes knowledge, and self-management behaviors among Latinos, there is a need to provide education and ongoing support to this population. Phone-based interventions have the potential to reach and engage both patients and their family members and friends.ObjectiveThe aim of this study was to investigate the feasibility, perceived usefulness, and potential effectiveness of a short text or voice message (STVM) intervention to activate (1) physical activity (PA) behavior change among urban, low-income Latino adults with type 2 diabetes and (2) supportive behaviors by their family members and friends.MethodsA 12-week pilot study randomized 42 participants recruited in person from a safety-net ambulatory care clinic in Los Angeles into one of the 3 study arms: control, phone messaging (PM), and phone messaging plus social support from family members and friends (PM+FF). All participants were prompted to set PA goals and to self-monitor PA behavior using pedometers and walking logs. PM and PM+FF participants received STVMs with reminders to review goals and self-monitor, PA behavior change education, and feedback on performance. Participants in the PM+FF arm also had their family members and friends receiving STVMs with suggestions for how they could support the participant’s PA behavior change efforts. Participants completed semistructured assessments in person at baseline, 6 weeks, and 12 weeks. Outcomes were PA (steps/day) and perceived social support from family members and friends.ResultsAmong PM and PM+FF participants, those who opted to receive text messages (short message service, SMS) responded to 62.7% (128/204) of SMS text messages requiring a response while those who opted to receive voice messages responded 30% (12/40) of the time. Participants perceived guidance in self-regulation as useful, particularly self-monitoring, goal setting, self-instruction, feedback, and social support. All participants increased PA at 6 weeks, but only the PM and PM+FF arms increased PA at 12 weeks. All study arms experienced an increase in perceived social support from family members and friends at 6 weeks, but only those in the PM+FF arm had an increase in the perception of social support at 12 weeks.ConclusionDesigning an STVM intervention based on self-regulation techniques is feasible and perceived as useful by participants. The STVM intervention has the potential to improve PA in terms of daily steps and perceived social support from family members and friends.Trial RegistrationClinicaltrials.gov NCT02850770; https://clinicaltrials.gov/ct2/show/NCT02850770 (Archived by WebCite at http://www.webcitation.org/query?id=1495567756845570)

Improved confidence in performing nutrition and physical activity behaviours mediates behavioural change in young adults: Mediation results of a randomised controlled mHealth intervention

Persons with multiple sclerosis (MS) are often physically inactive and sedentary. This observation has prompted the search for modifiable variables derived from established theories that act as correlates of physical activity. Such variables would presumably represent targets for interventions designed to promote change in physical activity behavior among persons with MS. The current study examined social cognitive variables as correlates of physical activity in persons with MS. Persons (N = 218) with relapsing-remitting MS completed a questionnaire battery that assessed physical activity behavior; self-efficacy for physical activity; physical, social, and self-evaluative outcome expectations for exercise, functional limitations as an impediment for physical activity, and exercise goal-setting. The battery was delivered and returned through the US postal service. Data were analyzed using covariance modeling in Mplus 3.0. Self-efficacy had indirect effects on physical activity via impediments (path coefficient = .10, P < .005), self-evaluative outcome expectations (path coefficient = .07, P < .025), and goal-setting (path coefficient = .09, P < .01). The model explained 40% of variance in self-reported physical activity. This cross-sectional study suggests that self-efficacy is indirectly associated with physical activity by way of goals, self-evaluative outcome expectations, and impediments in persons with relapsing-remitting MS.

ABSTRACTMotivation is a proximal determinant of behaviour, and increasing motivation is central to most health behaviour change interventions. This systematic review and meta-analysis sought to identify features of physical activity interventions associated with favourable changes in three prominent motivational constructs: intention, stage of change and autonomous motivation. A systematic literature search identified 89 intervention studies (k = 200; N = 19,212) which assessed changes in these motivational constructs for physical activity. Intervention descriptions were coded for potential moderators, including behaviour change techniques (BCTs), modes of delivery and theory use. Random effects comparative subgroup analyses identified 18 BCTs and 10 modes of delivery independently associated with changes in at least one motivational outcome (effect sizes ranged from d = 0.12 to d = 0.74). Interventions delivered face-to-face or in gym settings, or which included the BCTs ‘behavioural goal setting’, ‘self-monitoring (behaviour)’ or ‘behavioural practice/rehearsal’, or which combined self-monitoring (behaviour) with any other BCT derived from control theory, were all associated with beneficial changes in multiple motivational constructs (effect sizes ranged from d = 0.12 to d = 0.46). Meta-regression analyses indicated that increases in intention and stage of change, but not autonomous motivation, were significantly related to increases in physical activity. The intervention characteristics associated with changes in motivation seemed to form clusters related to behavioural experience and self-regulation, which have previously been linked to changes in physical activity behaviour. These BCTs and modes of delivery merit further systematic study, and can be used as a foundation for improving interventions targeting increases in motivation for physical activity.

Review Question/Objective The primary objective of this review is to identify the effectiveness of web-based interventions on weight loss and maintenance. The second objective is to identify the effectiveness of web-based interventions on behaviours associated with weight loss (eating and physical activity). The third objective is to identify what components of web-based interventions are associated with greater weight loss and maintenance, as well as lower attrition rates. Criteria for Inclusion Types of participants The quantitative component of this review will consider studies that include overweight and/or obese adults, aged greater than 18 years. Overweight and obesity will be defined as a body mass index (BMI) greater than or equal to 25(kg/m2). Types of intervention(s) The quantitative component of the review will consider studies that evaluate web-based interventions with the primary aim of achieving weight loss or weight maintenance following weight loss. This includes studies with the aim of achieving positive dietary and physical activity behaviour change for participants that include overweight/obesity outcome measures. However, if the stated aim is to achieve positive dietary and physical activity behaviour change for participants, and they do not include overweight/obesity outcome measures they will be excluded. At least one arm of the study must include a web-based intervention. A web-based intervention will be based around a website that participants receive information from and directly interface with. They are not required to input information into the website for the intervention to be included. Types of outcomes This review will consider studies that include the following outcome measures: Primary Outcome: Overweight/obesity related outcomes: weight (kg), % body weight lost, BMI, waist measurements, % body fat, % lost 5% of body weight. Secondary Outcomes: Dietary behaviours: energy intake, core food group intake (e.g. number of serves of fruit per day), macronutrient composition of diet (e.g. fat intake per day) Physical activity behaviours: energy expenditure, time spent in activity, steps per day. Effect modifiers/confounders: Compliance/engagement with website: website logins, completion of self-monitoring diaries, attendance at meetings/group discussions, retention etc Adjuncts to web-based intervention (e.g. contact with professional/face to face contact, other eHealth technology such as SMS, email, CD-Rom, Personal Digital Assistant (PDA) and use of rewards/prizes) Intervention based on theoretical models Intensity of web-based intervention: type and number of features included (e.g. self-monitoring diary, chat room, discussion board)

BackgroundRecent EULAR guidelines for the management of fibromyalgia syndrome (FMS) strongly recommend aerobic and strengthening exercise programmes, which demonstrate positive effects on symptoms and physical function.1 Despite these benefits, physical...

Physical activity (PA) and exercise programmes are recommended for the management of fibromyalgia. Despite positive effects on symptoms and function, PA promotion remains a significant clinical challenge. Behaviour change theories and techniques are recommended as part of complex health interventions; their integration into interventions aimed at PA behaviour in people with fibromyalgia is not known. This review explored behaviour change interventions targeting PA in adults with fibromyalgia. A systematic review was conducted; randomized and quasi-randomized controlled trials with at least one behaviour change intervention targeting PA were included. MEDLINE/OVID, EMBASE, PEDro, PsychINFO, CINAHL, Scopus, Web of Science, the Cochrane Central Register of Controlled Trials and relevant conference abstracts were searched. Two authors independently screened studies for inclusion and performed risk of bias assessments. Articles were reviewed for their use of behaviour change theory and behaviour change techniques (BCTs). The search identified 2491 records, from which eight studies (1416 participants) were included. PA and exercise behaviours were the primary focus of four interventions and were components of broader interventions in four studies. Behaviour change theories informed four interventions. Thirty-two different BCTs were used across studies. Five studies reported improvements in PA either post-intervention or at follow-up. Two studies used objective PA measures and seven studies used self-report measures. Short-term benefits in pain, quality of life, and physical fitness were also observed. Behaviour change interventions targeting PA in people with fibromyalgia have had limited success to date. With significant variations in intervention designs, the optimal intervention remains unknown.

Simple SummarySelf-efficacy has been identified as a crucial variable to reduce sedentarism in women with fibromyalgia. The present study aimed to evaluate the role of self-efficacy, the impact of fibromyalgia, and activity patterns on the objective physical activity levels. One hundred and twenty-three women with fibromyalgia participated in this cross-sectional study. Physical activity levels were assessed with accelerometers, while self-efficacy, activity patterns, and fibromyalgia impact were evaluated through questionnaires. Results revealed that self-efficacy for physical activity was directly related to light, moderate, and vigorous physical activity, as well as inversely related to sedentary time. Self-efficacy for walking and light physical activity seems to be more relevant than self-efficacy for moderate and vigorous physical activity to achieve higher levels of physical activity.Keeping high levels of physical activity is a challenge among chronic patients. In this regard, self-efficacy has been identified as a crucial variable to reduce sedentarism and physical inactivity in women with fibromyalgia. The current study aimed to evaluate the associations among objective physical activity levels, self-efficacy, activity patterns, and the impact of the disease, as well as to compare those variables between women with fibromyalgia with different self-efficacy levels. For this purpose, in this cross-sectional study, the physical activity levels of 123 women with fibromyalgia were assessed by accelerometers, together with self-efficacy, the impact of the disease, and activity patterns. Results revealed that self-efficacy for light or moderate physical activity was directly related to light (p < 0.01), moderate (p < 0.01), and vigorous physical activity (p < 0.05), as well as inversely related to sedentary time (p < 0.01). Moreover, the main differences were observed between those with low self-efficacy levels and the rest of the sample, while there were no differences between the high and the medium self-efficacy groups (p > 0.05). Thus, self-efficacy for walking and light physical activity seems to be more relevant than self-efficacy for moderate and vigorous physical activity to achieve higher levels of physical activity.

Public health strategies attempt to stimulate participation in physical activity, aiming at permanent behavior change. We assessed the sustained effect of participating in an exercise program on physical activity behavior 1 yr after completion of the program. Furthermore, we aimed to identify factors that predict sustained exercise participation. Previously low-active, postmenopausal women originally participating in an exercise intervention study (the Sex Hormones and Physical Exercise study) were recontacted 1 yr after finishing the study. Their current level of physical activity was assessed by the Modified Baecke Questionnaire. MET-hours per week spent on at least moderate-intensity activities were calculated and used to assess compliance to the international physical activity recommendation. Multivariable linear regression analysis was applied to investigate which factors predict a higher level of physical activity in the intervention group 1 yr after the study. Participation in the Sex Hormones and Physical Exercise study resulted in an increased level of physical activity in both the intervention (median at baseline and at 12 months = 4.9 and 19.8 MET x h x wk(-1), respectively) and the control groups (median at baseline and at 12 months = 4.3 and 5.8 MET x h x wk(-1), respectively). Although the intervention group did not maintain the high physical activity level achieved during the study, 1 yr later they remained more active than the control group (median = 12.1 and 7.9 MET x h x wk(-1), respectively, P = 0.04). Age, baseline activity, and employment were the strongest predictors of the physical activity level in the intervention group 1 yr after finishing the study. Sustained changes in physical activity behavior in previously low-active postmenopausal women are feasible after participation in a 1-yr exercise program.

The aim of this study was to explore the potential of free comprehensive primary preventive examination (CPPE) combined with cardiorespiratory fitness (CRF) test in terms of its attractiveness for general population and moreover to evaluate the induced behavioural changes. The main focus was on physical activity behaviour (PA). In 2009-2013, 250 people (100 men, 150 women) aged 18-65 years were examined. CPPE included assessment of health status and lifestyle, CRF test and individualized counselling. Expectations, reasons and motivations for participating were recorded. The sample was evaluated in terms of age, gender, lifestyle, body mass index, body fat percentage, CRF, and health characteristics. Evaluation according to subjective benefits, perceived effects on health and lifestyle was performed after six months using electronic feedback questionnaires (FQ). Comparison was made within groups formed according to the reported increase in PA. People aged 18-39 years accounted for 72.8% of the sample; mean age 34.4±11.0 years; 40.0% were men. Behavioural and health risks were lower in comparison with the general Czech population, but at least 1 of 5 assessed risk factors was present in 88.8% (low fruit and vegetable consumption 74.8%, low physical activity level (PAL) 45.6%, smoking 19.6%, risky alcohol use 18.8%, and stress load 10.4%). The most represented category of CRF was "endurance-trained" (both genders). CPPE was perceived as a source of information concerning health, CRF and lifestyle. 40.0% of men and 30.7% of women were focused on improvement in CRF. The response rate of FQ was 75.6%. Individuals with low PAL and low CRF provided feedback less often (p<0.05). In terms of perceived effect, 84.1% of the respondents implemented some kind of behavioural change; 60.9% reported increase in PA, but only 38.1% reported maintaining improvement in PA after 6 months. A higher proportion of reported lasting changes in PA occurred in subjects who were overweight/obese and in those with low CRF. Participants with low PAL and higher number of lifestyle risks more likely increased their PA only temporarily. Improvement in PA was associated with reported changes in diet (p<0.001). In the group of respondents there was an increase in self-perceived PA (SPA) compared to the baseline (p=0.001). Moreover, individuals who reported increase in PA showed improvement in subjectively perceived health. The testing of CRF appears to be a promising motivating factor for going through the intervention, especially for younger people and men. CPPE is effective at the individual level in terms of providing information and initiating behavioural changes in PA. However, this type of intervention is less attractive and less effective for individuals with a higher behavioural risk profile.

The Best Foot Forward (BFF) program was created to improve health-related behaviors. Physical activity self-efficacy (PASE) has been shown as an important factor related to physical activity (PA) in children. However, it is unknown if participation in the BFF program will increase PASE and PA behavior. PURPOSE: To examine change in PASE and subjectively-assessed PA following participation in the BFF program. METHODS: Seventy-five 4th grade students (mean±s.d: 10.1±0.4 yrs; 37 girls, 38 boys) from Eaton Rapids, Michigan were enrolled in the BFF program. Participants met weekly for one hour before school for 9 weeks. Each week participants were taught a lesson on physical activity and spent 20 minutes participating in physically active games in the gymnasium. Pre- and post-test evaluation were used to assess PASE, PA, and anthropometrics (height, weight) for each participant. Participants answered 4 questions on PASE asking how sure they felt that they could participate in 60 minutes of physical activity for 1–2 days, 3–4 days, 5–6 days, and 7 days. Participants rated their confidence in their ability to complete 60 minutes of MVPA over a 7-day period. A 5-point scale of different size circles ranging from small (“not sure”) to large (“very sure”) was used for each question. A composite score was calculated based on their responses. PA was assessed using a single question from the Youth Risk Behavior Survey (YRBS). Participants were asked on how many of the previous 7 days did they participate in at least 60 minutes of PA. A paired-samples t-test was used to compare anthropometrics, PASE, and PA from Weeks 1 and 9. RESULTS: Due to missing data, 16 participants were excluded from analysis. BMI was not significantly different between Week 1 (20.3±4.6 kg/m2) and Week 9 (20.4±4.6) (p>0.05). PASE significantly increased from Weeks 1 to 9 (3.3±1.3 vs. 3.7±1.2; p<0.05). PA also significantly increased from Week 1 to Week 9 (4.3± 2.0 vs. 5.3±1.9; p<0.001). CONCLUSION: PASE and PA improved following the BFF program. Receiving weekly lessons during the BFF program may have encouraged children’s belief in their ability to perform physical activity outside of the program. Future research should examine the relationships between PASE and objectively measured physical activity in children. MDCH 20142061–00

Physical and psychological symptoms limit physical activity for people with arthritis. This study examined if self-efficacy mediated a relationship between symptom and physical activity (PA) frequency change. This was a secondary analysis of older adults with arthritis and joint pain in a trial of a lifestyle PA program (n = 339). Measures were depressive symptoms, pain, fatigue, arthritis self-efficacy, PA self-efficacy, and PA frequency. A panel model was used to analyze relationships at baseline and changes at 20 weeks. The mean age was 68.8 years. At baseline, depression and fatigue were associated with arthritis self-efficacy (β = -.34 and -.24) and, in turn, PA self-efficacy (β = .63); PA self-efficacy was associated with PA (β = .15). Pain and depression changes were associated with arthritis self-efficacy change (β = -.20 and -.21) and, in turn, PA self-efficacy (β = .32) change; PA self-efficacy change was associated with PA change (β = .36). Change in symptom severity affected change in PA frequency. These relationships appeared to operate through self-efficacy. Over time, pain appeared to have a stronger relationship than fatigue with self-efficacy and PA. These findings support strategies to help people with arthritis strengthen their confidence for symptom coping and PA participation.

Changes in physical activity and short-term changes in health care charges: a prospective cohort study of older adults

The government of Malaysia has implemented a Movement Restriction Order (MCO) curfew on all citizens to prevent the Covid-19 pandemic from spreading. Studies have suggested that a long period of MCO will decrease overall weekly spending on energy for physical exercise in all age groups, ultimately promoting hypokinetic diseases. This study is interested in identifying the trend of physical activity behaviour changes during the Covid-19 MCO among university students. This study is also interested in comparing the mean score of physical activity level (inactive, minimum active, sufficient level) among samples. One hundred sixty-five (n=165) healthy samples age 19 to 23 years old currently enrolled as students from the Faculty of Sports Science and Recreation, University Teknologi Mara (FSR) answered the international physical activity questionnaire short form (IPAQ-SF) during the MCO period. Self-Reported Physical Activity Level has shown entirely contradicted from previous studies. 78.2% were at a sufficient level of physical activity; meanwhile, 20% were minimum, and 1.8% were reportedly inactive during the MCO period among FSR students. In addition, this study also found the differences of mean score in physical activity for sufficient level was (1438.78 SE=314.83), minimum active (-1268.65 SE=942.55), and inactive (-2707.43 SE=973.21). This study result showed that although, in restriction conditions in MCO, samples were still able to maintain their physical activity behaviour. The past physical activity practice can explain this phenomenon by these samples required throughout the lesson course, which has become a behaviour among these students.