%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65968 %T Calibration and Validation of Machine Learning Models for Physical Behavior Characterization: Protocol and Methods for the Free-Living Physical Activity in Youth (FLPAY) Study %A LaMunion,Samuel Robert %A Hibbing,Paul Robert %A Crouter,Scott Edward %+ Department of Kinesiology, Recreation, and Sports Studies, The University of Tennessee Knoxville, 1914 Andy Holt Avenue, HPER 343, Knoxville, TN, 37996, United States, 1 865 974 1272, scrouter@utk.edu %K physical behavior assessment %K youth activity %K wearable devices %K activity monitoring %K digital health %K physical behavior characterization %K criterion dataset %D 2025 %7 16.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Wearable activity monitors are increasingly used to characterize physical behavior. The development and validation of these characterization methods require criterion-labeled data typically collected in a laboratory or simulated free-living environment, which does not generally translate well to free-living due to limited behavior engagement in development that is not representative of free living. Objective: The Free-Living Physical Activity in Youth (FLPAY) study was designed in 2 parts to establish a criterion dataset for novel method development for identifying periods of transition between activities in youth. Methods: The FLPAY study used criterion measures of behavior (direct observation) and energy expenditure (indirect calorimetry) to label data from research-grade accelerometer-based devices for the purpose of developing and cross-validating models to identify transitions, classify activity type, and estimate energy expenditure in youth aged 6-18 years. The first part of this study was a simulated free-living protocol in the laboratory, comprising short (roughly 60-90 s) and long (roughly 4-5 min) bouts of 16 activities that were completed in various orders over the span of 2 visits. The second part of this study involved an independent sample of participants who agreed to be measured twice (2 hours each time) in free-living environments such as the home and community. Results: The FLPAY study was funded from 2016 to 2020. A no-cost extension was granted for 2021. A few secondary outcomes have been published, but extensive analysis of primary data is ongoing. Conclusions: The 2-part design of the FLPAY study emphasized the collection of naturalistic behaviors and periods of transition between activities in both structured and unstructured environments. This filled an important gap, considering the traditional focus on scripted activity routines in structured laboratory environments. This protocol paper details the FLPAY procedures and participants, along with details about criterion datasets, which will be useful in future studies analyzing the wealth of device-based data in diverse ways. International Registered Report Identifier (IRRID): RR1-10.2196/65968 %M 40239195 %R 10.2196/65968 %U https://www.researchprotocols.org/2025/1/e65968 %U https://doi.org/10.2196/65968 %U http://www.ncbi.nlm.nih.gov/pubmed/40239195 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68199 %T Changes in Physical Activity, Heart Rate, and Sleep Measured by Activity Trackers During the COVID-19 Pandemic Across 34 Countries: Retrospective Analysis %A Wyatt,Bastien %A Forstmann,Nicolas %A Badier,Nolwenn %A Hamy,Anne-Sophie %A De Larochelambert,Quentin %A Antero,Juliana %A Danino,Arthur %A Vercamer,Vincent %A De Villele,Paul %A Vittrant,Benjamin %A Lanz,Thomas %A Reyal,Fabien %A Toussaint,Jean-François %A Delrieu,Lidia %+ , Institute for Research in bioMedicine and Epidemiology of Sport, Université Paris Cité, 11 Avenue du Tremblay, Paris, 75012, France, 33 141744307, lidia.delrieu@insep.fr %K Covid-19 %K pandemic %K physical activity %K step %K activity tracker %K public health %K Withings %K heart rate %K wearable sensors %K sleep duration %K sleep quality %K pre-pandemic %K public health %K sedentary behavior %D 2025 %7 4.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic disrupted behavior within populations, affecting physical activity (PA), heart rate (HR), and sleep characteristics in particular. Activity trackers provide unique insights into these changes, enabling large-scale, real-time monitoring. Objective: This study aims to analyze the associations between the features of the COVID-19 pandemic worldwide and PA, HR, and sleep parameters, using data collected from activity trackers over a 3-year period. Methods: We performed a retrospective analysis using anonymized data collected from the 208,818 users of Withings Steel HR activity trackers, spanning 34 countries, over a 3-year period from January 2019 to March 2022. Key metrics analyzed included daily step counts, average heart rate, and sleep duration. The statistical methods used included descriptive analyses, time-trend analysis, and mixed models to evaluate the impact of restriction measures, controlling for potential confounders such as sex, age, and seasonal variations. Results: We detected a significant decrease in PA, with a 12.3% reduction in daily step count (from 5802 to 5082 steps/d) over the 3 years. The proportion of sedentary individuals increased from 38% (n=14,177) in 2019 to 52% (n=19,510) in 2020 and remained elevated at 51% (n=18,972) in 2022, while the proportion of active individuals dropped from 8% (n=2857) to 6% (n=2352) in 2020 before returning to 8% (n=2877) in 2022. In 2022, the global population had not returned to prepandemic PA levels, with a noticeable persistence of inactivity. During lockdowns, HR decreased by 1.5%, which was associated with lower activity levels. Sleep duration increased during restrictions, particularly in the countries with the most severe lockdowns (eg, an increase of 15 min in countries with stringent measures compared to 5 min in less restricted regions). Conclusions: The sustained decrease in PA and its physiological consequences highlight the need for public health strategies to mitigate the long-term effects of the measures taken during the pandemic. Despite the gradual lifting of restrictions, PA levels have not fully recovered, with lasting implications for global health. If similar circumstances arise in the future, priority should be given to measures for effectively increasing PA to counter the increase in sedentary behavior, mitigate health risks, and prevent the rise of chronic diseases. %M 40184182 %R 10.2196/68199 %U https://www.jmir.org/2025/1/e68199 %U https://doi.org/10.2196/68199 %U http://www.ncbi.nlm.nih.gov/pubmed/40184182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59878 %T Validation of Ecological Momentary Assessment With Reference to Accelerometer Data: Repeated-Measures Panel Study With Multilevel Modeling %A Noh,Jung Min %A Im,SongHyun %A Park,JooYong %A Kim,Jae Myung %A Lee,Miyoung %A Choi,Ji-Yeob %+ Department of Biomedical Sciences, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 02 740 8922, jiyeob.choi@gmail.com %K telemedicine %K wearable electronic devices %K physical activity %K mobile phone %K wearables %K smartphones %K ecological momentary assessment %K EMA %K global physical activity questionnaire %K GPAQ %K Bouchard’s physical activity %K multilevel modeling %K females %K women %K males %K men %K sensors %K evaluation %K comparative %K South Korea %D 2025 %7 1.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: There is growing interest in the real-time assessment of physical activity (PA) and physiological variables. Acceleration, particularly those collected through wearable sensors, has been increasingly adopted as an objective measure of physical activity. However, sensor-based measures often pose challenges for large-scale studies due to their associated costs, inability to capture contextual information, and restricted user populations. Smartphone-delivered ecological momentary assessment (EMA) offers an unobtrusive and undemanding means to measure PA to address these limitations. Objective: This study aimed to evaluate the usability of EMA by comparing its measurement outcomes with 2 self-report assessments of PA: Global Physical Activity Questionnaire (GPAQ) and a modified version of Bouchard Physical Activity Record (BAR). Methods: A total of 235 participants (137 female, 98 male, and 94 repeated) participated in one or more 7-day studies. Waist-worn sensors provided by ActiGraph captured accelerometer data while participants completed 3 self-report measures of PA. The multilevel modeling method was used with EMA, GPAQ, and BAR as separate measures, with 6 subdomains of physiological activity (overall PA, overall excluding occupational, transport, exercise, occupational, and sedentary) to model accelerometer data. In addition, EMA and GPAQ were further compared with 6 domains of PA from the BAR as outcome measures. Results: Among the 3 self-reporting instruments, EMA and BAR exhibited better overall performance in modeling the accelerometer data compared to GPAQ (eg EMA daily: β=.387, P<.001; BAR daily: β=.394, P<.001; GPAQ: β=.281, P<.001, based on repeated-only participants with step counts from accelerometer as dependent variables). Conclusions: Multilevel modeling on 3 self-report assessments of PA indicates that smartphone-delivered EMA is a valid and efficient method for assessing PA. %M 40168069 %R 10.2196/59878 %U https://www.jmir.org/2025/1/e59878 %U https://doi.org/10.2196/59878 %U http://www.ncbi.nlm.nih.gov/pubmed/40168069 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64384 %T User Experience With a Personalized mHealth Service for Physical Activity Promotion in University Students: Mixed Methods Study %A Wittmar,Silke %A Frankenstein,Tom %A Timm,Vincent %A Frei,Peter %A Kurpiers,Nicolas %A Wölwer,Stefan %A Schäfer,Axel Georg Meender %+ Faculty of Social Work and Health, HAWK University of Applied Sciences and Arts Hildesheim/Holzminden/Göttingen, Goschentor 1, Hildesheim, 31134, Germany, 49 5121881369, silke.wittmar@hawk.de %K usability testing %K health promotion %K exercise %K smartphone app %K mHealth %K physical activity %K user experience %K user %K university student %K undergraduate %K college %K student %K mixed methods %K physical fitness %K digital intervention %K mobile health %K promote %K engagement %K mobile phone %D 2025 %7 28.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Regular physical activity (PA) is known to offer substantial health benefits, including improved physical fitness, reduced risk of disease, enhanced psychological well-being, and better cognitive performance. Despite these benefits, many university students fail to meet recommended PA levels, risking long-term health consequences. Objective: This study evaluated the user experience (UX) of futur.move, a digital intervention aimed at promoting PA among university students. The service delivers personalized, evidence-based content to foster sustained engagement in PA. Methods: A mixed methods approach was used to evaluate the prototype of futur.move. UX assessments included on-site and online user tests, standardized questionnaires, and online focus groups. A total of 142 university students participated, with 23 joining additional focus groups. Each participant tested the service for 30 minutes. Quantitative data were collected using the User Experience Questionnaire and analyzed descriptively, followed by correlation analysis with variables such as PA level, age, gender, and experience with PA apps. Qualitative insights were gathered from transcribed focus group discussions and analyzed using content-structuring, qualitative content analysis. Quantitative findings were cross-validated with qualitative data. Results: The UX received positive ratings across 4 User Experience Questionnaire scales (range –3 to +3; higher numbers indicate positive UX): attractiveness (median 1.67, IQR 1.04-2.17), perspicuity (median 1.5, IQR 0.5-2), stimulation (median 1.5, IQR 1-2), and novelty (median 1.25, IQR 0.5-2). Weak correlations were found between adherence to World Health Organization guidelines for PA and the perspicuity subscale (η=0.232, P=.04), and between age and the perspicuity (Kendall τb=0.132, P=.03) and stimulation subscales (Kendall τb=0.144, P=.02), and a moderate correlation was found between gender and the novelty subscale (η=0.363, P=.004). Critical feedback from focus group discussions highlighted issues with manual data entry. Qualitative findings aligned with the quantitative results, emphasizing students’ appreciation for the personalized, diverse content and social networking features of futur.move. Conclusions: futur.move demonstrates favorable UX and aligns with student needs, particularly through its personalized content and social features. Improvements should focus on reducing manual data entry and enhancing feature clarity, particularly for the features “your condition” and “goal setting.” While correlations between UX ratings and demographic variables were weak to moderate, they warrant further investigation to better address the diverse target audience. The feedback from the students serves as a basis for further adapting the service to their needs and expectations. Future work will involve coding an advanced prototype and conducting a longitudinal study to assess its impact on PA behavior and sustained engagement. %M 40153787 %R 10.2196/64384 %U https://formative.jmir.org/2025/1/e64384 %U https://doi.org/10.2196/64384 %U http://www.ncbi.nlm.nih.gov/pubmed/40153787 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e59570 %T The Role of Environmental Factors in Technology-Assisted Physical Activity Intervention Studies Among Older Adults: Scoping Review %A Jansen,Carl-Philipp %A Nijland,Désirée %A Oppert,Jean-Michel %A Alcan,Veysel %A Keskinen,Kirsi E %A Matikainen-Tervola,Emmi %A Pajalic,Zada %A Rantakokko,Merja %A Tomsone,Signe %A Tuomola,Essi-Mari %A Portegijs,Erja %A Timmermans,Erik J %+ Geriatric Center, Medical Faculty Heidelberg, Heidelberg University, Rohrbacherstrasse 149, Heidelberg, 69126, Germany, 49 6221 319 1760, Carl-Philipp.Jansen@med.uni-heidelberg.de %K environmental factors %K intervention %K older adults %K physical activity %K technology %K PRISMA %D 2025 %7 13.3.2025 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The rapidly emerging integration of both technological applications and environmental factors in physical activity (PA) interventions among older adults highlights the need for an overarching investigation. Objective: This scoping review compiled the current literature and aimed to provide an overview of the role of physical, social, socioeconomic, and systemic environmental factors in technology-assisted PA interventions for older adults. Methods: We systematically searched 6 common databases up to September 16, 2024, for original longitudinal studies (with at least one preintervention measurement and one postintervention measurement) that reported on the role of environmental factors in technology-assisted PA interventions for independently living, community-dwelling older adults. In a stepwise process, data on study characteristics (step 1), environmental factors and their role in the included studies (step 2), and intervention outcomes and effects by type of environmental factor (step 3) were summarized. Results: A total of 8020 articles were screened, and 25 (0.31%) were included. Most studies were conducted in Europe (11/25, 44%), followed by North America (5/25, 20%), Asia (5/25, 20%), and Oceania (4/25, 16%). Social environmental factors were most often considered (19/25, 76%), followed by factors from the physical (8/25, 32%), socioeconomic (1/25, 4%), and systemic environment (1/25, 4%). Environmental factors were used as the outcome (8/25, 32%), setting variable (7/25, 28%), moderator or facilitator (8/25, 32%), and intervention component (3/25, 12%). In most studies (19/25, 76%), the intervention had a beneficial effect on the outcome of interest, and the included environmental factor played a supportive role in achieving this effect. In some studies, no effect (3/25, 12%), mixed effects (2/25, 8%), or adverse effects (1/25, 4%) of the interventions were reported. Conclusions: This is the first comprehensive description of how environmental factors interact with technology-assisted interventions to increase or optimize PA in older adults. It was found that the investigation of environmental factors in this field is at an early stage. Environmental factors were found to play a supportive role in achieving beneficial effects of technology-assisted PA interventions, but the findings were based on a heterogeneous empirical platform. Still, certain aspects such as the application of virtual reality environments and social (or peer) comparison have shown significant potential that remains to be leveraged. A better understanding of intervention results and support in tailoring intervention programs can be provided through the inclusion of environmental aspects in technology-assisted PA interventions for older adults. %M 40080814 %R 10.2196/59570 %U https://mhealth.jmir.org/2025/1/e59570 %U https://doi.org/10.2196/59570 %U http://www.ncbi.nlm.nih.gov/pubmed/40080814 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58715 %T Preadolescent Children Using Real-Time Heart Rate During Moderate to Vigorous Physical Activity: A Feasibility Study %A Lu,Lincoln %A Jake-Schoffman,Danielle E %A Lavoie,Hannah A %A Agharazidermani,Maedeh %A Boyer,Kristy Elizabeth %+ LearnDialogue Lab, Computer and Information Science and Engineering, University of Florida, 1889 Museum Road, Gainesville, FL, 32611, United States, 1 352 392 1133, lincolnlu@ufl.edu %K smartphone app %K physical activity %K heart rate %K wearable sensors %K youth %K commercial wearable device %K Garmin %K mobile phone %D 2025 %7 6.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Given the global burden of insufficient physical activity (PA) in children, effective behavioral interventions are needed to increase PA levels. Novel technologies can help expand the reach and accessibility of these programs. Despite the potential to use heart rate (HR) to target moderate- to vigorous-intensity PA (MVPA), most HR research to date has focused on the accuracy of HR devices or used HR for PA surveillance rather than as an intervention tool. Furthermore, most commercial HR sensors are designed for adults, and their suitability for children is unknown. Further research about the feasibility and usability of commercial HR devices is required to understand how children may use HR during PA. Objective: This study aimed to explore the use of a chest-worn HR sensor paired with a real-time HR display as an intervention tool among preadolescent children and the usability of a custom-designed app (Connexx) for viewing real-time HR. Methods: We developed Connexx, an HR information display app with an HR analytics portal to view HR tracking. Children were recruited via flyers distributed at local public schools, word of mouth, and social media posts. Eligible participants were children aged 9 to 12 years who did not have any medical contraindications to MVPA. Participants took part in a single in-person study session where they monitored their own HR using a commercial HR sensor, learned about HR, and engaged in a series of PAs while using the Connexx app to view their real-time HR. We took field note observations about participant interactions with the HR devices. Participants engaged in a semistructured interview about their experience using Connexx and HR during PA and completed the System Usability Scale (SUS) about the Connexx app. Study sessions were audio and video recorded and transcribed verbatim. Results: A total of 11 participants (n=6, 55% male; n=9, 82%, non-Hispanic White) with an average age of 10.4 (SD 1.0) years were recruited for the study. Data from observations, interviews, and SUS indicated that preadolescent children can use real-time HR information during MVPA. Observational and interview data indicated that the participants were able to understand their HR after a basic lesson and demonstrated the ability to make use of their HR information during PA. Interview and SUS responses demonstrated that the Connexx app was highly usable, despite some accessibility challenges (eg, small display font). Feedback about usability issues has been incorporated into a redesign of the Connexx app, including larger, color-coded fonts for HR information. Conclusions: The results of this study indicate that preadolescent children understood their HR data and were able to use it in real time during PA. The findings suggest that future interventions targeting MVPA in this population should test strategies to use HR and HR monitoring as direct program targets. %M 40053729 %R 10.2196/58715 %U https://humanfactors.jmir.org/2025/1/e58715 %U https://doi.org/10.2196/58715 %U http://www.ncbi.nlm.nih.gov/pubmed/40053729 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e68667 %T Combining Ecological Momentary Assessment and Social Network Analysis to Study Youth Physical Activity and Environmental Influences: Protocol for a Mixed Methods Feasibility Study %A Prochnow,Tyler %A Dunton,Genevieve F %A de la Haye,Kayla %A Pollack Porter,Keshia M %A Lee,Chanam %+ Department of Health Behavior, School of Public Health, Texas A&M University, 212 Adriance Lab, College Station, TX, 77843, United States, 1 2629450275, tprochnow@tamu.edu %K physical activity %K youth %K social environment %K built environment %K ecological momentary assessment %K social network analysis %K phenotypes %K accelerometry %K GPS %D 2025 %7 21.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity (PA) is crucial for youth health, but up to 74% of adolescents fail to meet recommended levels, especially during summer when structured supports associated with school are not available. The social and built environments significantly influence youth PA; yet, their complex interactions remain poorly understood. This study aims to evaluate the feasibility of combining ecological momentary assessment (EMA) and social network analysis to examine bidirectional influences among youth PA, built environments, and social networks during summer. Objective: The objectives are to (1) evaluate the feasibility and acceptability of the combined EMA and Social Network Analysis protocol, and (2) identify phenotypes using person-level, microtemporal, and dynamic overlap between social and built environments. Methods: This mixed methods feasibility study with an exploratory observational component will recruit 120 youth aged 12 years to 15 years from an urban school district in Central Texas, US. Participants will first complete a baseline survey to report their general social network patterns and environmental perceptions. Then participants will wear an ActiGraph LEAP accelerometer and respond to EMA prompts via smartphone for 7 days. EMA will assess real-time perceptions of social networks and surrounding built environments, which will be time-matched with accelerometer-assessed PA data. GPS coordinates will be collected with each EMA prompt to assess features of the built environment. Follow-up semistructured interviews will assess protocol acceptability. Results: This study has been funded by the National Heart, Lung, and Blood Institute. Data collection is expected in the summers of 2025, 2026, and 2027. Conclusions: This innovative approach combines EMA, SNA, accelerometry, and GPS data to provide unprecedented insights into the dynamic interplay between social networks, built environments, and youth PA during summer. Findings will inform the development of more targeted, effective interventions to promote PA among youth. While limitations include potential participant burden and generalizability, the study’s strengths in capturing real-time, contextualized data make it a valuable contribution to understanding youth PA determinants. International Registered Report Identifier (IRRID): PRR1-10.2196/68667 %M 39984166 %R 10.2196/68667 %U https://www.researchprotocols.org/2025/1/e68667 %U https://doi.org/10.2196/68667 %U http://www.ncbi.nlm.nih.gov/pubmed/39984166 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e52887 %T Participant Compliance With Ecological Momentary Assessment in Movement Behavior Research Among Adolescents and Emerging Adults: Systematic Review %A Wang,Shirlene %A Yang,Chih-Hsiang %A Brown,Denver %A Cheng,Alan %A Kwan,Matthew Y W %+ Department of Population and Public Health Sciences, University of Southern California, 1875 N Soto Street, Los Angeles, CA, 90032, United States, 1 3125327663, shirlene@northwestern.edu %K compliance %K ecological momentary assessment %K mobile health %K adolescents %K emerging adults %K physical activity %K movement behavior %K systematic review %K cognitive %K social %K development %K youth %K literature search %K inclusion %K data quality %K mobile phone %D 2025 %7 11.2.2025 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Adolescence through emerging adulthood represents a critical period associated with changes in lifestyle behaviors. Understanding the dynamic relationships between cognitive, social, and environmental contexts is informative for the development of interventions aiming to help youth sustain physical activity and limit sedentary time during this life stage. Ecological momentary assessment (EMA) is an innovative method involving real-time assessment of individuals’ experiences and behaviors in their naturalistic or everyday environments; however, EMA compliance can be problematic due to high participant burdens. Objective: This systematic review synthesized existing evidence pertaining to compliance in EMA studies that investigated wake-time movement behaviors among adolescent and emerging adult populations. Differences in EMA delivery scheme or protocol, EMA platforms, prompting schedules, and compensation methods—all of which can affect participant compliance and overall study quality—were examined. Methods: An electronic literature search was conducted in PubMed, PsycINFO, and Web of Science databases to select relevant papers that assessed movement behaviors among the population using EMA and reported compliance information for inclusion (n=52) in October 2022. Study quality was assessed using a modified version of the Checklist for Reporting of EMA Studies (CREMAS). Results: Synthesizing the existing evidence revealed several factors that influence compliance. The platform used for EMA studies could affect compliance and data quality in that studies using smartphones or apps might lessen additional burdens associated with delivering EMAs, yet most studies used web-based formats (n=18, 35%). Study length was not found to affect EMA compliance rates, but the timing and frequency of prompts may be critical factors associated with missingness. For example, studies that only prompted participants once per day had higher compliance (91% vs 77%), but more frequent prompts provided more comprehensive data for researchers at the expense of increased participant burden. Similarly, studies with frequent prompting within the day may provide more representative data but may also be perceived as more burdensome and result in lower compliance. Compensation type did not significantly affect compliance, but additional motivational strategies could be applied to encourage participant response. Conclusions: Ultimately, researchers should consider the best strategies to limit burdens, balanced against requirements to answer the research question or phenomena being studied. Findings also highlight the need for greater consistency in reporting and more specificity when explaining procedures to understand how EMA compliance could be optimized in studies examining physical activity and sedentary time among youth. Trial Registration: PROSPERO CRD42021282093; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282093 %M 39933165 %R 10.2196/52887 %U https://mhealth.jmir.org/2025/1/e52887 %U https://doi.org/10.2196/52887 %U http://www.ncbi.nlm.nih.gov/pubmed/39933165 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60559 %T A Digital Behavior Change Intervention for Health Promotion for Adults in Midlife: Protocol for a Multidimensional Assessment Study %A Soleymani,Dagmar %A Pougheon-Bertrand,Dominique %A Gagnayre,Rémi %+ , Health Promotion and Prevention Division, Santé publique France, 12 rue due Val d'Osne, Saint-Maurice, 94415, France, 33 0171482134, dagmar.soleymani@santepubliquefrance.fr %K digital behavior change intervention %K assessment protocol %K middle-aged adults %K health promotion %K user account %K mixed assessments %K health information technologies %D 2025 %7 7.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: To support lifelong health promotion and disease prevention, Santé publique France studied the methodology for building a social marketing scheme with a digital intervention targeting middle-aged adults, specifically socioeconomically disadvantaged groups. The digital intervention aims to encourage people aged 40-55 years to look after their health in the short and medium terms by adopting small actions relating to 8 health determinants: nutrition, physical activity, smoking, alcohol, stress, cognitive health, sleep, and environmental health. In the long term, the intervention intends to prevent frailty and reduce the burden of multimorbidities in older age, particularly for lower socioeconomic groups. Objective: This study aims to measure behavior changes among registered users of the future website. The protocol assesses the impact of the website based on users’ implementation of small actions relating to the 8 health determinants. Specifically, it intends to evaluate the website’s performance in terms of engaging a specific population, triggering behavior change, raising awareness about a multifactorial approach to health, and encouraging user interaction with the website’s resources. Methods: The methodology is based on clinical assessments developed alongside the website according to the functionalities offered to registered users in their personalized space. The assessment tool design draws on logic models for digital interventions, and their consistency for digital applications is verified. The target audience is clearly defined from the outset. The protocol sets out a 3-step assessment: upon registration, after 3 weeks of use, and after 10 weeks of use (end of assessment). Users are divided into 2 groups (socioeconomically disadvantaged users and others) to characterize differences and make corrections. The protocol uses a mixed assessment approach based on website traffic and user login data. Specific and identifiable behavior changes are documented by monitoring the same individuals from T0 to T2, using verbatim comments to classify them into profiles and conducting semistructured individual interviews with a sample of users. Results: The protocol creates a multidimensional assessment of digital intervention, showing that during a given timeline, interactions with users can reveal their capabilities, opportunities, and motivations to adopt healthy lifestyles. The protocol’s principles were integrated into the development of a personal account to assess users’ behavior changes. Given the delayed launch of the website, no recruitment or effects analysis of the protocol took place. Conclusions: As no multidimensional assessment protocol is currently available for digital behavior change interventions, our methods reveal that the different framework stages can strengthen the effect measurement, consolidate the choice of assumptions used within the logic model and steer the digital intervention toward action while reducing the burden of information. The suitability of the assessment protocol remains to be evaluated given the delayed launch of the website. International Registered Report Identifier (IRRID): PRR1-10.2196/60559 %M 39919300 %R 10.2196/60559 %U https://www.researchprotocols.org/2025/1/e60559 %U https://doi.org/10.2196/60559 %U http://www.ncbi.nlm.nih.gov/pubmed/39919300 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e63348 %T Exploring the Feasibility of a 5-Week mHealth Intervention to Enhance Physical Activity and an Active, Healthy Lifestyle in Community-Dwelling Older Adults: Mixed Methods Study %A Daniels,Kim %A Vonck,Sharona %A Robijns,Jolien %A Quadflieg,Kirsten %A Bergs,Jochen %A Spooren,Annemie %A Hansen,Dominique %A Bonnechère,Bruno %+ , Centre of Expertise in Care Innovation, Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Guffenslaan 39, Hasselt, 3500, Belgium, 32 485763451, kim.daniels@pxl.be %K mobile health %K mHealth %K feasibility %K physical activity %K older adults %K health promotion %K usability %K mobile phone %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA). Objective: The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot. Methods: Our study used a mixed methods approach to evaluate the MIA app’s acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based. Results: The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6%. Analysis showed general satisfaction with the app’s workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants. Conclusions: The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults. Trial Registration: ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515 %M 39869906 %R 10.2196/63348 %U https://aging.jmir.org/2025/1/e63348 %U https://doi.org/10.2196/63348 %U http://www.ncbi.nlm.nih.gov/pubmed/39869906 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e57255 %T Feature Selection for Physical Activity Prediction Using Ecological Momentary Assessments to Personalize Intervention Timing: Longitudinal Observational Study %A Kumar,Devender %A Haag,David %A Blechert,Jens %A Niebauer,Josef %A Smeddinck,Jan David %K digital health %K behavior change %K tailoring %K personalization %K adaptive systems %K ecological momentary assessments %K sensing %K questionnaires %K machine learning %K feature selection %K situated research %K physical activity %K implementation intentions %K barriers %K intention-behavior gap %K artificial intelligence %K AI %K well-being %K user assessment %K survey %K self-efficacy %K stress %K mood %K emotions %K mobile phone %D 2025 %7 24.1.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: There has been a surge in the development of apps that aim to improve health, physical activity (PA), and well-being through behavior change. These apps often focus on creating a long-term and sustainable impact on the user. Just-in-time adaptive interventions (JITAIs) that are based on passive sensing of the user’s current context (eg, via smartphones and wearables) have been devised to enhance the effectiveness of these apps and foster PA. JITAIs aim to provide personalized support and interventions such as encouraging messages in a context-aware manner. However, the limited range of passive sensing capabilities often make it challenging to determine the timing and context for delivering well-accepted and effective interventions. Ecological momentary assessment (EMA) can provide personal context by directly capturing user assessments (eg, moods and emotions). Thus, EMA might be a useful complement to passive sensing in determining when JITAIs are triggered. However, extensive EMA schedules need to be scrutinized, as they can increase user burden. Objective: The aim of the study was to use machine learning to balance the feature set size of EMA questions with the prediction accuracy regarding of enacting PA. Methods: A total of 43 healthy participants (aged 19‐67 years) completed 4 EMA surveys daily over 3 weeks. These surveys prospectively assessed various states, including both motivational and volitional variables related to PA preparation (eg, intrinsic motivation, self-efficacy, and perceived barriers) alongside stress and mood or emotions. PA enactment was assessed retrospectively via EMA and served as the outcome variable. Results: The best-performing machine learning models predicted PA engagement with a mean area under the curve score of 0.87 (SD 0.02) in 5-fold cross-validation and 0.87 on the test set. Particularly strong predictors included self-efficacy, stress, planning, and perceived barriers, indicating that a small set of EMA predictors can yield accurate PA prediction for these participants. Conclusions: A small set of EMA-based features like self-efficacy, stress, planning, and perceived barriers can be enough to predict PA reasonably well and can thus be used to meaningfully tailor JITAIs such as sending well-timed and context-aware support messages. %R 10.2196/57255 %U https://mhealth.jmir.org/2025/1/e57255 %U https://doi.org/10.2196/57255 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65611 %T Postpartum Remote Health Coaching Intervention for Individuals With a Hypertensive Disorder of Pregnancy: Proof-of-Concept Study %A Borrowman,Jaclyn D %A Carr,Lucas J %A Pierce,Gary L %A Story,William T %A Gibbs,Bethany Barone %A Whitaker,Kara M %K cardiovascular disease %K postpartum %K hypertensive disorders of pregnancy %K intervention %K physical activity intervention %K proof-of-concept %K cardiovascular health %K CVD risk %K cardiovascular disease risk %K feasibility %K acceptability %K health coaching %K women's health %K postnatal %D 2025 %7 8.1.2025 %9 %J JMIR Form Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death among women in America. Hypertensive disorders of pregnancy (HDP) negatively impact acute and long-term cardiovascular health, with approximately 16% of all pregnancies affected. With CVD 2‐4 times more likely after HDP compared to normotensive pregnancies, effective interventions to promote cardiovascular health are imperative. Objective: With postpartum physical activity (PA) interventions after HDP as an underexplored preventative strategy, we aimed in this study to assess (1) the feasibility and acceptability of a remotely delivered PA intervention for individuals with HDP 3‐6 months postpartum and (2) changes in average steps per day, skills related to PA behavior, and postpartum blood pressure (BP). Methods: A remotely delivered 14-week health coaching intervention was designed based on prior formative work. The health coaching intervention called the Hypertensive Disorders of Pregnancy Postpartum Exercise (HyPE) intervention was tested for feasibility and acceptability with a single-arm proof-of-concept study design. A total of 19 women who were 3‐6 months postpartum HDP; currently inactive; 18 years of age or older; resided in Iowa; and without diabetes, kidney disease, and CVD were enrolled. Feasibility was assessed by the number of sessions attended and acceptability by self-reported satisfaction with the program. Changes in steps achieved per day were measured with an activPAL4 micro, PA behavior skills via validated surveys online, and BP was assessed remotely with a research-grade Omron Series 5 (Omron Corporation) BP monitor. Results: Participants at enrollment were on average 30.3 years of age, 4.1 months postpartum, self-identified as non-Hispanic White (14/17, 82%), in a committed relationship (16/17, 94%), and had a bachelor’s degree (9/17, 53%). A total of 140 of 152 possible health coaching sessions were attended by those who started the intervention (n=19, 92%). Intervention completers (n=17) indicated they were satisfied with the program (n=17, 100%) and would recommend it to others (n=17, 100%). No significant changes in activPAL measured steps were observed from pre- to posttesting (mean 138.40, SD 129.40 steps/day; P=.75). Significant improvements were observed in PA behavior skills including planning (mean 5.35, SD 4.97 vs mean 15.06, SD 3.09; P<.001) and monitoring of PA levels (mean 7.29, SD 3.44 vs mean 13.00, SD 2.45; P<.001). No significant decreases were observed for systolic (mean –1.28, SD 3.59 mm Hg; Hedges g=–0.26; P=.16) and diastolic BP (mean –1.80, SD 5.03 mm Hg; Hedges g=–0.44; P=.12). Conclusions: While PA behaviors did not change, the intervention was found to be feasible and acceptable among this sample of at-risk women. After additional refinement, the intervention should be retested among a larger, more diverse, and less physically active sample. Trial Registration: ClinicalTrials.gov NCT06019715; https://clinicaltrials.gov/study/NCT06019715 %R 10.2196/65611 %U https://formative.jmir.org/2025/1/e65611 %U https://doi.org/10.2196/65611 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59521 %T Accuracy of the Huawei GT2 Smartwatch for Measuring Physical Activity and Sleep Among Adults During Daily Life: Instrument Validation Study %A Mei,Longfei %A He,Ziwei %A Hu,Liang %K smartwatch %K accelerometry %K free-living %K physical activity %K sleep %K validity %D 2024 %7 20.12.2024 %9 %J JMIR Form Res %G English %X Background: Smartwatches are increasingly popular for physical activity and health promotion. However, ongoing validation studies on commercial smartwatches are still needed to ensure their accuracy in assessing daily activity levels, which is important for both promoting activity-related health behaviors and serving research purposes. Objective: This study aimed to evaluate the accuracy of a popular smartwatch, the Huawei Watch GT2, in measuring step count (SC), total daily activity energy expenditure (TDAEE), and total sleep time (TST) during daily activities among Chinese adults, and test whether there are population differences. Methods: A total of 102 individuals were recruited and divided into 2 age groups: young adults (YAs) and middle-aged and older (MAAO) adults. Participants’ daily activity data were collected for 1 week by wearing the Huawei Watch GT2 on their nondominant wrist and the Actigraph GT3X+ (ActiGraph) on their right hip as the reference measure. The accuracy of the GT2 was examined using the intraclass correlation coefficient (ICC), Pearson product-moment correlation coefficient (PPMCC), Bland-Altman analysis, mean percentage error, and mean absolute percentage error (MAPE). Results: The GT2 demonstrated reasonable agreement with the Actigraph, as evidenced by a consistency test ICC of 0.88 (P<.001) and an MAPE of 25.77% for step measurement, an ICC of 0.75 (P<.001) and an MAPE of 33.79% for activity energy expenditure estimation, and an ICC of 0.25 (P<.001) and an MAPE of 23.29% for sleep time assessment. Bland-Altman analysis revealed that the GT2 overestimated SC and underestimated TDAEE and TST. The GT2 was better at measuring SC and TDAEE among YAs than among MAAO adults, and there was no significant difference between these 2 groups in measuring TST (P=.12). Conclusions: The Huawei Watch GT2 demonstrates good accuracy in step counting. However, its accuracy in assessing activity energy expenditure and sleep time measurement needs further examination. The GT2 demonstrated higher accuracy in measuring SC and TDAEE in the YA group than in the MAAO group. However, the measurement errors for TST did not differ significantly between the 2 age groups. Therefore, the watch may be suitable for monitoring several key parameters (eg, SC) of daily activity, yet caution is advised for its use in research studies that require high accuracy. %R 10.2196/59521 %U https://formative.jmir.org/2024/1/e59521 %U https://doi.org/10.2196/59521 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e66049 %T Using Video Cameras to Assess Physical Activity and Other Well-Being Behaviors in Urban Environments: Feasibility, Reliability, and Participant Reactivity Studies %A Benton,Jack S %A Evans,James %A Anderson,Jamie %A French,David P %+ Manchester Centre for Health Psychology, Division of Psychology and Mental Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 01613066000, jack.benton@manchester.ac.uk %K unobtrusive observation %K video cameras %K measurement %K physical activity %K well-being %K urban environments %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Unobtrusive observation is a promising method for assessing physical activity and other well-being behaviors (eg, social interactions) in urban environments, without participant burden and biases associated with self-report. However, current methods require multiple in-person observers. Using video cameras instead could allow for more accurate observations at lower cost and with greater flexibility in scheduling. Objective: This research aimed to test the feasibility of using stationary wireless video cameras to observe physical activity and other well-being behaviors, and to assess its reliability and potential participant reactivity. Methods: Across 3 cross-sectional studies, 148 hours of video recordings were collected from 6 outdoor public spaces in Manchester, United Kingdom. The videos were coded by 3 researchers using MOHAWk (Method for Observing Physical Activity and Wellbeing)—a validated in-person observation tool for assessing physical activity, social interactions, and people taking notice of the environment. Inter- and intrarater reliabilities were assessed using intraclass correlation coefficients (ICCs). Intercept surveys were conducted to assess public awareness of the cameras and whether they altered their behavior due to the presence of cameras. Results: The 148 hours of video recordings were coded in 85 hours. Interrater reliability between independent coders was mostly “excellent” (ICCs>0.90; n=36), with a small number of “good” (ICCs>0.75; n=2), “moderate” (ICCs=0.5-0.75; n=3), or “poor” (ICCs<0.5; n=1) ICC values. Reliability decreased at night, particularly for coding ethnic group and social interactions, but remained mostly “excellent” or “good.” Intrarater reliability within a single coder after a 2-week interval was “excellent” for all but 1 code, with 1 “good” ICC value for assessing vigorous physical activity, indicating that the coder could reproduce similar results over time. Intrarater reliability was generally similar during the day and night, apart from ICC values for coding ethnic group, which reduced from “excellent” to “good” at night. Intercept surveys with 86 public space users found that only 5 (5.8%) participants noticed the cameras used for this study. Importantly, all 5 said that they did not alter their behavior as a result of noticing these cameras, therefore, indicating no evidence of reactivity. Conclusions: Camera-based observation methods are more reliable than in-person observations and do not produce participant reactivity often associated with self-report methods. This method requires less time for data collection and coding, while allowing for safe nighttime observation without the risk to research staff. This research is a significant first step in demonstrating the potential for camera-based methods to improve natural experimental studies of real-world environmental interventions. It also provides a rigorous foundation for developing more scalable automated computer vision algorithms for assessing human behaviors. %M 39680427 %R 10.2196/66049 %U https://publichealth.jmir.org/2024/1/e66049 %U https://doi.org/10.2196/66049 %U http://www.ncbi.nlm.nih.gov/pubmed/39680427 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63457 %T Whole-Body and Segmental Phase Angles and Cognitive Function in the Older Korean Population: Cross-Sectional Analysis %A Chen,Jiaren %A Park,Jong-Hwan %A Lin,Chien-Yu %A Lai,Ting-Fu %A Kim,Du-Ri %A Shin,Myung-Jun %A Moon,Eunsoo %A Kang,Jung Mo %A Lee,Jong Won %A Cho,Yoon Jae %A Liao,Yung %A Goh,Tae Sik %A Lee,Jung Sub %K bioelectrical impedance analysis %K oxidative stress %K cellular health %K cognitive function %K older adults %K BIA %K phase angle %K PhA %D 2024 %7 16.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Recently, the phase angle (PhA) has emerged as an essential indicator of cellular health. Most studies have examined its association with physiological conditions, such as sarcopenia, frailty, and physical function, in older populations. Simultaneously, growing attention is being paid to the clinical relevance of segmental PhAs for future applications. However, few studies have explored the relationship between PhAs, especially segmental PhAs, and the psychological aspects of health, particularly cognitive function. Objective: We aimed to investigate the association between whole-body and segmental PhAs and cognitive function in older adults. Methods: Individuals aged 65 years and above were recruited from adult community groups residing in Busan, South Korea, through the 2022 Bus-based Screening and Assessment Network (BUSAN) study of Pusan National University Hospital. Participants’ whole-body and segmental PhAs were measured using a bioelectrical impedance analyzer (BWA 2.0 Body Water Analyzer, InBody), and cognitive functions (overall and subdomains, including memory, orientation, attention and calculation, and language) were self-reported using the Korean version of the Mini-Mental State Examination. Multiple linear regression analyses were performed to examine these associations. Results: This study included 625 older adults aged 65‐96 years (women: n=444, 71%; men: n=191, 29%). A positive association was observed between whole-body PhA and cognitive function (b=0.62, 95% CI 0.16‐1.08; P<.01). We observed significant positive associations between the PhA of the lower limbs (b=0.72, 95% CI 0.38‐1.06; P<.001) and cognitive function. Analysis of the Mini-Mental State Examination subdomains revealed that whole-body PhA was significantly related to memory (b=0.11, 95% CI 0.00‐0.22; P=.04); the PhA of the upper limbs was significantly related to orientation (b=0.29, 95% CI 0.09‐0.49; P=.01); and the PhA of the lower limbs was significantly related to orientation (b=0.24, 95% CI 0.10‐0.38; P<.001), attention and calculation (b=0.21, 95% CI 0.06‐0.37; P=.01), memory (b=0.14, 95% CI 0.05‐0.22; P=.001), and language functions (b=0.07, 95% CI 0.01‐0.12; P=.01). However, trunk PhA showed no significant association. Conclusions: Our findings bolster the emerging evidence of a significant positive correlation between whole-body PhA and cognitive function in our sample, with nuanced relationships observed across different segmental PhAs and cognitive subdomains. Therefore, this study revealed that PhAs could be a useful tool for screening or preventing cognitive decline in the general older population, offering substantial evidence for future interventional studies. Further research should delve into the mechanisms and assess targeted interventions that enhance regional physical function to support cognitive health in older adults. Further long-term investigation on these associations is warranted. %R 10.2196/63457 %U https://publichealth.jmir.org/2024/1/e63457 %U https://doi.org/10.2196/63457 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65095 %T Analysis of Physical Activity Using Wearable Health Technology in US Adults Enrolled in the All of Us Research Program: Multiyear Observational Study %A Singh,Rujul %A Tetrick,Macy K %A Fisher,James L %A Washington,Peter %A Yu,Jane %A Paskett,Electra D %A Penedo,Frank J %A Clinton,Steven K %A Benzo,Roberto M %+ Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Suite 200, 3650 Olentangy River Road, Columbus, OH, 43124, United States, 1 614 293 3675, roberto.benzo@osumc.edu %K Physical Activity Guidelines for Americans %K accelerometry %K All of Us Research Program %K wearable activity monitors %K health equity %K multiyear activity tracking %K activity intensity estimation %K US adult population %K sociodemographic determinants of physical activity %K physical activity %K wearables %K United States %K older adults %K observational studies %K longitudinal setting %K sociodemographic determinants %K physical activity data %K Fitbit data %K step-based method %K adherence %D 2024 %7 10.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: To date, no studies have examined adherence to the 2018 Physical Activity Guidelines for Americans (PAGA) in real-world longitudinal settings using objectively measured activity monitoring data. This study addresses this gap by using commercial activity monitoring (Fitbit) data from the All of Us dataset. Objective: The primary objectives were to describe the prevalence of adherence to the 2018 PAGA and identify associated sociodemographic determinants. Additionally, we compared 3 distinct methods of processing physical activity (PA) data to estimate adherence to the 2008 PAGA. Methods: We used the National Institutes of Health’s All of Us dataset, which contains minute-level Fitbit data for 13,947 US adults over a 7-year time span (2015-2022), to estimate adherence to PAGA. A published step-based method was used to estimate metabolic equivalents and assess adherence to the 2018 PAGA (ie, ≥150 minutes of moderate- to vigorous-intensity PA per week). We compared the step-based method, the heart rate–based method, and the proprietary Fitbit-developed algorithm to estimate adherence to the 2008 PAGA. Results: The average overall adherence to the 2018 PAGA was 21.6% (3006/13,947; SE 0.4%). Factors associated with lower adherence in multivariate logistic regression analysis included female sex (relative to male sex; adjusted odds ratio [AOR] 0.66, 95% CI 0.60-0.72; P<.001); BMI of 25.0-29.9 kg/m2 (AOR 0.53, 95% CI 0.46-0.60; P<.001), 30-34.9 kg/m2 (AOR 0.30, 95% CI 0.25-0.36; P<.001), or ≥35 kg/m2 (AOR 0.13, 95% CI 0.10-0.16; P<.001; relative to a BMI of 18.5-24.9 kg/m2); being aged 30-39 years (AOR 0.66, 95% CI 0.56-0.77; P<.001), 40-49 years (AOR 0.79, 95% CI 0.68-0.93; P=.005), or ≥70 years (AOR 0.74, 95% CI 0.62-0.87; P<.001; relative to being 18-29 years); and non-Hispanic Black race or ethnicity (AOR 0.63, 95% CI 0.50-0.79; P<.001; relative to non-Hispanic White race or ethnicity). The Fitbit algorithm estimated that a larger percentage of the sample (10,307/13,947, 73.9%; 95% CI 71.2-76.6) adhered to the 2008 PAGA compared to the heart rate method estimate (4740/13,947, 34%; 95% CI 32.8-35.2) and the step-based method (1401/13,947, 10%; 95% CI 9.4-10.6). Conclusions: Our results show significant sociodemographic differences in PAGA adherence and notably different estimates of adherence depending on the algorithm used. These findings warrant the need to account for these disparities when implementing PA interventions and the need to establish an accurate and reliable method of using commercial accelerometers to examine PA, particularly as health care systems begin integrating wearable device data into patient health records. %M 39658010 %R 10.2196/65095 %U https://www.jmir.org/2024/1/e65095 %U https://doi.org/10.2196/65095 %U http://www.ncbi.nlm.nih.gov/pubmed/39658010 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50041 %T Tracked Physical Activity Levels Before and After a Change in Incentive Strategy Among UK Adults Using a Rewards App: Retrospective Quasi-Experimental Study %A McCarthy,Hannah %A Potts,Henry W W %A Fisher,Abigail %+ University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 2000, h.potts@ucl.ac.uk %K mHealth %K rewards %K incentives %K physical activity %K smartphone %K apps %K mobile apps %K app-based intervention %K behavior change %K exercise %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Financial incentives delivered via apps appear to be effective in encouraging physical activity. However, the literature on different incentive strategies is limited, and the question remains whether financial incentives offer a cost-effective intervention that could be funded at the population level. Objective: This study aimed to explore patterns of tracked physical activity by users of an incentive-based app before and after a change in incentive strategy. A business decision to alter the incentives in a commercially available app offered a natural experiment to explore GPS-tracked data in a retrospective, quasi-experimental study. The purpose of this exploratory analysis was to inform the design of future controlled trials of incentives delivered via an app to optimize their usability and cost-effectiveness. Methods: Weekly minutes of tracked physical activity were explored among a sample of 1666 participants. A Friedman test was used to determine differences in physical activity before and after the change in incentive strategies. Post hoc Wilcoxon tests were used to assess minutes of physical activity in the 2 weeks before and after the change. A secondary analysis explored longitudinal patterns of physical activity by plotting the mean and median minutes of physical activity from 17 weeks before and 13 weeks after the change in incentive strategy. CIs were calculated using bias-corrected bootstraps. Demographics were also explored in this way. Results: There were significant differences in the weekly minutes of activity before and after the change in incentive strategy (Friedman χ22=42, P<.001). However, a longitudinal view of the data showed a more complex and marked variation in activity over time that undermined the conclusions of the before/after analysis. Conclusions: Short-term before-and-after observational studies of app-tracked physical activity may result in misleading conclusions about the effectiveness of incentive strategies. Longitudinal views of the data show that important fluctuations are occurring over time. Future studies of app-tracked physical activity should explore such variations by using longitudinal analyses and accounting for possible moderating variables to better understand what an effective incentive might be, for whom, and at what cost. %M 39657165 %R 10.2196/50041 %U https://formative.jmir.org/2024/1/e50041 %U https://doi.org/10.2196/50041 %U http://www.ncbi.nlm.nih.gov/pubmed/39657165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60193 %T Impact of Providing a Personalized Data Dashboard on Ecological Momentary Assessment Compliance Among College Students Who Use Substances: Pilot Microrandomized Trial %A Linden-Carmichael,Ashley %A Stull,Samuel W %A Wang,Danny %A Bhandari,Sandesh %A Lanza,Stephanie T %+ The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, 320E Biobehavioral Health Building, University Park, PA, 16802, United States, 1 541 346 1978, AshleyLC@uoregon.edu %K ecological momentary assessment %K data dashboard %K study compliance %K substance use %K substance use behavior %K college student %K alcohol %K cannabis %K cannabis use %K personalized data dashboard %K EMA protocol %K EMA %K health behaviors %K survey %K compliance %K self-reported %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The landscape of substance use behavior among young adults has observed rapid changes over time. Intensive longitudinal designs are ideal for examining and intervening in substance use behavior in real time but rely on high participant compliance in the study protocol, representing a significant challenge for researchers. Objective: This study aimed to evaluate the effect of including a personalized data dashboard (DD) in a text-based survey prompt on study compliance outcomes among college students participating in a 21-day ecological momentary assessment (EMA) study. Methods: Participants (N=91; 61/91, 67% female and 84/91, 92% White) were college students who engaged in recent alcohol and cannabis use. Participants were randomized to either complete a 21-day EMA protocol with 4 prompts/d (EMA Group) or complete the same EMA protocol with 1 personalized message and a DD indicating multiple metrics of progress in the study, delivered at 1 randomly selected prompt/d (EMA+DD Group) via a microrandomized design. Study compliance, completion time, self-reported protocol experiences, and qualitative responses were assessed for both groups. Results: Levels of compliance were similar across groups. Participants in the EMA+DD Group had overall faster completion times, with significant week-level differences in weeks 2 and 3 of the study (P=.047 and P=.03, respectively). Although nonsignificant, small-to-medium effect sizes were observed when comparing the groups in terms of compensation level (P=.08; Cohen w=0.19) and perceived burden (P=.09; Cohen d=-0.36). Qualitative findings revealed that EMA+DD participants perceived that seeing their progress facilitated engagement. Within the EMA+DD Group, providing a DD at the moment level did not significantly impact participants’ likelihood of completing the EMA or completion time at that particular prompt (all P>.05), with the exception of the first prompt of the day (P=.01 and P<.001). Conclusions: Providing a DD may be useful to increase engagement, particularly for researchers aiming to assess health behaviors shortly after a survey prompt is deployed to participants’ mobile devices. International Registered Report Identifier (IRRID): RR2-10.2196/57664 %M 39637378 %R 10.2196/60193 %U https://formative.jmir.org/2024/1/e60193 %U https://doi.org/10.2196/60193 %U http://www.ncbi.nlm.nih.gov/pubmed/39637378 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58186 %T Effectiveness of Ayush Rasayana A and B on the Quality of Life of Older Adults: Protocol for a Cluster Randomized Controlled Trial %A Mundada,Pallavi %A Makhija,Deepa %A Mata,Sunita %A Kachare,Kalpana %A Manathottathil,Aparna %A Sharma,Abha %A Rao,Bhogavalli Chandra Sekhara %A Rana,Rakesh %A Tripathi,Arunabh %A Rana,Kiran %A Joshi,Vandana %A Raturi,Ashish %A Singh,Anukampa %A Srikanth,N %A Acharya,Rabinarayan %+ Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Government of India, 61-65, opp. D Block, Janakpuri Institutional Area, Janakpuri, New Delhi, 110058, India, 91 9911331074, drdeepamakhija@yahoo.co.in %K Ayush Rasayana A %K Ayush Rasayana B %K cluster-randomized trial %K geriatrics %K Ayurveda %K quality of life %K complementary and alternative medicine %D 2024 %7 11.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: With advancing age among older adults, the associated debilities increase, indicating a deteriorating health status as there is a gradual loss of muscle mass, strength, and functionality. Ayush Rasayana A and B are coded Ayurvedic medicines developed from herbal extracts. This study has been planned to prevent debilitating conditions and improve the quality of life (QOL) in older adults. Objective: This study aimed to assess the effectiveness of Ayush Rasayana A and B on the QOL, quality of sleep, and functionality of older adults, along with the tolerability of the intervention. Methods: This was a multicenter, open-label, cluster randomized controlled trial conducted with 720 participants aged 60 to 75 years. The participants were divided into 2 groups (intervention and control), with both receiving Ayurvedic ancillary treatment for 3 months. The intervention group additionally received 10 g of Ayush Rasayana A orally once daily at bedtime for 6 days, followed by 1.5 g of Ayush Rasayana B orally twice daily before food for the remaining 84 days. The assessment criteria included the Older People’s Quality of Life Questionnaire Brief, Katz Index of Independence in Activities of Daily Living, Pittsburgh Sleep Quality Index, Five Times Sit-to-Stand Test, and shoulder and scapular movements. Any change in hematological and biochemical parameters and occurrence of treatment-emergent adverse events were also assessed during the study period. Results: The recruitment of the participants started in December 2023, and the final follow-up was completed in April 2024. Out of the total 720 enrolled participants, 686 (95.3%) completed the study up to the last follow-up. Conclusions: This study may provide evidence-based data to establish preventive treatment protocols for enhancing the QOL and functionality among older adults. The study results may also be helpful for the planning of interdisciplinary health policies for improving the health conditions of different populations International Registered Report Identifier (IRRID): DERR1-10.2196/58186 %M 39527794 %R 10.2196/58186 %U https://www.researchprotocols.org/2024/1/e58186 %U https://doi.org/10.2196/58186 %U http://www.ncbi.nlm.nih.gov/pubmed/39527794 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59497 %T Data Analytics in Physical Activity Studies With Accelerometers: Scoping Review %A Liang,Ya-Ting %A Wang,Charlotte %A Hsiao,Chuhsing Kate %+ Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd, Taipei, 10055, Taiwan, 886 2 33668032, ckhsiao@ntu.edu.tw %K accelerometer %K association %K behavioral study %K classification %K digital biomarkers %K digital health %K physical activity %K prediction %K statistical method %K wearable %D 2024 %7 11.9.2024 %9 Review %J J Med Internet Res %G English %X Background: Monitoring free-living physical activity (PA) through wearable devices enables the real-time assessment of activity features associated with health outcomes and provision of treatment recommendations and adjustments. The conclusions of studies on PA and health depend crucially on reliable statistical analyses of digital data. Data analytics, however, are challenging due to the various metrics adopted for measuring PA, different aims of studies, and complex temporal variations within variables. The application, interpretation, and appropriateness of these analytical tools have yet to be summarized. Objective: This research aimed to review studies that used analytical methods for analyzing PA monitored by accelerometers. Specifically, this review addressed three questions: (1) What metrics are used to describe an individual’s free-living daily PA? (2) What are the current analytical tools for analyzing PA data, particularly under the aims of classification, association with health outcomes, and prediction of health events? and (3) What challenges exist in the analyses, and what recommendations for future research are suggested regarding the use of statistical methods in various research tasks? Methods: This scoping review was conducted following an existing framework to map research studies by exploring the information about PA. Three databases, PubMed, IEEE Xplore, and the ACM Digital Library, were searched in February 2024 to identify related publications. Eligible articles were classification, association, or prediction studies involving human PA monitored through wearable accelerometers. Results: After screening 1312 articles, 428 (32.62%) eligible studies were identified and categorized into at least 1 of the following 3 thematic categories: classification (75/428, 17.5%), association (342/428, 79.9%), and prediction (32/428, 7.5%). Most articles (414/428, 96.7%) derived PA variables from 3D acceleration, rather than 1D acceleration. All eligible articles (428/428, 100%) considered PA metrics represented in the time domain, while a small fraction (16/428, 3.7%) also considered PA metrics in the frequency domain. The number of studies evaluating the influence of PA on health conditions has increased greatly. Among the studies in our review, regression-type models were the most prevalent (373/428, 87.1%). The machine learning approach for classification research is also gaining popularity (32/75, 43%). In addition to summary statistics of PA, several recent studies used tools to incorporate PA trajectories and account for temporal patterns, including longitudinal data analysis with repeated PA measurements and functional data analysis with PA as a continuum for time-varying association (68/428, 15.9%). Conclusions: Summary metrics can quickly provide descriptions of the strength, frequency, and duration of individuals’ overall PA. When the distribution and profile of PA need to be evaluated or detected, considering PA metrics as longitudinal or functional data can provide detailed information and improve the understanding of the role PA plays in health. Depending on the research goal, appropriate analytical tools can ensure the reliability of the scientific findings. %M 39259962 %R 10.2196/59497 %U https://www.jmir.org/2024/1/e59497 %U https://doi.org/10.2196/59497 %U http://www.ncbi.nlm.nih.gov/pubmed/39259962 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57804 %T Measurement of Daily Actions Associated With Mental Health Using the Things You Do Questionnaire–15-Item: Questionnaire Development and Validation Study %A Bisby,Madelyne A %A Jones,Michael P %A Staples,Lauren %A Dear,Blake %A Titov,Nickolai %+ MindSpot Clinic, MQ Health, Macquarie University, 16 University Avenue, Macquarie Park, 2109, Australia, 61 298508724, madelyne.bisby@mq.edu.au %K daily actions %K depression %K anxiety %K psychometric %K mental health %K questionnaire %K activities %K goals %K plans %K healthy habits %K habits %K psychometric %K treatment-seeking %K treatment %K confirmatory factor analysis %K survey %K adult %K adult %K assessment %K digital psychology service %K digital %K psychology %K depression symptoms %K anxiety symptoms %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A large number of modifiable and measurable daily actions are thought to impact mental health. The “Things You Do” refers to 5 types of daily actions that have been associated with mental health: healthy thinking, meaningful activities, goals and plans, healthy habits, and social connections. Previous studies have reported the psychometric properties of the Things You Do Questionnaire (TYDQ)–21-item (TYDQ21). The 21-item version, however, has an uneven distribution of items across the 5 aforementioned factors and may be lengthy to administer on a regular basis. Objective: This study aimed to develop and evaluate a brief version of the TYDQ. To accomplish this, we identified the top 10 and 15 items on the TYDQ21 and then evaluated the performance of the 10-item and 15-item versions of the TYDQ in community and treatment-seeking samples. Methods: Using confirmatory factor analysis, the top 2 or 3 items were used to develop the 10-item and 15-item versions, respectively. Model fit, reliability, and validity were examined for both versions in 2 samples: a survey of community adults (n=6070) and adults who completed an assessment at a digital psychology service (n=14,878). Treatment responsivity was examined in a subgroup of participants (n=448). Results: Parallel analysis supported the 5-factor structure of the TYDQ. The brief (10-item and 15-item) versions were associated with better model fit than the 21-item version, as revealed by its comparative fit index, root-mean-square error of approximation, and Tucker-Lewis index. Configural, metric, and scalar invariance were supported. The 15-item version explained more variance in the 21-item scores than the 10-item version. Internal consistency was appropriate (eg, the 15-item version had a Cronbach α of >0.90 in both samples) and there were no marked differences between how the brief versions correlated with validated measures of depression or anxiety symptoms. The measure was responsive to treatment. Conclusions: The 15-item version is appropriate for use as a brief measure of daily actions associated with mental health while balancing brevity and clinical utility. Further research is encouraged to replicate our psychometric evaluation in other settings (eg, face-to-face services). Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613000407796; https://tinyurl.com/2s67a6ps %M 39038286 %R 10.2196/57804 %U https://formative.jmir.org/2024/1/e57804 %U https://doi.org/10.2196/57804 %U http://www.ncbi.nlm.nih.gov/pubmed/39038286 %0 Journal Article %@ 2291-9279 %I %V 12 %N %P e58411 %T Effect of Elastic Resistance on Exercise Intensity and User Satisfaction While Playing the Active Video Game BoxVR in Immersive Virtual Reality: Empirical Study %A Polechoński,Jacek %A Przepiórzyński,Alan %A Polechoński,Piotr %A Tomik,Rajmund %K virtual reality %K VR %K game %K gaming %K immersive %K immersion %K health-related physical activity %K physical activity %K exercise %K active video games %K attractiveness %K enjoyment scale %K enjoyment %K serious games %K elastic resistance %K resistance %D 2024 %7 16.7.2024 %9 %J JMIR Serious Games %G English %X Background: One of the main contemporary forms of physical activity (PA) involves exercises and games in an immersive virtual reality (VR) environment, which allows the user to practice various forms of PA in a small space. Unfortunately, most of the currently available VR games and workout applications are mostly based on upper body movements, especially the arms, which do not guarantee sufficiently high exercise intensity and health benefits. Therefore, it is worth seeking solutions to help increase the exercise load during PA in VR. Objective: The main aim of this study was to evaluate the effect of elastic arm resistance in the form of latex resistance bands of different elasticity levels on the intensity of students’ PA while playing the BoxVR game. We further assessed the satisfaction of this form of exercise and its associations with PA intensity. Methods: A total of 21 healthy and physically fit men (mean age 22.5, SD 2.0 years) were included in the study. The tests consisted of 3 10-minute games. One game was run with no load and the other two were run with 1.5-meter latex resistance bands (low and high resistance). The order of the tests was randomized and the participants rested for 20 minutes after each exercise. Exercise intensity was estimated using objective (heart rate monitoring) and subjective (Borg scale) methods. The Physical Activity Enjoyment Scale was used to assess satisfaction with the PA. The effect of elastic resistance on exercise intensity and user enjoyment was estimated using ANOVA for repeated measures. Results: The ANOVA results indicated that incorporation of elastic resistance caused a significant change (F2,40=20.235, P<.001; η²p=0.503) in the intensity of PA in VR, which was low while playing without resistance and then increased to a moderate level with additional resistance. The use of elastic bands also changed participants’ perceptions of the enjoyment of exercise in VR (F2,40=9.259, P<.001; η²p=0.316). The students rated their satisfaction with PA in VR on a 7-point scale highly and similarly when exercising without an upper limb load (mean 6.19, SD 0.61) and with slight elastic resistance (mean 6.17, SD 0.66), whereas their satisfaction declined significantly (mean 5.66, SD 0.94) when incorporating a higher load. Conclusions: The intensity of PA among students playing the BoxVR game is at a relatively low level. With the added resistance of elastic bands attached to the upper limbs, the intensity of the exercise increased to a moderate level, as recommended for obtaining health benefits. Participants rated the enjoyment of PA in VR highly. The use of slight elastic resistance did not negatively affect satisfaction with the BoxVR game, although user satisfaction declined with a higher load. Further research should be undertaken to increase the effectiveness of exercise in VR so that regular users can enjoy the health benefits. %R 10.2196/58411 %U https://games.jmir.org/2024/1/e58411 %U https://doi.org/10.2196/58411 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50542 %T Effect of Menstrual Cycle and Hormonal Contraception on Musculoskeletal Health and Performance: Protocol for a Prospective Cohort Design and Cross-Sectional Comparison %A Myers,Sarah J %A Knight,Rebecca L %A Wardle,Sophie L %A Waldock,Kirsty AM %A O'Leary,Thomas J %A Jones,Richard K %A Muckelt,Paul E %A Eisenhauer,Anton %A Tang,Jonathan CY %A Fraser,William D %A Greeves,Julie P %+ Army Health and Performance Research, Army Headquarters, Army Health Branch, Blenheim Building, Marlborough Lines, Andover, SP11 8HT, United Kingdom, 44 0 3001579149, julie.greeves143@mod.gov.uk %K estrogens %K oestradiol %K progesterone %K calcium %K musculoskeletal health %K hormonal contraceptive %D 2024 %7 11.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Women of reproductive age experience cyclical variation in the female sex steroid hormones 17β-estradiol and progesterone during the menstrual cycle that is attenuated by some hormonal contraceptives. Estrogens perform a primary function in sexual development and reproduction but have nonreproductive effects on bone, muscle, and sinew tissues (ie, ligaments and tendons), which may influence injury risk and physical performance. Objective: The purpose of the study is to understand the effect of the menstrual cycle and hormonal contraceptive use on bone and calcium metabolism, and musculoskeletal health and performance. Methods: A total of 5 cohorts of physically active women (aged 18-40 years) will be recruited to participate: eumenorrheic, nonhormonal contraceptive users (n=20); combined oral contraceptive pill (COCP) users (n=20); hormonal implant users (n=20); hormonal intrauterine system users (n=20); and hormonal injection users (n=20). Participants must have been using the COCP and implant for at least 1 year and the intrauterine system and injection for at least 2 years. First-void urine samples and fasted blood samples will be collected for biochemical analysis of calcium and bone metabolism, hormones, and metabolic markers. Knee extensor and flexor strength will be measured using an isometric dynamometer, and lower limb tendon and stiffness, tone, and elasticity will be measured using a Myoton device. Functional movement will be assessed using a single-leg drop to assess the frontal plane projection angle and the qualitative assessment of single leg loading. Bone density and macro- and microstructure will be measured using ultrasound, dual-energy x-ray absorptiometry, and high-resolution peripheral quantitative computed tomography. Skeletal material properties will be estimated from reference point indentation, performed on the flat surface of the medial tibia diaphysis. Body composition will be assessed by dual-energy x-ray absorptiometry. The differences in outcome measures between the hormonal contraceptive groups will be analyzed in a one-way between-group analysis of covariance. Within the eumenorrheic group, the influence of the menstrual cycle on outcome measures will be assessed using a linear mixed effects model. Within the COCP group, differences across 2 time points will be analyzed using the paired-samples 2-tailed t test. Results: The research was funded in January 2020, and data collection started in January 2022, with a projected data collection completion date of August 2024. The number of participants who have consented at the point of manuscript submission is 66. It is expected that all data analysis will be completed and results published by the end of 2024. Conclusions: Understanding the effects of the menstrual cycle and hormonal contraception on musculoskeletal health and performance will inform contraceptive choices for physically active women to manage injury risk. Trial Registration: ClinicalTrials.gov NCT05587920; https://classic.clinicaltrials.gov/ct2/show/NCT05587920 International Registered Report Identifier (IRRID): DERR1-10.2196/50542 %M 38990638 %R 10.2196/50542 %U https://www.researchprotocols.org/2024/1/e50542 %U https://doi.org/10.2196/50542 %U http://www.ncbi.nlm.nih.gov/pubmed/38990638 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e52811 %T Quality of Life, Physical Activity Participation, and Perceptions of Physical Rehabilitation Among Community-Reintegrated Veterans With Lower Limb Amputation in Sri Lanka: Convergent Parallel Mixed Methods Study %A Wijekoon,Ashan %A Gamage Dona,Dilanthi %A Jayawardana,Subashini %A Beane,Abigail %+ Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo, 00800, Sri Lanka, 94 112695300, ashan@nicslk.com %K amputation %K community-based rehabilitation %K lower limb %K military %K physical activity %K quality of life %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Lower limb amputation (LLA) impacts physical activity (PA) participation and quality of life (QoL). To minimize the effects of these challenges, LLA survivors need to have opportunities to engage in appropriately tailored rehabilitation throughout their lives. However, in Sri Lanka, where a 3-decade civil war resulted in trauma-related LLA among young male soldiers, access to rehabilitation was limited to the immediate postinjury period. Developing rehabilitation interventions for these veterans requires an understanding of their current health status and rehabilitation perceptions. Objective: This study was conducted to evaluate the QoL and PA participation of veterans with LLA and explore perceptions of factors influencing their PA participation and expectations for a future community-based physical rehabilitation (CBPR) intervention. Methods: This mixed methods study combined a comparative cross-sectional quantitative survey with qualitative semistructured interviews in 5 districts of Sri Lanka. QoL and PA participation were assessed among community-reintegrated veterans with LLA (n=85) and compared with a matched able-bodied cohort (control; n=85) using Mann-Whitney U and Chi-square tests. PA was assessed in terms of metabolic equivalent of task (MET) minutes per week and was computed for walking, moderate-intensity, and vigorous-intensity activities. PA was classified as sufficiently active, low, or sedentary. The design of interview questions was guided by the Theoretical Domains Framework and followed a phenomenological approach. Interviews were conducted with 25 veterans and were analyzed thematically, and the perceptions regarding PA participation and CBPR were codified using the Consolidated Framework for Implementation Research (CFIR). Results: Based on the quantitative survey findings, scores for both physical (P<.001) and psychological (P<.001) well-being and participation in walking (P=.004) and vigorous-intensity activities (P<.001) were significantly lower among veterans than among controls. A “sedentary” classification was made for 43% (34/79) of veterans and 12% (10/82) of controls. Veterans mostly engaged in moderate-intensity PA inside the house (49/79, 62%) and in the yard (30/79, 38%). Qualitative interviews revealed that barriers to PA exist at individual (eg, comorbidity burden), primary care (eg, absence of community rehabilitation services), and policy levels (eg, limited resources) and facilitators exist primarily at societal (eg, inclusive community) and individual levels (eg, preinjury activity baseline and positive attitudes toward exercise). Expectations regarding CBPR included individualized rehabilitation parameters; functional exercises; and involvement of peers, amputee societies, and community health care providers. The nonresponse rate for interviews was 7% (2/27). Conclusions: The findings of reduced PA participation, poor QoL, and physical and psychological impairments among relatively young veterans reveal the long-term impacts of living with LLA in the absence of long-term rehabilitation. Policy-level changes need to be implemented along with behavior-change strategies to promote PA participation and minimize physical inactivity–induced health issues. Veterans’ perceptions regarding future CBPR programs were positive and centered on holistic, individualized, and peer-led activities. %M 38869933 %R 10.2196/52811 %U https://rehab.jmir.org/2024/1/e52811 %U https://doi.org/10.2196/52811 %U http://www.ncbi.nlm.nih.gov/pubmed/38869933 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50957 %T The Influence of Incentive-Based Mobile Fitness Apps on Users’ Continuance Intention With Gender Moderation Effects: Quantitative and Qualitative Study %A Faizah,Aaya %A Hardian,Alifah Fatimah Azzahra %A Nandini,Rania Devina %A Handayani,Putu Wuri %A Harahap,Nabila Cyldea %+ Faculty of Computer Science, University of Indonesia, Kampus UI, Depok, 16424, Indonesia, 62 217863419, Putu.wuri@cs.ui.ac.id %K incentive %K fitness %K mobile fitness apps %K gender %K continuance usage intention %K Indonesia %K mobile phone %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A survey conducted by McKinsey & Company reported that, as of May 2022, as many as 26% of Indonesians had recently started to engage actively in physical activity, 32% undertook regular physical activity, and 9% exercised intensely. The Fourth Industrial Revolution has spurred the rapid development of mobile fitness apps (MFAs) used to track people’s sports activities. However, public interest in using these apps for any length of time is still relatively low. Objective: In this study, we aimed to determine the effect of incentives (eg, self-monitoring, social support, platform rewards, and external influence) on the use of MFAs and the moderating effect of gender on users’ continuance usage intention. Methods: The study used a mixed methods approach. Quantitative data were collected through a web-based questionnaire and qualitative data from interviews with 30 respondents. The quantitative data, collected from 379 valid responses, were processed using covariance-based structural equation modeling. The qualitative data were processed using thematic analysis. The MFAs included in this research were those used as sports or physical activity trackers, such as Apple Fitness, Strava, Nike Run Club, and Fita. Results: The results of the data analysis show that 3 groups of incentives, namely, self-monitoring, platform rewards, and external influence (with the exception of social support), affect the perceived usefulness of these apps. Gender was also shown to moderate user behavior in relation to physical activity. The study showed that women were more likely to be motivated to exercise by social and external factors, while men paid greater attention to the tracking features of the app and to challenges and rewards. Conclusions: This research contributes to the field of health promotion by providing guidance for MFA developers. %M 38837199 %R 10.2196/50957 %U https://humanfactors.jmir.org/2024/1/e50957 %U https://doi.org/10.2196/50957 %U http://www.ncbi.nlm.nih.gov/pubmed/38837199 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e53020 %T Characterizing Walking Behaviors in Aged Residential Care Using Accelerometry, With Comparison Across Care Levels, Cognitive Status, and Physical Function: Cross-Sectional Study %A Mc Ardle,Ríona %A Taylor,Lynne %A Cavadino,Alana %A Rochester,Lynn %A Del Din,Silvia %A Kerse,Ngaire %K residential aged care facility %K cognitive dysfunction %K mobility limitation %K accelerometry %K physical activity %K aged residential care %D 2024 %7 4.6.2024 %9 %J JMIR Aging %G English %X Background: Walking is important for maintaining physical and mental well-being in aged residential care (ARC). Walking behaviors are not well characterized in ARC due to inconsistencies in assessment methods and metrics as well as limited research regarding the impact of care environment, cognition, or physical function on these behaviors. It is recommended that walking behaviors in ARC are assessed using validated digital methods that can capture low volumes of walking activity. Objective: This study aims to characterize and compare accelerometry-derived walking behaviors in ARC residents across different care levels, cognitive abilities, and physical capacities. Methods: A total of 306 ARC residents were recruited from the Staying UpRight randomized controlled trial from 3 care levels: rest home (n=164), hospital (n=117), and dementia care (n=25). Participants’ cognitive status was classified as mild (n=87), moderate (n=128), or severe impairment (n=61); physical function was classified as high-moderate (n=74) and low-very low (n=222) using the Montreal Cognitive Assessment and the Short Physical Performance Battery cutoff scores, respectively. To assess walking, participants wore an accelerometer (Axivity AX3; dimensions: 23×32.5×7.6 mm; weight: 11 g; sampling rate: 100 Hz; range: ±8 g; and memory: 512 MB) on their lower back for 7 days. Outcomes included volume (ie, daily time spent walking, steps, and bouts), pattern (ie, mean walking bout duration and alpha), and variability (of bout length) of walking. Analysis of covariance was used to assess differences in walking behaviors between groups categorized by level of care, cognition, or physical function while controlling for age and sex. Tukey honest significant difference tests for multiple comparisons were used to determine where significant differences occurred. The effect sizes of group differences were calculated using Hedges g (0.2-0.4: small, 0.5-0.7: medium, and 0.8: large). Results: Dementia care residents showed greater volumes of walking (P<.001; Hedges g=1.0-2.0), with longer (P<.001; Hedges g=0.7-0.8), more variable (P=.008 vs hospital; P<.001 vs rest home; Hedges g=0.6-0.9) bouts compared to other care levels with a lower alpha score (vs hospital: P<.001; Hedges g=0.9, vs rest home: P=.004; Hedges g=0.8). Residents with severe cognitive impairment took longer (P<.001; Hedges g=0.5-0.6), more variable (P<.001; Hedges g=0.4-0.6) bouts, compared to those with mild and moderate cognitive impairment. Residents with low-very low physical function had lower walking volumes (total walk time and bouts per day: P<.001; steps per day: P=.005; Hedges g=0.4-0.5) and higher variability (P=.04; Hedges g=0.2) compared to those with high-moderate capacity. Conclusions: ARC residents across different levels of care, cognition, and physical function demonstrate different walking behaviors. However, ARC residents often present with varying levels of both cognitive and physical abilities, reflecting their complex multimorbid nature, which should be considered in further work. This work has demonstrated the importance of considering a nuanced framework of digital outcomes relating to volume, pattern, and variability of walking behaviors among ARC residents. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001827224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376298&isReview=true %R 10.2196/53020 %U https://aging.jmir.org/2024/1/e53020 %U https://doi.org/10.2196/53020 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51546 %T Highlighting Unseen Activity Through 48-Hour Continuous Measurement in Subacute Stroke Rehabilitation: Preliminary Cohort Study %A Mizuno,Emi %A Ogasawara,Takayuki %A Mukaino,Masahiko %A Yamaguchi,Masumi %A Tsukada,Shingo %A Sonoda,Shigeru %A Otaka,Yohei %+ Department of Rehabilitation Medicine, Hokkaido University Hospital, Kita14, Nishi5, Kita-ku, Sapporo, 0608648, Japan, 81 117066066, masahikovn@gmail.com %K activity monitoring %K smart clothing system %K stroke %K unseen %K monitoring %K recovery %K physical condition %K deconditioning %K muscle wasting %K wearable technology %K wearable %K activity level %K rehabilitation %K physical therapy %K heart rate %K ADL %K activities of daily living %K training %K older people %K mobile phone %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Motor impairments not only lead to a significant reduction in patient activity levels but also trigger a further deterioration in motor function due to deconditioning, which is an issue that is particularly pronounced during hospitalization. This deconditioning can be countered by sustaining appropriate activity levels. Activities that occur outside of scheduled programs, often overlooked, are critical in this context. Wearable technology, such as smart clothing, provides a means to monitor these activities. Objective: This study aimed to observe activity levels in patients who had strokes during the subacute phase, focusing on both scheduled training sessions and other nontraining times in an inpatient rehabilitation environment. A smart clothing system is used to simultaneously measure heart rate and acceleration, offering insights into both the amount and intensity of the physical activity. Methods: In this preliminary cohort study, 11 individuals undergoing subacute stroke rehabilitation were enrolled. The 48-hour continuous measurement system, deployed at admission and reassessed 4 weeks later, monitored accelerometry data for physical activity (quantified with a moving SD of acceleration [MSDA]) and heart rate for intensity (quantified with percent heart rate reserve). The measurements were performed using a wearable activity monitoring system, the hitoe (NTT Corporation and Toray Industries, Inc) system comprising a measuring garment (wear or strap) with integrated electrodes, a data transmitter, and a smartphone. The Functional Independence Measure was used to assess the patients’ daily activity levels. This study explored factors such as differences in activity during training and nontraining periods, correlations with activities of daily living (ADLs) and age, and changes observed after 4 weeks. Results: A significant increase was found in the daily total MSDA after the 4-week program, with the average percent heart rate reserve remaining consistent. Physical activity during training positively correlated with ADL levels both at admission (ρ=0.86, P<.001) and 4 weeks post admission (ρ=0.96, P<.001), whereas the correlation between age and MSDA was not significant during training periods at admission (ρ=–0.41, P=.21) or 4 weeks post admission (ρ=–0.25, P=.45). Conversely, nontraining activity showed a negative correlation with age, with significant negative correlations with age at admission (ρ=–0.82, P=.002) and 4 weeks post admission (ρ=–0.73, P=.01). Conclusions: Inpatient rehabilitation activity levels were positively correlated with ADL levels. Further analysis revealed a strong positive correlation between scheduled training activities and ADL levels, whereas nontraining activities showed no such correlation. Instead, a negative correlation between nontraining activities and age was observed. These observations suggest the importance of providing activity opportunities for older patients, while it may also suggest the need for adjusting the activity amount to accommodate the potentially limited fitness levels of this demographic. Future studies with larger patient groups are warranted to validate and further elucidate these findings. %M 38809596 %R 10.2196/51546 %U https://formative.jmir.org/2024/1/e51546 %U https://doi.org/10.2196/51546 %U http://www.ncbi.nlm.nih.gov/pubmed/38809596 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53442 %T Digital Food Frequency Questionnaire Assessing Adherence to the Norwegian Food–Based Dietary Guidelines and Other National Lifestyle Recommendations: Instrument Validation Study %A Henriksen,Hege Berg %A Knudsen,Markus Dines %A Hjartåker,Anette %A Blomhoff,Rune %A Carlsen,Monica Hauger %+ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, PO Box 1046, Blindern, Oslo, 0372, Norway, 47 99459673, h.b.henriksen@medisin.uio.no %K digital food frequency questionnaire %K lifestyle assessment tool %K relative validity %K physical activity %K Norwegian food–based dietary guidelines %K Norway %K Norwegian %K food %K foods %K diet %K dietary %K lifestyle %K assessment %K digital questionnaire %K investigation %K food intake %K dietary intake %K dietary intakes %K observation %K monitoring %K youths %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K cross-sectional study %D 2024 %7 30.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Valid assessment tools are needed when investigating adherence to national dietary and lifestyle guidelines. Objective: The relative validity of the new digital food frequency questionnaire, the DIGIKOST-FFQ, against 7-day weighed food records and activity sensors was investigated. Methods: In total, 77 participants were included in the validation study and completed the DIGIKOST-FFQ and the weighed food record, and of these, 56 (73%) also used the activity sensors. The DIGIKOST-FFQ estimates the intake of foods according to the Norwegian food–based dietary guidelines (FBDGs) in addition to lifestyle factors. Results: At the group level, the DIGIKOST-FFQ showed good validity in estimating intakes according to the Norwegian FBDG. The median differences were small and well below portion sizes for all foods except “water” (median difference 230 g/day). The DIGIKOST-FFQ was able to rank individual intakes for all foods (r=0.2-0.7). However, ranking estimates of vegetable intakes should be interpreted with caution. Between 69% and 88% of the participants were classified into the same or adjacent quartile for foods and between 71% and 82% for different activity intensities. The Bland-Altman plots showed acceptable agreements between DIGIKOST-FFQ and the reference methods. The absolute amount of time in “moderate to vigorous intensity” was underestimated with the DIGIKOST-FFQ. However, estimated time in “moderate to vigorous intensity,” “vigorous intensity,” and “sedentary time” showed acceptable correlations and good agreement between the methods. The DIGIKOST-FFQ was able to identify adherence to the Norwegian FBDG and physical activity recommendations. Conclusions: The DIGIKOST-FFQ gave valid estimates of dietary intakes and was able to identify individuals with different degrees of adherence to the Norwegian FBDG and physical activity recommendations. Moderate physical activity was underreported, water was overreported, and vegetables showed poor correlation, which are important to consider when interpreting the data. Good agreement was observed between the methods in estimating dietary intakes and time in “moderate to vigorous physical activity,” “sedentary time,” and “sleep.” %M 38687986 %R 10.2196/53442 %U https://www.jmir.org/2024/1/e53442 %U https://doi.org/10.2196/53442 %U http://www.ncbi.nlm.nih.gov/pubmed/38687986 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50996 %T Association Between Frequency of Muscle-Strengthening Exercise and Depression Symptoms Among Middle and High School Students: Cross-Sectional Survey Study %A Wang,Hao %A Du,Huaidong %A Guan,Yunqi %A Zhong,Jieming %A Li,Na %A Pan,Jin %A Yu,Min %+ Department of Noncommunicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang Distric, Hangzhou, 310051, China, 86 571 87115005, zjcdcmyu@163.com %K depression symptoms %K muscle-strengthening exercise %K adolescents %K cross-sectional study %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Existing literature on the association between the frequency of muscle-strengthening exercise (MSE) and depression among adolescents is limited and contradictory. Objective: This study aimed to elucidate the association of MSE frequency with depression symptoms among middle and high school students in China. Methods: A total of 27,070 students in grades 7-12 from 376 middle and high schools were surveyed using an anonymous self-administered questionnaire between April and June 2022. Information on engaging in MSE was self-reported, and depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Poisson regression was used to examine the association between MSE frequency and depression symptoms. Results: Among the 27,006 eligible students, 51.6% (n=13,933) were boys, and the mean age was 15.6 (SD 1.7) years. The overall prevalence of meeting MSE recommendations (ie, engaging in MSE ≥3 days/week) was 34.6% (95% CI 32.6%-36.6%; n=9145); the prevalence was higher in boys (43.8%, 95% CI 41.8%-45.8%; 6067/13,933) than in girls (24.3%, 95% CI 22%-26.6%; 3078/13,073; P<.001). A total of 5882 (21.8%) students reported having depression symptoms. After adjustment for sociodemographic status, lifestyle factors, academic performance, and experience of physical fighting, compared to students who did not engage in MSE, the prevalence ratios (PRs) for depression symptoms were 0.98 (95% CI 0.97-0.99) for those engaging in MSE once a week, 0.95 (95% CI 0.93-0.97) for 2 days/week, 0.93 (95% CI 0.90-0.96) for 3 days/week, 0.90 (95% CI 0.87-0.94) for 4 days/week, 0.88 (95% CI 0.84-0.93) for 5 days/week, 0.86 (95% CI 0.81-0.92) for 6 days/week, and 0.84 (95% CI 0.78-0.90) for 7 days/week, respectively. Conclusions: The overall prevalence of meeting MSE recommendations among Chinese adolescents is low. The frequency of MSE was inversely associated with depression symptoms. %M 38630529 %R 10.2196/50996 %U https://publichealth.jmir.org/2024/1/e50996 %U https://doi.org/10.2196/50996 %U http://www.ncbi.nlm.nih.gov/pubmed/38630529 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55795 %T Examining and Comparing the Validity and Reproducibility of Scales to Determine the Variety of Vegetables Consumed: Validation Study %A Ominami,Kaya %A Kushida,Osamu %+ Department of Nutrition and Life Sciences, School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan, 81 542645832, kushida@u-shizuoka-ken.ac.jp %K vegetable %K variety %K scale %K validity %K reproducibility %K dietary records %K nutrition %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous studies have reported that vegetable variety reduces the risk for noncommunicable diseases independent of the amount consumed. Objective: This study aimed to examine and compare the validity and reproducibility of several scales to determine vegetable variety. Methods: In total, 23 nutrition students in Japan reported their vegetable intake over the past month using a self-administered questionnaire between July and August 2021. Specifically, four scales were used: (1) a single question regarding the number of vegetables consumed (scale A); (2) a scale containing 9 vegetable subgroups included in the brief-type self-administered diet history questionnaire (scale B); (3) a scale containing 19 vegetable items included in a self-administered diet history questionnaire (scale C); and (4) a scale containing 20 vegetable items from the Ranking of Vegetable Consumers in Japan, which was analyzed based on a report on the National Health and Nutrition Survey in Japan (scale D). Scale validity was assessed by correlation with the number of vegetables consumed, which was collected from dietary records for 7 consecutive days. Reproducibility was assessed by test-retest reliability. Results: Regarding the validity of the 4 scales, significant correlations were found between scales C (ρ=0.51) and D (ρ=0.44) with vegetable variety based on dietary records, but scales A (ρ=0.28) and B (ρ=0.22) were not significantly correlated. Reproducibility showed a significant correlation in scale B (ρ=0.45) and strong correlations in scales C (ρ=0.73) and D (ρ=0.75). Conclusions: The scales for vegetable items have acceptable validity and reproducibility compared to the scales that used a single question or vegetable subgroup and, therefore, may determine the variety of vegetables consumed. %M 38603775 %R 10.2196/55795 %U https://formative.jmir.org/2024/1/e55795 %U https://doi.org/10.2196/55795 %U http://www.ncbi.nlm.nih.gov/pubmed/38603775 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49772 %T Association Between Physical Activity and the Risk of Burnout in Health Care Workers: Systematic Review %A Mincarone,Pierpaolo %A Bodini,Antonella %A Tumolo,Maria Rosaria %A Sabina,Saverio %A Colella,Riccardo %A Mannini,Linda %A Sabato,Eugenio %A Leo,Carlo Giacomo %+ Biological and Environmental Sciences and Technology Department, University of Salento, Strada per Monteroni, Lecce, 73100, Italy, 1 3890118275, mariarosaria.tumolo@unisalento.it %K burnout %K Maslach Burnout Inventory %K MBI %K Copenhagen Burnout Inventory %K CBI %K Professional Fulfillment Index %K PFI %K physical activity %K health care workers %K public health policy %D 2024 %7 18.3.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Burnout is a multidimensional psychological syndrome that arises from chronic workplace stress. Health care workers (HCWs), who operate in physically and emotionally exhausting work contexts, constitute a vulnerable group. This, coupled with its subsequent impact on patients and public economic resources, makes burnout a significant public health concern. Various self-care practices have been suggested to have a positive effect on burnout among HCWs. Of these, physical activity stands out for its ability to combine psychological, physiological, and biochemical mechanisms. In fact, it promotes psychological detachment from work and increases self-efficacy by inhibiting neurotransmitters and neuromodulators, increasing endorphin levels, enhancing mitochondrial function, and attenuating the hypothalamic pituitary-adrenal axis response to stress. Objective: Our objective was to conduct a systematic review of the evidence on the association between physical activity and burnout among HCWs. Methods: We considered HCWs, physical activity, and burnout, framing them as population, exposure, and outcome, respectively. We searched APA PsycArticles, MEDLINE, and Scopus until July 2022. We extracted relevant data on study design, methods to measure exposure and outcome, and statistical approaches. Results: Our analysis encompassed 21 independent studies. Although 10% (2/21) of the studies explicitly focused on physical activity, the remaining investigations were exploratory in nature and examined various predictors, including physical activity. The most commonly used questionnaire was the Maslach Burnout Inventory. Owing to the heterogeneity in definitions and cutoffs used, the reported prevalence of burnout varied widely, ranging from 7% to 83%. Heterogeneity was also observed in the measurement tools used to assess physical activity, with objective measures rarely used. In total, 14% (3/21) of the studies used structured questionnaires to assess different types of exercise, whereas most studies (18/21, 86%) only recorded the attainment of a benchmark or reported the frequency, intensity, or duration of exercise. The reported prevalence of physically active HCWs ranged from 44% to 87%. The analyses, through a variety of inferential approaches, indicated that physical activity is often associated with a reduced risk of burnout, particularly in the domains of emotional exhaustion and depersonalization. Furthermore, we compiled and classified a list of factors associated with burnout. Conclusions: Our comprehensive overview of studies investigating the association between physical activity and burnout in HCWs revealed significant heterogeneity in definitions, measurements, and analyses adopted in the literature. To address this issue, it is crucial to adopt a clear definition of physical activity and make thoughtful choices regarding measurement tools and methodologies for data analysis. Our considerations regarding the measurement of burnout and the comprehensive list of associated factors have the potential to improve future studies aimed at informing decision-makers, thus laying the foundation for more effective management measures to address burnout. %M 38498040 %R 10.2196/49772 %U https://publichealth.jmir.org/2024/1/e49772 %U https://doi.org/10.2196/49772 %U http://www.ncbi.nlm.nih.gov/pubmed/38498040 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e51962 %T The Potential of Exercise on Lifestyle and Skin Function: Narrative Review %A Oizumi,Ryosuke %A Sugimoto,Yoshie %A Aibara,Hiromi %+ Faculty of Nursing, Shijonawate gakuen University, Gakuen-cyo, 6-45, Osaka, Daito-shi, 574-0001, Japan, 81 72 813 2601, r-oizumi@un.shijonawate-gakuen.ac.jp %K skin function %K lifestyle %K exercise %K reviews %K knowledge synthesis %K Review methods %K review methodology %K literature review %K literature reviews %K narrative review %K narrative reviews %K skin %K dermatology %K exercise %K physical activity %K fitness %K lifestyles %K smoking %K diet %K sleep %K sugar intake %K life habits %K skin barrier %D 2024 %7 14.3.2024 %9 Review %J JMIR Dermatol %G English %X Background: The skin is an important organ of the human body and has moisturizing and barrier functions. Factors such as sunlight and lifestyle significantly affect these skin functions, with sunlight being extremely damaging. The effects of lifestyle habits such as smoking, diet, and sleep have been studied extensively. It has been found that smoking increases the risk of wrinkles, while excessive fat and sugar intake leads to skin aging. Lack of sleep and stress are also dangerous for the skin’s barrier function. In recent years, the impact of exercise habits on skin function has been a focus of study. Regular exercise is associated with increased blood flow to the skin, elevated skin temperature, and improved skin moisture. Furthermore, it has been shown to improve skin structure and rejuvenate its appearance, possibly through promoting mitochondrial biosynthesis and affecting hormone secretion. Further research is needed to understand the effects of different amounts and content of exercise on the skin. Objective: This study aims to briefly summarize the relationship between lifestyle and skin function and the mechanisms that have been elucidated so far and introduce the expected effects of exercise on skin function. Methods: We conducted a review of the literature using PubMed and Google Scholar repositories for relevant literature published between 2000 and 2022 with the following keywords: exercise, skin, and life habits. Results: Exercise augments the total spectrum power density of cutaneous blood perfusion by a factor of approximately 8, and vasodilation demonstrates an enhancement of approximately 1.5-fold. Regular exercise can also mitigate age-related skin changes by promoting mitochondrial biosynthesis. However, not all exercise impacts are positive; for instance, swimming in chlorinated pools may harm the skin barrier function. Hence, the exercise environment should be considered for its potential effects on the skin. Conclusions: This review demonstrates that exercise can potentially enhance skin function retention. %M 38483460 %R 10.2196/51962 %U https://derma.jmir.org/2024/1/e51962 %U https://doi.org/10.2196/51962 %U http://www.ncbi.nlm.nih.gov/pubmed/38483460 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51562 %T Lifestyle Medicine Implementation in 8 Health Systems: Protocol for a Multiple Case Study Investigation %A Ames,Meghan L %A Karlsen,Micaela C %A Sundermeir,Samantha M %A Durrwachter,Neve %A Hemmingson,Tyler A %A Reznar,Melissa M %A Staffier,Kara Livingston %A Weeks,Bruce %A Gittelsohn,Joel %+ Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, United States, 1 4105168000, meghan.ames@jhu.edu %K healthy lifestyle %K implementation science %K lifestyle medicine %K multiple case study %K noncommunicable diseases %K prevention %K qualitative methods %D 2024 %7 13.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Lifestyle medicine (LM) is the use of therapeutic lifestyle changes (including a whole-food, plant-predominant eating pattern; regular physical activity; restorative sleep; stress management; avoidance of risky substances; and positive social connection) to prevent and treat chronic illness. Despite growing evidence, LM is still not widely implemented in health care settings. Potential challenges to LM implementation include lack of clinician training, staffing concerns, and misalignment of LM services with fee-for-service reimbursement, but the full range of factors facilitating or obstructing its implementation and long-term success are not yet understood. To learn important lessons for success and failure, it is crucial to understand the experiences of different LM programs. Objective: This study aims to describe in depth the protocol used to identify barriers and facilitators impacting the implementation of LM in health systems. Methods: The study team comprises team members at the American College of Lifestyle Medicine (ACLM), including staff and researchers with expertise in public health, LM, and qualitative research. We recruited health systems that were members of the ACLM Health Systems Council. From among 15 self-nominating health systems, we selected 7 to represent a diversity of geographic location, type, size, expertise, funding, patients, and LM services. Partway through the study, we recruited 1 additional contrasting health system to serve as a negative case. For each case, we conducted in-depth interviews, document reviews, site visits (limited due to the COVID-19 pandemic), and study team debriefs. Interviews lasted 45-90 minutes and followed a semistructured interview guide, loosely based on the Consolidated Framework for Implementation Research (CFIR) model. We are constructing detailed case narrative reports for each health system that are subsequently used in cross-case analyses to develop a contextually rich and detailed understanding of various predetermined and emergent topics. Cross-case analyses will draw on a variety of methodologies, including in-depth case familiarization, inductive or deductive coding, and thematic analysis, to identify cross-cutting themes. Results: The study team has completed data collection for all 8 participating health systems, including 68 interviews and 1 site visit. We are currently drafting descriptive case narratives, which will be disseminated to participating health systems for member checking and shared broadly as applied vignettes. We are also conducting cross-case analyses to identify critical facilitators and barriers, explore clinician training strategies to facilitate LM implementation, and develop an explanatory model connecting practitioner adoption of LM and experiences of burnout. Conclusions: This protocol paper offers real-world insights into research methods and practices to identify barriers and facilitators to the implementation of LM in health systems. Findings can advise LM implementation across various health system contexts. Methodological limitations and lessons learned can guide the execution of other studies with similar methodologies. International Registered Report Identifier (IRRID): DERR1-10.2196/51562 %M 38320320 %R 10.2196/51562 %U https://www.researchprotocols.org/2024/1/e51562 %U https://doi.org/10.2196/51562 %U http://www.ncbi.nlm.nih.gov/pubmed/38320320 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e48147 %T Action Opportunities to Pursue Responsible Digital Care for People With Intellectual Disabilities: Qualitative Study %A Siebelink,Nienke M %A van Dam,Kirstin N %A Lukkien,Dirk R M %A Boon,Brigitte %A Smits,Merlijn %A van der Poel,Agnes %+ Academy Het Dorp, Kemperbergerweg 139e, Arnhem, 6816RP, Netherlands, 31 0651656387, nienke.siebelink@academyhetdorp.nl %K ethics %K value-based health care %K digital technology %K intellectual disability %K digital care %D 2024 %7 28.2.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Responsible digital care refers to any intentional systematic effort designed to increase the likelihood of a digital care technology developed through ethical decision-making, being socially responsible and aligned with the values and well-being of those impacted by it. Objective: We aimed to present examples of action opportunities for (1) designing “technology”; (2) shaping the “context” of use; and (3) adjusting the behavior of “users” to guide responsible digital care for people with intellectual disabilities. Methods: Three cases were considered: (1) design of a web application to support the preparation of meals for groups of people with intellectual disabilities, (2) implementation of an app to help people with intellectual disabilities regulate their stress independently, and (3) implementation of a social robot to stimulate interaction and physical activity among people with intellectual disabilities. Overall, 26 stakeholders participated in 3 multistakeholder workshops (case 1: 10/26, 38%; case 2: 10/26, 38%; case 3: 6/26, 23%) based on the “guidance ethics approach.” We identified stakeholders’ values based on bottom-up exploration of experienced and expected effects of using the technology, and we formulated action opportunities for these values in the specific context of use. Qualitative data were analyzed thematically. Results: Overall, 232 effects, 33 values, and 156 action opportunities were collected. General and case-specific themes were identified. Important stakeholder values included quality of care, autonomy, efficiency, health, enjoyment, reliability, and privacy. Both positive and negative effects could underlie stakeholders’ values and influence the development of action opportunities. Action opportunities comprised the following: (1) technology: development of the technology (eg, user experience and customization), technology input (eg, recipes for meals, intervention options for reducing stress, and activities), and technology output (eg, storage and use of data); (2) context: guidelines, training and support, policy or agreements, and adjusting the physical environment in which the technology is used; and (3) users: integrating the technology into daily care practice, by diminishing (eg, “letting go” to increase the autonomy of people with intellectual disabilities), retaining (eg, face-to-face contact), and adding (eg, evaluation moments) certain behaviors of care professionals. Conclusions: This is the first study to provide insight into responsible digital care for people with intellectual disabilities by means of bottom-up exploration of action opportunities to take account of stakeholders’ values in designing technology, shaping the context of use, and adjusting the behavior of users. Although part of the findings may be generalized, case-specific insights and a complementary top-down approach (eg, predefined ethical frameworks) are essential. The findings represent a part of an ethical discourse that requires follow-up to meet the dynamism of stakeholders’ values and further develop and implement action opportunities to achieve socially desirable, ethically acceptable, and sustainable digital care that improves the lives of people with intellectual disabilities. %M 38416547 %R 10.2196/48147 %U https://mental.jmir.org/2024/1/e48147 %U https://doi.org/10.2196/48147 %U http://www.ncbi.nlm.nih.gov/pubmed/38416547 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e52252 %T eHealth Tools Supporting Early Childhood Education and Care Centers to Assess and Enhance Nutrition and Physical Activity Environments: Protocol for a Scoping Review %A Hayek,Joyce %A Elliott,Katharine %A Vermette,Makayla %A Lafave,Lynne MZ %+ Department of Health and Physical Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada, 1 403 440 5967, llafave@mtroyal.ca %K early childhood education and care %K childcare %K nutrition %K physical activity %K healthy eating environment %K eHealth %K digital technology %K health technology %K digital public health %K eating %K diet %K dietary %K exercise %K child %K children %K childhood %K pediatric %K pediatrics %K digital health %K early childhood educators %K ECEC %K knowledge synthesis %K review methods %K review methodology %K scoping %K mobile phone %D 2023 %7 24.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many children today are growing up in environments that predispose them to develop noncommunicable diseases. While no single preventive solution exists, evidence supports interventions in childcare settings for establishing good nutrition and physical activity behaviors as a “critical window” that could reduce the risk of developing noncommunicable diseases later in life. Emerging eHealth tools have shown potential in promoting best practices for nutrition and physical activity environments in early childhood education and care (ECEC) settings. Objective: The primary objective of this review is to map the breadth of available evidence on eHealth tools currently available to assess and support best practices for nutrition, physical activity, or both in ECEC settings and to highlight potential research directions. Methods: This scoping review will be conducted in accordance with the Joanna Briggs Institute Manual for Scoping Reviews with adherence to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist guidelines. Eligibility is based on the Population, Concept, and Context criteria as follows: (1) early childhood educators (population); (2) eHealth (digital) technology, such as websites, smartphone apps, email, and social media (concept); and (3) measurement and intervention tools to support best practices for nutrition, physical activity, or both in ECEC settings (context). The information sources for this review are the bibliographic databases PubMed, Scopus, CINAHL Plus, ERIC, and Embase in English and French with no date restrictions. Following this, a scan of gray literature will be undertaken. The electronic search strategy was developed in collaboration with two librarians. Two independent reviewers will screen the titles and abstracts of all relevant publications against inclusion criteria, followed by a full-text review using a data extraction tool developed by the reviewers. A synthesis of included papers will describe the publication, assessment, and intervention tool details. A summary of the findings will describe the types of eHealth assessment tools available, psychometric properties, eHealth intervention components, and theoretical frameworks used for development. Results: Preliminary searches of bibliographic databases to test and calibrate the search were carried out in May 2023. Study selection based on titles and abstracts was started in August 2023. The developed search strategy will guide our search for gray literature. The findings will be presented in visualized data map format, waffle chart, or tabular format accompanied by a narrative discussion. The scoping review is planned for completion in 2024. Conclusions: A structured review of the literature will provide a summary of the range and type of eHealth tools available for ECEC programs to assess and improve nutrition environments, physical activity environments, or both in order to identify gaps in the current evidence base and provide insights to guide future intervention research. Trial Registration: Open Science Framework XTRNZ; https://osf.io/xtrnz International Registered Report Identifier (IRRID): DERR1-10.2196/52252 %M 37874616 %R 10.2196/52252 %U https://www.researchprotocols.org/2023/1/e52252 %U https://doi.org/10.2196/52252 %U http://www.ncbi.nlm.nih.gov/pubmed/37874616 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46622 %T Effectiveness of Computer-Tailored Health Communication in Increasing Physical Activity in People With or at Risk of Long-Term Conditions: Systematic Review and Meta-Analysis %A Hao,Longdan %A Goetze,Stefan %A Alessa,Tourkiah %A Hawley,Mark S %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, The Innovation Centre, 217 Portobello, Sheffield, S1 4DP, United Kingdom, 44 114 2222000, mark.hawley@sheffield.ac.uk %K computer-tailored health communication %K meta-analysis %K long-term conditions %K physical activity promotion %D 2023 %7 4.10.2023 %9 Review %J J Med Internet Res %G English %X Background: Regular physical activity (PA) is beneficial for enhancing and sustaining both physical and mental well-being as well as for the management of preexisting conditions. Computer-tailored health communication (CTHC) has been shown to be effective in increasing PA and many other health behavior changes in the general population. However, individuals with or at risk of long-term conditions face unique barriers that may limit the applicability of CTHC interventions to this population. Few studies have focused on this cohort, providing limited evidence for the effectiveness of CTHC in promoting PA. Objective: This systematic review and meta-analysis aims to assess the effectiveness of CTHC in increasing PA in individuals with or at risk of long-term conditions. Methods: A systematic review and meta-analysis were conducted to evaluate the effect of CTHC in increasing PA in people with or at risk of long-term conditions. Hedges g was used to calculate the mean effect size. The total effect size was pooled and weighted using inverse variance. When possible, potential moderator variables were synthesized, and their effectiveness was evaluated by subgroups analysis with Q test for between-group heterogeneity Qb. Potential moderator variables included behavior change theories and models providing the fundamental logic for CTHC design, behavior change techniques and tailoring strategies to compose messages, and computer algorithms to achieve tailoring. Several methods were used to examine potential publication bias in the results, including the funnel plot, Egger test, Begg test, fail-safe N test, and trim-and-fill method. Results: In total, 24 studies were included in the systematic review for qualitative analysis and 18 studies were included in the meta-analysis. Significant small to medium effect size values were found when comparing CTHC to general health information (Hedges g=0.16; P<.001) and to no information sent to participants (Hedges g=0.29; P<.001). Half of the included studies had a low to moderate risk of bias, and the remaining studies had a moderate to high risk of bias. Although the results of the meta-analysis indicated no evidence of publication bias, caution is required when drawing definitive conclusions due to the limited number of studies in each subgroup (N≤10). Message-tailoring strategies, implementation strategies, behavior change theories and models, and behavior change techniques were synthesized from the 24 studies. No strong evidence was found from subgroup analyses on the effectiveness of using particular behavior change theories and models or from using particular message-tailoring and implementation strategies. Conclusions: This study demonstrates that CTHC is effective in increasing PA for people with or at risk of long-term conditions, with significant small to medium effects compared with general health information or no information. Further studies are needed to guide design decisions for maximizing the effectiveness of CTHC. %M 37792469 %R 10.2196/46622 %U https://www.jmir.org/2023/1/e46622 %U https://doi.org/10.2196/46622 %U http://www.ncbi.nlm.nih.gov/pubmed/37792469 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e52161 %T Advancing Understanding of Just-in-Time States for Supporting Physical Activity (Project JustWalk JITAI): Protocol for a System ID Study of Just-in-Time Adaptive Interventions %A Park,Junghwan %A Kim,Meelim %A El Mistiri,Mohamed %A Kha,Rachael %A Banerjee,Sarasij %A Gotzian,Lisa %A Chevance,Guillaume %A Rivera,Daniel E %A Klasnja,Predrag %A Hekler,Eric %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 8584299370, jup014@ucsd.edu %K just-in-time adaptive intervention %K JITAI %K just-in-time %K JIT %K walking %K physical activity %K needs %K opportunity %K receptivity %K mobile phone %D 2023 %7 26.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Just-in-time adaptive interventions (JITAIs) are designed to provide support when individuals are receptive and can respond beneficially to the prompt. The notion of a just-in-time (JIT) state is critical for JITAIs. To date, JIT states have been formulated either in a largely data-driven way or based on theory alone. There is a need for an approach that enables rigorous theory testing and optimization of the JIT state concept. Objective: The purpose of this system ID experiment was to investigate JIT states empirically and enable the empirical optimization of a JITAI intended to increase physical activity (steps/d). Methods: We recruited physically inactive English-speaking adults aged ≥25 years who owned smartphones. Participants wore a Fitbit Versa 3 and used the study app for 270 days. The JustWalk JITAI project uses system ID methods to study JIT states. Specifically, provision of support systematically varied across different theoretically plausible operationalizations of JIT states to enable a more rigorous and systematic study of the concept. We experimentally varied 2 intervention components: notifications delivered up to 4 times per day designed to increase a person’s steps within the next 3 hours and suggested daily step goals. Notifications to walk were experimentally provided across varied operationalizations of JIT states accounting for need (ie, whether daily step goals were previously met or not), opportunity (ie, whether the next 3 h were a time window during which a person had previously walked), and receptivity (ie, a person previously walked after receiving notifications). Suggested daily step goals varied systematically within a range related to a person’s baseline level of steps per day (eg, 4000) until they met clinically meaningful targets (eg, averaging 8000 steps/d as the lower threshold across a cycle). A series of system ID estimation approaches will be used to analyze the data and obtain control-oriented dynamical models to study JIT states. The estimated models from all approaches will be contrasted, with the ultimate goal of guiding rigorous, replicable, empirical formulation and study of JIT states to inform a future JITAI. Results: As is common in system ID, we conducted a series of simulation studies to formulate the experiment. The results of our simulation studies illustrated the plausibility of this approach for generating informative and unique data for studying JIT states. The study began enrolling participants in June 2022, with a final enrollment of 48 participants. Data collection concluded in April 2023. Upon completion of the analyses, the results of this study are expected to be submitted for publication in the fourth quarter of 2023. Conclusions: This study will be the first empirical investigation of JIT states that uses system ID methods to inform the optimization of a scalable JITAI for physical activity. Trial Registration: ClinicalTrials.gov NCT05273437; https://clinicaltrials.gov/ct2/show/NCT05273437 International Registered Report Identifier (IRRID): DERR1-10.2196/52161 %M 37751237 %R 10.2196/52161 %U https://www.researchprotocols.org/2023/1/e52161 %U https://doi.org/10.2196/52161 %U http://www.ncbi.nlm.nih.gov/pubmed/37751237 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e46991 %T The Impact of Physical Activity Intensity on the Dynamic Progression of Cardiometabolic Multimorbidity: Prospective Cohort Study Using UK Biobank Data %A Liu,Bao-Peng %A Zhu,Jia-Hui %A Wan,Li-Peng %A Zhao,Zhen-Yu %A Wang,Xinting %A Jia,Cun-Xian %+ Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhua Xi Road, No 44, Jinan, 250012, China, 86 88382141 ext 8809, jiacunxian@sdu.edu.cn %K physical activity intensity %K PA %K dynamic progression %K cardiometabolic multimorbidity %K cohort study %K CMM %D 2023 %7 25.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although many studies have reported on the associations between the amount of physical activity (PA) and the transitions of cardiometabolic multimorbidity (CMM), the evidence for PA intensity has not been fully evaluated. Objective: This study aimed to explore the impact of PA intensity on the dynamic progression of CMM. Methods: The prospective cohort of this study using data from the UK Biobank included 359,773 participants aged 37-73 years who were recruited from 22 centers between 2006 and 2010. The diagnoses of CMM, which included the copresence of type 2 diabetes (T2D), ischemic heart disease, and stroke, were obtained from first occurrence fields provided by the UK Biobank, which included data from primary care, hospital inpatient record, self-reported medical condition, and death registers. The PA intensity was assessed by the proportion of vigorous PA (VPA) to moderate to vigorous PA (MVPA). Multistate models were used to evaluate the effect of PA intensity on the dynamic progression of CMM. The first model (model A) included 5 transitions, namely free of cardiometabolic disease (CMD) to first occurrence of CMD (FCMD), free of CMD to death, FCMD to CMM, FCMD to mortality, and CMM to mortality. The other model (model B) used specific CMD, namely T2D, ischemic heart disease, and stroke, instead of FCMD and included 11 transitions in this study. Results: The mean age of the included participants (N=359,773) was 55.82 (SD 8.12) years at baseline, and 54.55% (196,271/359,773) of the participants were female. Compared with the participants with no VPA, participants with intensity levels of >0.75 to <1 for VPA to MVPA had a 13% and 27% lower risk of transition from free of CMD to FCMD (hazard ratio [HR] 0.87, 95% CI 0.83-0.91) and mortality (HR 0.73, 95% CI 0.66-0.79) in model A, respectively. The HR for the participants with no moderate PA was 0.82 (95% CI 0.73-0.92) compared with no VPA. There was a substantially protective effect of higher PA intensity on the transitions from free of CMD to T2D and from T2D to mortality, which reveals the importance of PA intensity for the transitions of T2D. More PA and greater intensity had a synergistic effect on decreasing the risk of the transitions from free of CMD to FCMD and mortality. Male participants, younger adults, adults with a higher BMI, current or previous smokers, and excessive alcohol drinkers could obtain more benefits from higher PA intensity for the lower risk of at least 1 transition from free of CMD, then to CMM, and finally to mortality. Conclusions: This study suggests that higher PA intensity is an effective measure for preventing CMM and mortality in the early period of CMM development. Relevant interventions related to higher PA intensity should be conducted. %M 37747776 %R 10.2196/46991 %U https://publichealth.jmir.org/2023/1/e46991 %U https://doi.org/10.2196/46991 %U http://www.ncbi.nlm.nih.gov/pubmed/37747776 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46650 %T Pacing Variation in Multistage Ultramarathons: Internet-Based Cross-Sectional Study %A Fariod,Mielad %A Olher,Rafael Reis %A Sousa,Caio Victor %A Scheer,Volker %A Cuk,Ivan %A Nikolaidis,Pantelis Theodoros %A Thuany,Mabliny %A Weiss,Katja %A Knechtle,Beat %+ Medbase St Gallen Am Vadianplatz, Vadianstrasse 26, St Gallen, 9001, Switzerland, 41 715340131, beat.knechtle@hispeed.ch %K ultramarathon %K pacing %K gender difference %K performance %K variation %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Ultramarathon running is the most popular ultraendurance competition in terms of the number of races and runners competing annually worldwide; however, no study has compared pacing and performance over a long period. Objective: This study analyzes the pacing of successful finishers and nonfinishers in multistage ultramarathons worldwide. Methods: A total of 4079 athletes (men=3288; women=791) competing in 99 multistage ultramarathon events from 1983 to 2021 were analyzed, including the number of participants, age, gender, rank, and running speed of successful finishers. Results: The results showed a significant increase in the number of events (n=338) and a significant increase in the number of finishers and nonfinishers (n=5575) in the ultramarathons worldwide during this period. The general linear models (GLMs) of pacing variation showed nonsignificant effects for gender (F1,36.2=2.5; P=.127; ηp2=0.063) and age group (F10,10=0.6; P=.798; ηp2=0.367), but it showed a significant interaction (gender × age) effect (F10,2689=2.3; P=.008; ηp2=0.009). Post hoc analyses showed that men have a higher pacing variation than women in the under 30 years (U30), U35, U45, and U50 groups. Additionally, the fastest women’s age group (U35) had the lowest pacing variation. The GLM of pacing variation by gender and event distance showed significant effects for both gender (F1,3=18.5; P<.001; ηp2=0.007) and distance (F2,3=20.1; P<.001; ηp2=0.015). Post hoc analyses showed a growing pacing variation with increasing race distance for both men and women. In addition, men had a higher variation in long events. Furthermore, there was a significant main effect for both genders (F1,3=33.7; P<.001; ηp2=0.012) and rank (F1,3=136.6; P<.001; ηp2=0.048) on performance, with men being faster than women. Pacing varied greatly due to gender (F1,3=4.0; P=.047; ηp2=0.001), with a lower (ie, more even) pacing variation for male athletes in the top 3 finishers. Male nonfinishers showed a higher performance than female nonfinishers (F1,1340=25.6; P<.001), and no difference was identified for pacing variation (F1,789=1.5; P=.228) based on gender. In addition, a weak but significant correlation (r=–0.130; P<.001) was identified between the average running speed and pacing variation for both female and male nonfinishers. Conclusions: In summary, multistage ultramarathon competitions showed an increasing number of competitors and a higher performance challenge. Men have a higher pacing (ie, less even) variation than women, especially observed in longer events. A higher pacing variation was associated with lower performance for men, women, and nonfinishers. %M 37610796 %R 10.2196/46650 %U https://formative.jmir.org/2023/1/e46650 %U https://doi.org/10.2196/46650 %U http://www.ncbi.nlm.nih.gov/pubmed/37610796 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42394 %T Adding Mobile Elements to Online Physical Activity Interventions for Adults Aged Over 50 Years: Prototype Development Study %A Collombon,Eline H G M %A Peels,Denise A %A Bolman,Catherine A W %A de Bruijn,Gert-Jan %A Lechner,Lilian %+ Faculty of Psychology, Open Universiteit, Valkenburgerweg 177, Heerlen, 6419 AT, Netherlands, 31 455762888, Eline.Collombon@ou.nl %K prototype %K pilot test %K eHealth %K mHealth %K physical activity %K older adults %K development %K usability %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Only a minority of adults aged over 50 years meet physical activity (PA) guidelines of the World Health Organization (WHO). eHealth interventions are proven effective tools to help this population increase its PA levels in the short term, among which the Active Plus and I Move interventions have been developed by our own research group. To achieve long-term effects, increase intervention use, and decrease dropout rates, 3 emergent but different mobile elements (an activity tracker, an ecological momentary intervention [EMI] program, and a chatbot) were added separately to Active Plus and I Move. In this study, the prototype development and pilot-testing of these interventions is described. Objective: This study aims to enhance 2 existing PA-stimulating computer-based interventions with 3 mobile elements (an activity tracker, an EMI program, or a chatbot) and test the prototypes on usability and appreciation within a target population of adults aged over 50 years. Methods: A systematic design protocol consisting of development, evaluation, and adaptation procedures was followed with involvement of the target population. Literature searches separated per mobile element and interviews with the target population (N=11) led to 6 prototypes: Active Plus or I Move including (1) an activity tracker, (2) EMI, or (3) a chatbot. These prototypes were tested on usability and appreciation during pilot tests (N=47) and subsequently fine-tuned based on the results. Results: The literature searches and interviews provided important recommendations on the preferences of the target population, which enabled us to develop prototypes. The subsequent pilot tests showed that the mobile elements scored moderate to good on usability, with average System Usability Scale (SUS) scores of 52.2-82.2, and moderate to good on enjoyment and satisfaction, with average scores ranging from 5.1 to 8.1 on a scale of 1-10. The activity tracker received the best scores, followed by EMI, followed by the chatbot. Based on the findings, the activity tracker interventions were fine-tuned and technical difficulties regarding EMI and the chatbot were solved, which is expected to further improve usability and appreciation. Conclusions: During this study, 6 prototypes of online PA interventions with added mobile elements were developed and tested for usability and appreciation. Although all prototypes scored moderate to high on usability, enjoyment, and satisfaction, it can be concluded that the integration of an activity tracker with a computer-based PA intervention is the most promising option among the 3 mobile elements tested during this study. The prototype development steps of the systematic design protocol followed can be considered useful and successful for the purposes of this study. The interventions can now be evaluated on a larger scale through a randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.2196/31677 %M 36696157 %R 10.2196/42394 %U https://formative.jmir.org/2023/1/e42394 %U https://doi.org/10.2196/42394 %U http://www.ncbi.nlm.nih.gov/pubmed/36696157 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e35933 %T A Short Digital Food Frequency Questionnaire (DIGIKOST-FFQ) Assessing Dietary Intake and Other Lifestyle Factors Among Norwegians: Qualitative Evaluation With Focus Group Interviews and Usability Testing %A Henriksen,Hege Berg %A Knudsen,Markus Dines %A Carlsen,Monica Hauger %A Hjartåker,Anette %A Blomhoff,Rune %+ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, Oslo, 0372, Norway, 47 99459673, h.b.henriksen@medisin.uio.no %K digital assessment tool %K assessment tool %K food frequency questionnaire %K food %K diet %K nutrition %K questionnaire %K focus group %K interview %K usability %K physical activity %K lifestyle factor %K dietary intake %K digital health %K chronic disease %K chronic condition %K health promotion %K cancer %K survivor %K usability %K thematic analysis %K research tool %K measurement tool %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In-person dietary counseling and interventions have shown promising results in changing habits toward healthier lifestyles, but they are costly to implement in large populations. Developing digital tools to assess individual dietary intake and lifestyle with integrated personalized feedback systems may help overcome this challenge. We developed a short digital food frequency questionnaire, known as the DIGIKOST-FFQ, to assess diet and other lifestyle factors based on the Norwegian Food-Based Dietary Guidelines. The DIGIKOST-FFQ includes a personalized feedback system, the DIGIKOST report, that benchmarks diet and lifestyle habits. We used qualitative focus group interviews and usability tests to test the feasibility and usability of the DIGIKOST application. Objective: We aimed to explore attitudes, perceptions, and challenges in completing the DIGIKOST-FFQ. We also investigated perceptions and understanding of the personalized feedback in the DIGIKOST report and the technical flow and usability of the DIGIKOST-FFQ and the DIGIKOST report. Methods: Healthy individuals and cancer survivors were invited to participate in the focus group interviews. The transcripts were analyzed using thematic analysis. Another group of healthy individuals completed the usability testing, which was administered individually by a moderator and 2 observers. The results were analyzed based on predefined assignments and discussion with the participants about the interpretation of the DIGIKOST report and technical flow of the DIGIKOST-FFQ. Results: A total of 20 individuals participated in the focus group interviews, divided into 3 groups of healthy individuals and 3 groups of cancer survivors. Each group consisted of 3 to 4 individuals. Five main themes were investigated: (1) completion time (on average 19.1, SD 8.3, minutes, an acceptable duration), (2) layout (participants reported the DIGIKOST-FFQ was easy to navigate and had clear questions but presented challenges in reporting dietary intake, sedentary time, and physical activity in the last year), (3) questions (the introductory questions on habitual intake worked well), (4) pictures (the pictures were very helpful, but some portion sizes were difficult to differentiate and adding weight in grams would have been helpful), and (5) motivation (users were motivated to obtain personalized feedback). Four individuals participated in the usability testing. The results showed that the users could seamlessly log in, give consent, fill in the DIGIKOST-FFQ, and receive, print, and read the DIGIKOST report. However, parts of the report were perceived as difficult to interpret. Conclusions: The DIGIKOST-FFQ was overall well received by participants, who found it feasible to use; however, some adjustments with regard to reporting dietary intake and lifestyle habits were suggested. The DIGIKOST report with personalized feedback was the main motivation to complete the questionnaire. The results from the usability testing revealed a need for adjustments and updates to make the report easier to read. %M 36346647 %R 10.2196/35933 %U https://formative.jmir.org/2022/11/e35933 %U https://doi.org/10.2196/35933 %U http://www.ncbi.nlm.nih.gov/pubmed/36346647 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e38027 %T Study of the Kinetics of the Determinants of Performance During a Mountain Ultramarathon: Multidisciplinary Protocol of the First Trail Scientifique de Clécy 2021 %A Mauvieux,Benoit %A Hingrand,Corentin %A Drigny,Joffrey %A Hodzic,Amir %A Baron,Pauline %A Hurdiel,Rémy %A Jouffroy,Romain %A Vauthier,Jean-Charles %A Pessiglione,Mathias %A Wiehler,Antonius %A Degache,Francis %A Pavailler,Sébastien %A Heyman,Elsa %A Plard,Mathilde %A Noirez,Philippe %A Dubois,Blaise %A Esculier,Jean François %A Nguyen,Anh Phong %A Van Cant,Joachim %A Roy Baillargeon,Olivier %A Pairot de Fontenay,Benoit %A Delaunay,Pierre Louis %A Besnard,Stéphane %+ U1075 Comete/INSERM, Université de Caen, PFRS, Laboratoire Comete, 2 rue des Rochambelles, Caen, 14000, France, 33 616765793, corentin.hingrand@unicaen.fr %K ultramarathon %K trail-running %K sports physiology %K sleep deprivation %K fatigue %K blood biology %K muscular function %K biomechanics %K motivation %K cognition %K self-esteem %D 2022 %7 15.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The growing interest of the scientific community in trail running has highlighted the acute effects of practice at the time of these races on isolated aspects of physiological and structural systems; biological, physiological, cognitive, and muscular functions; and the psychological state of athletes. However, no integrative study has been conducted under these conditions with so many participants and monitoring of pre-, per-, and postrace variables for up to 10 days over a distance close to 100 miles. Objective: The aim of this study was to evaluate the kinetics of the performance parameters during a 156 km trail run and 6000 m of elevation gain in pre-, per-, and postrace conditions. The general hypothesis is based on significant alterations in the psychological, physiological, mechanical, biological, and cognitive parameters. Methods: The Trail Scientifique de Clécy took place on November 11, 2021. This prospective experimental study provides a comprehensive exploration of the constraints and adaptations of psychophysiological and sociological variables assessed in real race conditions during a trail running of 156 km on hilly ground and 6000 m of elevation gain (D+). The study protocol allowed for repeatability of study measurements under the same experimental conditions during the race, with the race being divided into 6 identical loops of 26 km and 1000 m D+. Measurements were conducted the day before and the morning of the race, at the end of each lap, after a pit stop, and up to 10 days after the race. A total of 55 participants were included, 43 (78%) men and 12 (22%) women, who were experienced in ultra–trail-running events and with no contraindications to the practice of this sport. Results: The launch of the study was authorized on October 26, 2021, under the trial number 21-0166 after a favorable opinion from the Comité de Protection des Personnes Ouest III (21.09.61/SIRIPH 2G 21.01586.000009). Of the 55 runners enrolled, 41 (75%) completed the race and 14 (25%) dropped out for various reasons, including gastric problems, hypothermia, fatigue, and musculoskeletal injuries. All the measurements for each team were completed in full. The race times (ie, excluding the measurements) ranged from 17.8206 hours for the first runner to 35.9225 hours for the last runner. The average time to complete all measurements for each lap was 64 (SD 3) minutes. Conclusions: The Trail Scientifique de Clécy, by its protocol, allowed for a multidisciplinary approach to the discipline. This approach will allow for the explanation of the studied parameters in relation to each other and observation of the systems of dependence and independence. The initial results are expected in June 2022. International Registered Report Identifier (IRRID): RR1-10.2196/38027 %M 35704381 %R 10.2196/38027 %U https://www.researchprotocols.org/2022/6/e38027 %U https://doi.org/10.2196/38027 %U http://www.ncbi.nlm.nih.gov/pubmed/35704381 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e36429 %T Promoting Physical Activity Among University Students During the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial %A Goncalves,Aurelie %A Bernal,Caroline %A Korchi,Karim %A Nogrette,Maxence %A Deshayes,Maxime %A Philippe,Antony G %A Gisclard,Béatrice %A Charbonnier,Elodie %+ APSY-V, Université de Nîmes, Rue du docteur Georges Salan CS13019, Nîmes, F-30021, France, 33 04 66 36 45 18, aurelie.goncalves@unimes.fr %K physical activity %K psychological factors %K university student %K COVID-19 %D 2022 %7 13.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Since the beginning of the COVID-19 pandemic, sanitary context and e-learning have greatly modified student lifestyles and led to deteriorations in their mental health. An increase in anxiety and depressive symptoms and sedentary behaviors, reduction in physical activity, and a stronger tendency to move toward unhealthy diet have been demonstrated. This finding highlights the need for innovative interventions to promote healthy lifestyle among students. Objective: This research protocol aims to evaluate the effects of an intervention program on the lifestyle and psychological state of students. Methods: Students from University of Nîmes were recruited and randomly assigned to 1 of 2 following conditions: an intervention group and a control group. Participants in the intervention group were engaged in an 8-week physical activity program. Prior to the start of the program, design-based innovative workshops were conducted with participants to ensure that the program was co-constructed by the users and met their specific needs. Students in the control group did not receive any intervention. For each group, measures of physical activity, sedentary time, anthropometric data, sleep, physical condition, and psychological variables (eg, anxiety, depression, motivation, body appreciation, perceived control, well-being) were conducted at baseline and 9 weeks later. Results: A total of 110 participants were initially included. Reporting of the results is projected for the spring of 2022. Conclusions: It is anticipated that this innovative intervention co-constructed by pairs will promote a healthier lifestyle and psychological health in students. There is every reason to believe that a mobilized co-construction approach is a promising strategy to limit unhealthy habits and promote physical activity while increasing motivation. The development and evaluation of interventions to address the specific needs of university students is essential and could be transferred to other vulnerable populations such as people with chronic diseases or older people. Trial Registration: ClinicalTrials.gov NCT05019482; https://clinicaltrials.gov/ct2/show/NCT05019482 International Registered Report Identifier (IRRID): DERR1-10.2196/36429 %M 35700019 %R 10.2196/36429 %U https://www.researchprotocols.org/2022/6/e36429 %U https://doi.org/10.2196/36429 %U http://www.ncbi.nlm.nih.gov/pubmed/35700019 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e31521 %T Patterns of Physical Activity Among University Students and Their Perceptions About the Curricular Content Concerned With Health: Cross-sectional Study %A Verma,Arun Kumar %A Singh,Girish %A Patwardhan,Kishor %+ Department of Kriya Sharir, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, C/1, New Medical Enclave, Banaras Hindu University, Varanasi, 221005, India, 91 9415290426, kpatwardhan@bhu.ac.in %K physical activity %K university students %K university %K exercise %K students %K inactive %K curricula %K healthy lifestyle %K higher education %D 2022 %7 29.4.2022 %9 Original Paper %J JMIRx Med %G English %X Background: University students are at risk of losing their focus on maintaining healthy levels of physical activity because of their engagements with curricular and cocurricular activities. In India, the physical activity levels of the adult population have been reported to be declining in the recent years. However, studies focusing on university students pertaining to their physical activity are lacking in the Indian context. Moreover, a question that has not been properly addressed is the following: “do the curricula in higher education promote physical activity?” Objective: Our paper aims at describing the physical activity levels of the students in a large public-funded central university located in northern India. The study also aims at capturing the student perceptions about the emphasis they receive on leading a physically active lifestyle during their routine curricular activities. Methods: This is a cross-sectional descriptive study and uses International Physical Activity Questionnaire—Long Form to record physical activity among 4586 students. Stratified sampling method was used to enroll the students from each stream (faculty). Out of 30,667 students, about 15% were included from each faculty. The study was conducted between 2016 and 2019. To capture the student perceptions, we used a newly developed 5-item scale. Results: From a total of 4586 participants in the study, 2828 (61.7%) were male and 1758 (38.3%) were female students. The mean age of our sample was 22.34 (SD 3.12) years. Our results indicate that about 14.5% (n=666) of all students in the study fall under the “Inactive” category. Furthermore, the perception about the curricular content pertaining to physical activity varied widely between the students of different streams. Conclusions: Our sample reported a better physical activity pattern in comparison to the reported overall physical activity levels of the adult population of India. Our results also suggest that health-related topics are inadequately represented in many of the streams of higher education in the university. %M 37725547 %R 10.2196/31521 %U https://med.jmirx.org/2022/2/e31521 %U https://doi.org/10.2196/31521 %U http://www.ncbi.nlm.nih.gov/pubmed/37725547 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37279 %T Investigating New Sensory Methods Related to Taste Sensitivity, Preferences, and Diet of Mother-Infant Pairs and Their Relationship With Body Composition and Biomarkers: Protocol for an Explorative Study %A Fuchs-Neuhold,Bianca %A Staubmann,Wolfgang %A Peterseil,Marie %A Rath,Anna %A Schweighofer,Natascha %A Kronberger,Anika %A Riederer,Monika %A van der Kleyn,Moenie %A Martin,Jochen %A Hörmann-Wallner,Marlies %A Waldner,Irmgard %A Konrad,Manuela %A Aufschnaiter,Anna Lena %A Siegmund,Barbara %A Berghold,Andrea %A Holasek,Sandra %A Pail,Elisabeth %+ Health Perception Lab, Institute of Dietetics and Nutrition, FH JOANNEUM GmbH - University of Applied Sciences, Eggenberger Allee 11, Graz, 8010, Austria, 43 316 5453 ext 6726, bianca.fuchsneuhold@fh-joanneum.at %K taste %K preferences %K nutrition %K biomarkers %K body composition %K air displacement plethysmography %K Baby Facial Actions Coding System %K mother %K infant %K parenting %K pediatrics %K prenatal %K postnatal %D 2022 %7 27.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early experiences with different flavors play an important role in infant development, including food and taste acceptance. Flavors are already perceived in utero with the development of the taste and olfactory system and are passed on to the child through breast and bottle feeding. Therefore, the first 1000 days of life are considered a critical window for infant developmental programming. Objective: The objective of our study is to investigate, both in the prenatal and postnatal period, taste sensitivity, preferences, and dietary diversity of mother-infant pairs. The explorative study design will also report on the impact of these variables on body composition (BC) and biomarkers. In contrast to conventional methods, this study involves long-term follow-up data collection from mother-infant pairs; moreover, the integration of audiovisual tools for recording infants' expressions pertaining to taste stimuli is a novelty of this study. Considering these new methodological approaches, the study aims to assess taste-related data in conjunction with BC parameters like fat-free mass or fat mass, biomarkers, and nutritional intake in infants and children. Methods: Healthy pregnant women aged between 18 and 50 years (BMI≥18.5 kg/m2 to ≤30 kg/m2; <28 weeks of gestation) were recruited from January 2014 to October 2014. The explorative design implies 2 center visits during pregnancy (24-28 weeks of gestation and 32-34 weeks of gestation) and 2 center visits after delivery (6-8 weeks postpartum and 14-16 weeks postpartum) as well as follow-up visits at 1, 3-3.5, and 6 years after delivery. Data collection encompasses anthropometric and biochemical measurements as well as BC analyses with air displacement plethysmography, taste perception assessments, and multicomponent questionnaires on demographics, feeding practices, and nutritional and lifestyle behaviors. Audiovisual data from infants’ reactions to sensory stimuli are collected and coded by trained staff using Baby Facial Action Coding and the Body Action Posture System. Birth outcomes and weight development are obtained from medical records, and additional qualitative data are gathered from 24 semistructured interviews. Results: Our cohort represents a homogenous group of healthy women with stringent exclusion criteria. A total of 54 women met the eligibility criteria, whereas 47 mother-child pairs completed data collection at 4 center visits during and after pregnancy. Follow-up phases, data analyses, and dissemination of the findings are scheduled for the end of 2023. The study was approved by the ethics committee of the Medical University of Graz (EC No 26–066 ex 13/14), and all participants provided informed consent. Conclusions: The results of this study could be useful for elucidating the connections between maternal and infant statuses regarding diet, taste, biomarkers, and prenatal and postnatal weight development. This study may also be relevant to the establishment of further diagnostic and interventional strategies targeting childhood obesity and early body fat development. International Registered Report Identifier (IRRID): DERR1-10.2196/37279 %M 35475790 %R 10.2196/37279 %U https://www.researchprotocols.org/2022/4/e37279 %U https://doi.org/10.2196/37279 %U http://www.ncbi.nlm.nih.gov/pubmed/35475790 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32387 %T Effects of COVID-19 on Physical Activity and Its Relationship With Mental Health in a US Community Sample: Cross-sectional, Convenience Sampling–based Online Survey %A Zhang,Wei %A Velez,Dominick %+ Department of Psychology, New Jersey City University, 2039 John F. Kennedy Blvd, Jersey City, NJ, 07305, United States, 1 2012002000 ext 3063, wzhang@njcu.edu %K physical activity %K COVID-19 %K mental health %K depression %K anxiety %K United States %K survey %K cross-sectional %K distress %K risk %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 restrictions may make it difficult for people to engage in the recommended amounts of physical activity (PA). Objective: The influence of the COVID-19 pandemic on PA, as well as the links between PA and mental health, was investigated in this study. Methods: Participants were recruited using convenience sampling and responded to an online survey between April 15 and July 1, 2021, with ages ranging from 18 to 24 years (n=156, 40.9% of the sample) to ≥55 years (n=28, 7.4% of the sample). To assess general psychological distress, depression, anxiety, and pandemic anxiety, a battery of mental health assessments was used. The International Physical Activity Questionnaire - Short Form was used to collect PA data from participants, who were then classified as inactive, minimally active, or highly active. Participants also indicated the locations where they performed PA before and during COVID-19. Results: A sample of 381 individuals was included in this research. The logistic regression analysis results were interpreted as odds ratios (ORs), where an OR higher than 1 indicated a greater chance of an event occurring and an OR less than 1 implied a lower likelihood of an event occurring. Logistic regression results revealed that inactive individuals were more likely to develop psychological distress (OR 2.17, 95% CI 1.27-3.69, P=.004), depression (OR 3.81, 95% CI 1.92-7.57, P<.001), and anxiety (OR 1.86, 95% CI 0.99-3.47, P=.05) as compared to highly active individuals. Furthermore, when compared to highly active people, those who were only minimally active had a higher risk of depression (OR 2.14, 95% CI 1.05-4.33, P=.04). Wilcoxon signed-rank tests revealed that COVID-19 has a greater impact on reducing the chances of less active individuals engaging in PA outside and in public spaces. Highly active people's physical exercise locations had changed less, and their exercise frequency at home increased. Conclusions: Programmatic and policy interventions geared particularly toward enhancing PA among those less active may be a helpful strategy for addressing the worldwide pandemic’s mental health crisis. %M 35302509 %R 10.2196/32387 %U https://formative.jmir.org/2022/4/e32387 %U https://doi.org/10.2196/32387 %U http://www.ncbi.nlm.nih.gov/pubmed/35302509 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e35040 %T Effect of the Nintendo Ring Fit Adventure Exergame on Running Completion Time and Psychological Factors Among University Students Engaging in Distance Learning During the COVID-19 Pandemic: Randomized Controlled Trial %A Wu,Yi-Syuan %A Wang,Wei-Yun %A Chan,Ta-Chien %A Chiu,Yu-Lung %A Lin,Hung-Che %A Chang,Yu-Tien %A Wu,Hao-Yi %A Liu,Tzu-Chi %A Chuang,Yu-Cheng %A Wu,Jonan %A Chang,Wen-Yen %A Sun,Chien-An %A Lin,Meng-Chiung %A Tseng,Vincent S %A Hu,Je-Ming %A Li,Yuan-Kuei %A Hsiao,Po-Jen %A Chen,Chao-Wen %A Kao,Hao-Yun %A Lee,Chia-Cheng %A Hsieh,Chung-Bao %A Wang,Chih-Hung %A Chu,Chi-Ming %+ School of Public Health, National Defense Medical Center, Rm. 4317, 4F., No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei, 114201, Taiwan, 886 2 8792 3100 ext 18438, chuchiming@web.de %K exergaming %K cardiac force index %K running %K physical activity %K sleep quality %K mood disorders %K digital health %K physical fitness %K Nintendo Ring Fit Adventure %K COVID-19 pandemic %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The COVID-19 outbreak has not only changed the lifestyles of people globally but has also resulted in other challenges, such as the requirement of self-isolation and distance learning. Moreover, people are unable to venture out to exercise, leading to reduced movement, and therefore, the demand for exercise at home has increased. Objective: We intended to investigate the relationships between a Nintendo Ring Fit Adventure (RFA) intervention and improvements in running time, cardiac force index (CFI), sleep quality (Chinese version of the Pittsburgh Sleep Quality Index score), and mood disorders (5-item Brief Symptom Rating Scale score). Methods: This was a randomized prospective study and included 80 students who were required to complete a 1600-meter outdoor run before and after the intervention, the completion times of which were recorded in seconds. They were also required to fill out a lifestyle questionnaire. During the study, 40 participants (16 males and 24 females, with an average age of 23.75 years) were assigned to the RFA group and were required to exercise for 30 minutes 3 times per week (in the adventure mode) over 4 weeks. The exercise intensity was set according to the instructions given by the virtual coach during the first game. The remaining 40 participants (30 males and 10 females, with an average age of 22.65 years) were assigned to the control group and maintained their regular habits during the study period. Results: The study was completed by 80 participants aged 20 to 36 years (mean 23.20, SD 2.96 years). The results showed that the running time in the RFA group was significantly reduced. After 4 weeks of physical training, it took females in the RFA group 19.79 seconds (P=.03) and males 22.56 seconds (P=.03) less than the baseline to complete the 1600-meter run. In contrast, there were no significant differences in the performance of the control group in the run before and after the fourth week of intervention. In terms of mood disorders, the average score of the RFA group increased from 1.81 to 3.31 for males (difference=1.50, P=.04) and from 3.17 to 4.54 for females (difference=1.38, P=.06). In addition, no significant differences between the RFA and control groups were observed for the CFI peak acceleration (CFIPA)_walk, CFIPA_run, or sleep quality. Conclusions: RFA could either maintain or improve an individual’s physical fitness, thereby providing a good solution for people involved in distance learning or those who have not exercised for an extended period. Trial Registration: ClinicalTrials.gov NCT05227040; https://clinicaltrials.gov/ct2/show/NCT05227040 %M 35315780 %R 10.2196/35040 %U https://games.jmir.org/2022/1/e35040 %U https://doi.org/10.2196/35040 %U http://www.ncbi.nlm.nih.gov/pubmed/35315780 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30863 %T Continuous Monitoring of Vital Signs With Wearable Sensors During Daily Life Activities: Validation Study %A Haveman,Marjolein E %A van Rossum,Mathilde C %A Vaseur,Roswita M E %A van der Riet,Claire %A Schuurmann,Richte C L %A Hermens,Hermie J %A de Vries,Jean-Paul P M %A Tabak,Monique %+ Department of Surgery, University Medical Center Groningen, University of Groningen, BA60, Hanzeplein 1, Groningen, 9713 GZ, Netherlands, 31 625646832, m.e.haveman@umcg.nl %K wearable sensors %K telemonitoring %K continuous monitoring %K vital signs %K mHealth %K wearable %K biosensor %K validity %K accuracy %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Continuous telemonitoring of vital signs in a clinical or home setting may lead to improved knowledge of patients’ baseline vital signs and earlier detection of patient deterioration, and it may also facilitate the migration of care toward home. Little is known about the performance of available wearable sensors, especially during daily life activities, although accurate technology is critical for clinical decision-making. Objective: The aim of this study is to assess the data availability, accuracy, and concurrent validity of vital sign data measured with wearable sensors in volunteers during various daily life activities in a simulated free-living environment. Methods: Volunteers were equipped with 4 wearable sensors (Everion placed on the left and right arms, VitalPatch, and Fitbit Charge 3) and 2 reference devices (Oxycon Mobile and iButton) to obtain continuous measurements of heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), and temperature. Participants performed standardized activities, including resting, walking, metronome breathing, chores, stationary cycling, and recovery afterward. Data availability was measured as the percentage of missing data. Accuracy was evaluated by the median absolute percentage error (MAPE) and concurrent validity using the Bland-Altman plot with mean difference and 95% limits of agreement (LoA). Results: A total of 20 volunteers (median age 64 years, range 20-74 years) were included. Data availability was high for all vital signs measured by VitalPatch and for HR and temperature measured by Everion. Data availability for HR was the lowest for Fitbit (4807/13,680, 35.14% missing data points). For SpO2 measured by Everion, median percentages of missing data of up to 100% were noted. The overall accuracy of HR was high for all wearable sensors, except during walking. For RR, an overall MAPE of 8.6% was noted for VitalPatch and that of 18.9% for Everion, with a higher MAPE noted during physical activity (up to 27.1%) for both sensors. The accuracy of temperature was high for VitalPatch (MAPE up to 1.7%), and it decreased for Everion (MAPE from 6.3% to 9%). Bland-Altman analyses showed small mean differences of VitalPatch for HR (0.1 beats/min [bpm]), RR (−0.1 breaths/min), and temperature (0.5 °C). Everion and Fitbit underestimated HR up to 5.3 (LoA of −39.0 to 28.3) bpm and 11.4 (LoA of −53.8 to 30.9) bpm, respectively. Everion had a small mean difference with large LoA (−10.8 to 10.4 breaths/min) for RR, underestimated SpO2 (>1%), and overestimated temperature up to 2.9 °C. Conclusions: Data availability, accuracy, and concurrent validity of the studied wearable sensors varied and differed according to activity. In this study, the accuracy of all sensors decreased with physical activity. Of the tested sensors, VitalPatch was found to be the most accurate and valid for vital signs monitoring. %M 34994703 %R 10.2196/30863 %U https://formative.jmir.org/2022/1/e30863 %U https://doi.org/10.2196/30863 %U http://www.ncbi.nlm.nih.gov/pubmed/34994703 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e29494 %T An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study %A Thirumalai,Mohanraj %A Brown,Nashira %A Niranjan,Soumya %A Townsend,Sh'Nese %A Powell,Mary Anne %A Neal,Whitney %A Schleicher,Erica %A Raparla,Venkatadri %A Oster,Robert %A Demark-Wahnefried,Wendy %A Pekmezi,Dori %+ Department of Health Services Administration, School of Health Professions, University of Birmingham at Alabama, SHPB #590E, 1716 9th Avenue South, Birmingham, AL, 35244, United States, 1 2059347189, mohanraj@uab.edu %K interactive voice response systems %K usability %K exercise %K physical activity %K rural health %K telehealth %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. Objective: The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. Methods: A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. Results: The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying excellent usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. Conclusions: The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention. %M 34982714 %R 10.2196/29494 %U https://humanfactors.jmir.org/2022/1/e29494 %U https://doi.org/10.2196/29494 %U http://www.ncbi.nlm.nih.gov/pubmed/34982714 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e25589 %T Perceived Impact of Outdoor Swimming on Health: Web-Based Survey %A Massey,Heather %A Gorczynski,Paul %A Harper,C Mark %A Sansom,Lisa %A McEwan,Kieren %A Yankouskaya,Alla %A Denton,Hannah %+ Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Spinnaker building, Cambridge road, Portsmouth, PO1 2ER, United Kingdom, 44 02392843545, heather.massey@port.ac.uk %K open water swimming %K blue space %K blue gym %K mental health %K physical health %D 2022 %7 4.1.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Outdoor swimming in lakes, lidos (outdoor pools), rivers, and the sea has grown in popularity in many countries, including the United Kingdom. Many anecdotal accounts indicate improvements in medical conditions, which are considered a consequence of outdoor swimming. Objective: The aim of this study is to better understand outdoor swimmers’ perceptions of their health and the extent to which participation impacted their existing self-reported symptoms. Methods: A survey was conducted to investigate outdoor swimming behaviors and reports of any diagnosed medical conditions. Medical conditions were coded into categories, and descriptive statistics were generated regarding the outdoor swimmers’ behaviors and the effect that outdoor swimming had on their medical symptoms if any. The medical categories were clustered into five larger categories based on their prevalence in the current sample: mental health; musculoskeletal and injury; neurological; cardiovascular and blood disease; and other, which comprises inflammatory, immune, endocrine, and respiratory conditions. Results: In total, 722 outdoor swimmers responded, of whom 498 (68.9%) were female. The probability of outdoor swimming having some positive impact on health across all medical categories was 3.57 times higher compared with no impact (B=1.28, 95% CI 0.63-1.91; P<.001), 44.32 times higher for the mental health category (B=3.79, 95% CI 2.28-5.30; P<.001), 5.25 times higher for musculoskeletal and injury category (B=1.66, 95% CI 0.52-2.79; P=.004), and 4.02 times higher for the other category (B=1.39, 95% CI 0.27-2.51; P=.02). Overall, outdoor swimming was associated with perceived reductions in symptoms of poor mental health (χ22=25.1; P<.001), musculoskeletal and injury (χ22=8.2; P=.04), cardiovascular and blood (χ22=14.7; P=.006), and other conditions (χ22=18.2; P<.001). Conclusions: Physical activity in the form of outdoor swimming is perceived to have positive impacts on health and is associated with perceived symptom reductions in mental health, musculoskeletal and injury, and cardiovascular and blood conditions. This study cannot provide causal relationships or provide mechanistic insights. However, it does provide a starting point for more targeted prospective intervention research into individual conditions or categories of conditions to establish the impact in those who choose to start outdoor swimming. %M 34982711 %R 10.2196/25589 %U https://www.i-jmr.org/2022/1/e25589 %U https://doi.org/10.2196/25589 %U http://www.ncbi.nlm.nih.gov/pubmed/34982711 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30578 %T A Pragmatic Intervention Using Financial Incentives for Pregnancy Weight Management: Feasibility Randomized Controlled Trial %A Krukowski,Rebecca %A Johnson,Brandi %A Kim,Hyeonju %A Sen,Saunak %A Homsi,Riad %+ Department of Public Health Science, University of Virginia, PO Box 800765, Charlottesville, VA, 22908-0765, United States, 1 434 924 1000, bkrukowski@virginia.edu %K pregnancy %K weight %K physical activity %K self-weighing %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Excessive gestational weight gain (GWG) is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated into standard obstetric care are needed, and financial incentives are a promising approach. Objective: The aim of this study is to evaluate the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, in a behavioral program. The program provided small incentives for meeting behavioral goals of self-weighing and physical activity as well as larger outcome incentives for meeting GWG goals. Methods: We recruited 40 adult women in their first trimester of pregnancy from February 2019 to September 2019 at an obstetric clinic. Participants were randomized to 3 intervention components using a 2×2×2 factorial design: daily incentives for self-weighing (lottery vs certain loss), incentives for adhering to the Institute of Medicine’s GWG guidelines based on BMI category (monthly vs overall), and incentives for reaching physical activity goals (yes vs no). Participants were asked to complete daily weigh-ins using the Withings Body wireless scale provided by the study, as well as wear a physical activity tracker (Fitbit Flex 2). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, were assessed. Weight assessments were conducted at baseline, 32-week gestation, and 36-week gestation. Results: Participants were enrolled at, on average, 9.6 (SD 1.8) weeks’ gestation. Of the 39 participants who were oriented to their condition and received the intervention, 24 (62%) were Black or African American, 30 (77%) were not married, and 29 (74%) had an annual household income of less than US $50,000. Of the 39 participants, 35 (90%) completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness of, and the enjoyment of using, the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not. Conclusions: A financial incentive–based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy GWG. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive–based interventions for healthy GWG behaviors. Trial Registration: ClinicalTrials.gov NCT03834194; https://clinicaltrials.gov/ct2/show/NCT03834194 %M 34951594 %R 10.2196/30578 %U https://formative.jmir.org/2021/12/e30578 %U https://doi.org/10.2196/30578 %U http://www.ncbi.nlm.nih.gov/pubmed/34951594 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30558 %T A Digital Health Fall Prevention Program for Older Adults: Feasibility Study %A Jacobson,Claire L %A Foster,Lauren C %A Arul,Hari %A Rees,Amanda %A Stafford,Randall S %+ Age Bold Inc, Los Angeles, CA, United States, 1 6503811395, lauren@agebold.com %K older adults %K accidental falls %K fall prevention %K digital health %K technology %K exercise %K longevity and healthy aging %K program evaluation %K aging %K elderly %K health strategy %D 2021 %7 23.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: About 1 in 3 adults aged 65 and older falls annually. Exercise interventions are effective in reducing the fall risk and fall rate among older adults. In 2020, startup company Age Bold Inc. disseminated the Bold Fall Prevention Program, aiming to reduce falls among older adults through a remotely delivered, digital exercise program. Objective: We conducted a feasibility study to assess the delivery of the Bold Fall Prevention Program remotely and evaluate the program's impact on 2 primary outcomes—annualized fall rate and weekly minutes of physical activity (PA)—over 6 months of follow-up. Methods: Older adults at high risk of falling were screened and recruited for the feasibility study via nationwide digital advertising strategies. Self-reported outcomes were collected via surveys administered at the time of enrollment and after 3 and 6 months. Responses were used to calculate changes in the annualized fall rate and minutes of PA per week. Results: The remote delivery of a progressive digital fall prevention program and associated research study, including remote recruitment, enrollment, and data collection, was deemed feasible. Participants successfully engaged at home with on-demand video exercise classes, self-assessments, and online surveys. We enrolled 65 participants, of whom 48 (74%) were women, and the average participant age was 72.6 years. Of the 65 participants, 54 (83%) took at least 1 exercise class, 40 (62%) responded to at least 1 follow-up survey at either 3 or 6 months, 20 (31%) responded to both follow-up surveys, and 25 (39%) were lost to follow-up. Among all participants who completed at least 1 follow-up survey, weekly minutes of PA increased by 182% (ratio change=2.82, 95% CI 1.26-6.37, n=35) from baseline and annualized falls per year decreased by 46% (incidence rate ratio [IRR]=0.54, 95% CI 0.32-0.90, n=40). Among only 6-month survey responders (n=31, 48%), weekly minutes of PA increased by 206% (ratio change=3.06, 95% CI 1.43-6.55) from baseline to 6 months (n=30, 46%) and the annualized fall rate decreased by 28% (IRR=0.72, 95% CI 0.42-1.23) from baseline to 6 months. Conclusions: The Bold Fall Prevention Program provides a feasible strategy to increase PA and reduce the burden of falls among older adults. %M 34837492 %R 10.2196/30558 %U https://formative.jmir.org/2021/12/e30558 %U https://doi.org/10.2196/30558 %U http://www.ncbi.nlm.nih.gov/pubmed/34837492 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28040 %T Test-Retest Reliability of Home-Based Fitness Assessments Using a Mobile App (R Plus Health) in Healthy Adults: Prospective Quantitative Study %A Lin,I-I %A Chen,You-Lin %A Chuang,Li-Ling %+ School of Physical Therapy & Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, No. 259 Wen-hua 1st Rd, Guishan Dist, Taoyuan, 33302, Taiwan, 886 3 2118800 ext 3177, lchuang@gap.cgu.edu.tw %K mobile health app %K reliability %K home-based fitness assessments %K healthy adults %K mobile phone %K digital health %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor physical fitness has a negative impact on overall health status. An increasing number of health-related mobile apps have emerged to reduce the burden of medical care and the inconvenience of long-distance travel. However, few studies have been conducted on home-based fitness tests using apps. Insufficient monitoring of physiological signals during fitness assessments have been noted. Therefore, we developed R Plus Health, a digital health app that incorporates all the components of a fitness assessment with concomitant physiological signal monitoring. Objective: The aim of this study is to investigate the test-retest reliability of home-based fitness assessments using the R Plus Health app in healthy adults. Methods: A total of 31 healthy young adults self-executed 2 fitness assessments using the R Plus Health app, with a 2- to 3-day interval between assessments. The fitness assessments included cardiorespiratory endurance, strength, flexibility, mobility, and balance tests. The intraclass correlation coefficient was computed as a measure of the relative reliability of the fitness assessments and determined their consistency. The SE of measurement, smallest real difference at a 90% CI, and Bland–Altman analyses were used to assess agreement, sensitivity to real change, and systematic bias detection, respectively. Results: The relative reliability of the fitness assessments using R Plus Health was moderate to good (intraclass correlation coefficient 0.8-0.99 for raw scores, 0.69-0.99 for converted scores). The SE of measurement and smallest real difference at a 90% CI were 1.44-6.91 and 3.36-16.11, respectively, in all fitness assessments. The 95% CI of the mean difference indicated no significant systematic error between the assessments for the strength and balance tests. The Bland–Altman analyses revealed no significant systematic bias between the assessments for all tests, with a few outliers. The Bland–Altman plots illustrated narrow limits of agreement for upper extremity strength, abdominal strength, and right leg stance tests, indicating good agreement between the 2 assessments. Conclusions: Home-based fitness assessments using the R Plus Health app were reliable and feasible in young, healthy adults. The results of the fitness assessments can offer a comprehensive understanding of general health status and help prescribe safe and suitable exercise training regimens. In future work, the app will be tested in different populations (eg, patients with chronic diseases or users with poor fitness), and the results will be compared with clinical test results. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000030905; http://www.chictr.org.cn/showproj.aspx?proj=50229 %M 34657835 %R 10.2196/28040 %U https://formative.jmir.org/2021/12/e28040 %U https://doi.org/10.2196/28040 %U http://www.ncbi.nlm.nih.gov/pubmed/34657835 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e29712 %T Association of Innate and Acquired Aerobic Capacity With Resilience in Healthy Adults: Protocol for a Randomized Controlled Trial of an 8-Week Web-Based Physical Exercise Intervention %A Ochmann,David T %A Philippi,Keito F A %A Zeier,Peter %A Sandner,Magdalena %A Hillen,Barlo %A Neuberger,Elmo W I %A Ruiz de Azua,Inigo %A Lieb,Klaus %A Wessa,Michèle %A Lutz,Beat %A Simon,Perikles %A Brahmer,Alexandra %+ Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg-University Mainz, Albert-Schweitzer-Str. 22, Mainz, 55128, Germany, 49 61313937283, albrahme@uni-mainz.de %K stress resilience %K eHealth %K aerobic capacity %K peak oxygen uptake %K cortisol %K kynurenic acid %K endocannabinoids %D 2021 %7 29.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity alleviates chronic stress. The latest research suggests a relationship between resilience and physical fitness. Beneficial adaptations of the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, endocannabinoid system, and tryptophan pathway, which are induced by an active lifestyle, are considered to be conducive to resilience. However, detailed knowledge on the molecular link between the effects of acute and chronic physical exercise and improved resilience to stress in humans is missing. Moreover, the relationship between innate and acquired aerobic capacity and resilience is poorly understood. Objective: The aim of this study is to implement a human exercise intervention trial addressing the following main hypotheses: a high innate aerobic capacity is associated with high resilience to stress, and web-based physical exercise training improves aerobic capacity of physically inactive adults, which is accompanied by improved resilience. In this setting, we will analyze the relationship between resilience parameters and innate and acquired aerobic capacity as well as circulating signaling molecules. Methods: A total of 70 healthy, physically inactive (<150 minutes/week of physical activity) adults (aged 18-45 years) will be randomly assigned to an intervention or control group. Participants in the intervention group will receive weekly training using progressive endurance and interval running adapted individually to their remotely supervised home training performance via web-based coach support. A standardized incremental treadmill exercise test will be performed before and after the intervention period of 8 weeks to determine the innate and acquired aerobic capacity (peak oxygen uptake). Before and after the intervention, psychological tests and questionnaires that characterize parameters implicated in resilience will be applied. Blood and saliva will be sampled for the analysis of cortisol, lactate, endocannabinoids, catecholamines, kynurenic acid, and further circulating signal transducers. Statistical analysis will provide comprehensive knowledge on the relationship between aerobic capacity and resilience, as well as the capacity of peripheral factors to mediate the promoting effects of exercise on resilience. Results: The study was registered in October 2019, and enrollment began in September 2019. Of the 161 participants who were initially screened via a telephone survey, 43 (26.7%) fulfilled the inclusion criteria and were included in the study. Among the 55% (17/31) of participants in the intervention group and 45% (14/31) of participants in the control group who completed the study, no serious adverse incidents were reported. Of 43 participants, 4 (9%) withdrew during the program (for individual reasons) and 8 (19%) have not yet participated in the program; moreover, further study recruitment was paused for an indeterminate amount of time because of the COVID-19 pandemic. Conclusions: Our study aims to further define the physiological characteristics of human resilience, and it may offer novel approaches for the prevention and therapy of mental disorders via an exercise prescription. International Registered Report Identifier (IRRID): DERR1-10.2196/29712 %M 34847062 %R 10.2196/29712 %U https://www.researchprotocols.org/2021/11/e29712 %U https://doi.org/10.2196/29712 %U http://www.ncbi.nlm.nih.gov/pubmed/34847062 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e28024 %T Improvements in Diet and Physical Activity–Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study %A Cyriac,Jissy %A Jenkins,Sarah %A Patten,Christi A %A Hayes,Sharonne N %A Jones,Clarence %A Cooper,Lisa A %A Brewer,LaPrincess C %+ Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, United States, 1 507 266 1376, brewer.laprincess@mayo.edu %K African Americans %K cardiovascular health disparities %K mHealth lifestyle intervention %K diet %K physical activity %K mobile phone %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: African Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans. Objective: This study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change. Methods: This study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory–informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression. Results: Participants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=−0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively). Conclusions: Our findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans. %M 34766917 %R 10.2196/28024 %U https://mhealth.jmir.org/2021/11/e28024 %U https://doi.org/10.2196/28024 %U http://www.ncbi.nlm.nih.gov/pubmed/34766917 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e23968 %T Need for Cognition Among Users of Self-Monitoring Systems for Physical Activity: Survey Study %A Halttu,Kirsi %A Oinas-Kukkonen,Harri %+ Oulu Advanced Research on Service and Information Systems Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, P.O. Box 3000, Oulu, FI-90014, Finland, 358 458601190, kirsi.halttu@oulu.fi %K self-monitoring %K wearables %K physical activity tracking %K mHealth %K need for cognition %K persuasive design %K tailoring %K user research %K mobile phone %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Need for cognition (NFC) is among the most studied personality traits in psychology. Despite its apparent relevance for engaging with technology and the use of information, it has not been studied in the context of self-monitoring systems and wearables for health. This study is the first to explore the relationship between NFC and commercial self-monitoring systems among healthy users. Objective: This study aims to explore the effect of NFC levels on the selection of self-monitoring systems and evaluation of system features of self-monitoring and feedback, as well as perceived credibility and perceived persuasiveness. We also assessed perceived behavior change in the form of self-reported activity after adopting the system. Methods: Survey data were collected in October 2019 among university students and personnel. The invitation to respond to the questionnaire was addressed to those who had used a digital system to monitor their physical activity for at least two months. The web-based questionnaire comprised the following 3 parts: details of system use, partially randomly ordered theoretical measurement items, and user demographics. The data were analyzed using structural equation modeling. The effect of NFC was assessed both as 3 groups (low, moderate, and high) and as a continuous moderator variable. Results: In all, 238 valid responses to the questionnaire were obtained. Individuals with high NFC reported all tested system features with statistically significantly higher scores. The NFC also had some effect on system selection. Hypothesized relationships with perceived credibility gained support in a different way for individuals with low and high NFC; for those with low NFC, credibility increased the persuasiveness of the system, but this effect was absent among individuals with high NFC. For users with high NFC, credibility was related to feedback and self-monitoring and perhaps continuously evaluated during prolonged use instead of being a static system property. Furthermore, the relationship between perceived persuasiveness and self-reported activity after adopting the system had a large effect size (Cohen f2=0.355) for individuals with high NFC, a small effect size for individuals with moderate NFC (Cohen f2=0.107), and a nonsignificant path (P=.16) for those with low NFC. We also detected a moderating effect of NFC in two paths on perceived persuasiveness but only among women. Our research model explained 59.2%, 63.9%, and 47.3% of the variance in perceived persuasiveness of the system among individuals with low, moderate, and high NFC, respectively. Conclusions: The system choices of individuals seem to reflect their intrinsic motivations to engage with rich data, and commercial systems might themselves be a tailoring strategy. Important characteristics of the system, such as perceived credibility, have different roles depending on the NFC levels. Our data demonstrate that NFC as a trait that differentiates information processing has several implications for the selection, design, and tailoring of self-monitoring systems. %M 34647894 %R 10.2196/23968 %U https://formative.jmir.org/2021/10/e23968 %U https://doi.org/10.2196/23968 %U http://www.ncbi.nlm.nih.gov/pubmed/34647894 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31273 %T Supporting Mental Health During the COVID-19 Pandemic Using a Digital Behavior Change Intervention: An Open-Label, Single-Arm, Pre-Post Intervention Study %A Summers,Charlotte %A Wu,Philip %A Taylor,Alisdair J G %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 7969091134, charlotte@ddm.health %K stress %K mental health %K COVID-19 %K digital therapy %K mHealth %K support %K behavior %K intervention %K online intervention %K outcome %K wellbeing %K sleep %K activity %K nutrition %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is taking a toll on people’s mental health, particularly as people are advised to adhere to social distancing, self-isolation measures, and government-imposed national lockdowns. Digital health technologies have an important role to play in keeping people connected and in supporting their mental health and well-being. Even before the COVID-19 pandemic, mental health and social services were already strained. Objective: Our objective was to evaluate the 12-week outcomes of the digitally delivered Gro Health intervention, a holistic digital behavior change app designed for self-management of mental well-being, sleep, activity, and nutrition. Methods: The study used a quasi-experimental research design consisting of an open-label, single-arm, pre-post intervention engagement using a convenience sample. Adults who had joined the Gro Health app (intervention) and had a complete baseline dataset (ie, 7-item Generalized Anxiety Disorder scale, Perceived Stress Scale, and 9-item Patient Health Questionnaire) were followed up at 12 weeks (n=273), including 33 (12.1%) app users who reported a positive COVID-19 diagnosis during the study period. User engagement with the Gro Health platform was tracked by measuring total minutes of app engagement. Paired t tests were used to compare pre-post intervention scores. Linear regression analysis was performed to assess the relationship between minutes of active engagement with the Gro Health app and changes in scores across the different mental health measures. Results: Of the 347 study participants, 273 (78.67%) completed both the baseline and follow-up surveys. Changes in scores for anxiety, perceived stress, and depression were predicted by app engagement, with the strongest effect observed for changes in perceived stress score (F1,271=251.397; R2=0.479; P<.001). Conclusions: A digital behavior change platform that provides remote mental well-being support can be effective in managing depression, anxiety, and perceived stress during times of crisis such as the current COVID-19 pandemic. The outcomes of this study may also support the implementation of remote digital health apps supporting behavior change and providing support for low levels of mental health within the community. %M 34459740 %R 10.2196/31273 %U https://formative.jmir.org/2021/10/e31273 %U https://doi.org/10.2196/31273 %U http://www.ncbi.nlm.nih.gov/pubmed/34459740 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e25464 %T Characteristics of Participants and Nonparticipants in a Blended Internet-Based Physical Activity Trial for Breast and Prostate Cancer Survivors: Cross-sectional Study %A vd Wiel,Hester J %A Stuiver,Martijn M %A May,Anne M %A van Grinsven,Susan %A Benink,Marlou F A %A Aaronson,Neil K %A Oldenburg,Hester S A %A van der Poel,Henk G %A van Harten,Wim H %A Groen,Wim G %+ Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, Netherlands, 31 0205129111, w.v.harten@nki.nl %K internet-based intervention %K physical activity %K nonparticipants %K breast cancer survivors %K prostate cancer survivors %K RCT %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: As the number of cancer survivors is increasing, it is important to be able to offer exercise and physical activity (PA)–promoting interventions that are both effective and reasonably accessible. Internet-based interventions are typically less expensive and more accessible alternatives to on-site supervised interventions. Currently, little is known about the characteristics of nonparticipants in PA promotion trials in the cancer survivorship setting, both in general and specifically in trials using internet-supported interventions. Objective: This study aims to gain insight into the characteristics associated with nonparticipation in a blended internet-based supported intervention trial to promote PA. Methods: Breast and prostate cancer survivors, 3-36 months after primary curative treatment, were invited to participate in the PABLO trial; this trial compared an internet-based intervention to enhance PA levels, with or without additional support from a physical therapist, to usual care. Participants and nonparticipants were asked to complete a comprehensive questionnaire assessing sociodemographics, fatigue, and health-related quality of life. Baseline data for participants and nonparticipants were compared using the independent Student t test and chi-square test. Results: The inclusion rate in the trial was 11.03% (137/1242). Of the nonparticipants, 13.95% (154/1104) completed the questionnaire. Participants were more highly educated (P=.04), had a paid job less often (P=.03), and were on sick leave more often (P=.03). They reported less PA per week, both moderate (P=.03) and vigorous (P<.01), before diagnosis and during leisure time (P<.01, effect size [ES]=0.44). They reported a significantly lower stage of change (P≤.01), lower self-efficacy (P<.01, ES=0.61), perceived barriers to PA (P<.01, ES=0.54), and more general fatigue (P<.01, ES=0.60). Participants reported lower health-related quality of life for most domains (ES ranging from 0.34 for mental health to 0.48 for social functioning). No significant differences were found for other sociodemographics, mood state, or attitudes toward or perceived social support for PA. Conclusions: The participants who self-selected for trial participation reported lower PA levels before diagnosis and a stronger need for support compared with nonparticipants. The trial thus included those patients who might benefit the most from internet-based supportive PA interventions. Trial Registration: Netherlands trial register NTR6911; https://www.trialregister.nl/trial/6733 %M 34609311 %R 10.2196/25464 %U https://cancer.jmir.org/2021/4/e25464 %U https://doi.org/10.2196/25464 %U http://www.ncbi.nlm.nih.gov/pubmed/34609311 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 3 %P e31247 %T Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study %A Correia,Fernando D %A Molinos,Maria %A Neves,Carlos %A Janela,Dora %A Carvalho,Diana %A Luis,Sara %A Francisco,Gerard E %A Lains,Jorge %A Bento,Virgilio %+ Neurology Department, Centro Hospitalar e Universitário do Porto, Largo do Prof Abel Salazar, Porto, 4099-001, Portugal, 351 966557789, fanacorreia@gmail.com %K acute ankle sprains %K physical rehabilitation %K home-based digital rehabilitation %K digital therapy %K rehabilitation %K sprain %K digital health %K therapy %K rehabilitation %K prospective %K longitudinal %K cohort %K ankle %K soft tissue %K physical therapy %K pain %K outcome %K fatigue %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence. Objective: We aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains. Methods: We performed a prospective longitudinal cohort study of individuals eligible for workers’ compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure–activities of daily living (FAAM–ADL) and FAAM–Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction. Results: In total, 93 (89.4%) patients completed the program and 79 (76.0%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of –2.72 points (95% CI –3.31 to –2.13) on the NPRS (49.8% reduction), 21.7 points (95% CI 17.13-26.27) on the FAAM–ADL (41.1% increase), and 37.8 points (95% CI 30.45-45.15) on the FAAM-Sports (151.8% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9% attained full recovery and were discharged with no residual disability. Conclusions: Being far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results. This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions. Trial Registration: ClinicalTrials.gov NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022 %M 34499038 %R 10.2196/31247 %U https://rehab.jmir.org/2021/3/e31247 %U https://doi.org/10.2196/31247 %U http://www.ncbi.nlm.nih.gov/pubmed/34499038 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26224 %T Understanding Preferences for Lifestyle-Focused Visual Text Messages in Patients With Cardiovascular and Chronic Respiratory Disease: Discrete Choice Experiment %A Choi,Michael %A Raeside,Rebecca %A Hyun,Karice %A Partridge,Stephanie R %A Thiagalingam,Aravinda %A Redfern,Julie %+ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Level 6, Block K, Westmead Hospital, Westmead, Sydney, 2154, Australia, 61 88909214, julie.redfern@sydney.edu.au %K mHealth %K cardiovascular disease %K respiratory disease %K visual communication %K lifestyle change %K consumer preferences %K secondary prevention %K rehabilitation %K persuasive health technology %D 2021 %7 20.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Supporting healthy lifestyle changes is a key aim of cardiovascular and pulmonary rehabilitation programs. SMS text messaging programs have demonstrated effectiveness in cardiovascular disease risk reduction, weight loss, increasing physical activity, and smoking cessation. The optimization of SMS text messaging programs may deliver greater population benefits as mobile phone use becomes ubiquitous. Visual messaging (ie, image-based messages) has the potential to communicate health messages via digital technology and result in enhanced engagement. Objective: This study aims to determine and understand patient preferences for lifestyle-focused visual text messages that support cardiovascular and pulmonary rehabilitation. Methods: A discrete choice experiment was conducted in a 4-stage iterative process to elicit patient preferences for visual message features. Attribute and level development yielded 3 attributes (purpose, image type, and web address), and 16 choice sets were subsequently constructed according to a full factorial design. Patients participating in cardiovascular and pulmonary rehabilitation were surveyed (on the web) for their preferences regarding the visual message choice sets. Respondents were asked to choose among 16 pairs of visual messages regarding key lifestyle behaviors, namely, physical activity and nutrition. The data were analyzed using a conditional logit model. Results: There was a total of 1728 observations from 54 unique respondents. Two factors that were associated with patient preference were gain-framed purpose compared with no purpose (odds ratio [OR] 1.93, 95% CI 1.40-2.65) and real images compared with cartoon images (OR 1.26, 95% CI 1.04-1.54). A loss-framed purpose was less preferred than no purpose (OR 0.55, 95% CI 0.42-0.74). Overall, patients preferred positive images that were colorful and engaged with text that supported the image and had a preference for images of real people rather than cartoons. Conclusions: A discrete choice experiment is a scientific method for eliciting patient preferences for a visual messaging intervention that is designed to support changes in lifestyle behaviors. SMS text messaging programs that use visual aids may result in greater patient satisfaction by using a gain frame, using real images, and avoiding a loss frame. Further research is needed to explore the feasibility of implementation and the health and behavioral outcomes associated with such visual messaging programs. %M 34542413 %R 10.2196/26224 %U https://www.jmir.org/2021/9/e26224 %U https://doi.org/10.2196/26224 %U http://www.ncbi.nlm.nih.gov/pubmed/34542413 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28337 %T The Impact of COVID-19–Related Restrictions on Social and Daily Activities of Parents, People With Disabilities, and Older Adults: Protocol for a Longitudinal, Mixed Methods Study %A Reid,Holly %A Miller,William Cameron %A Esfandiari,Elham %A Mohammadi,Somayyeh %A Rash,Isabelle %A Tao,Gordon %A Simpson,Ethan %A Leong,Kai %A Matharu,Parmeet %A Sakakibara,Brodie %A Schmidt,Julia %A Jarus,Tal %A Forwell,Susan %A Borisoff,Jaimie %A Backman,Catherine %A Alic,Adam %A Brooks,Emily %A Chan,Janice %A Flockhart,Elliott %A Irish,Jessica %A Tsukura,Chihori %A Di Spirito,Nicole %A Mortenson,William Ben %+ Rehabilitation Research Program, GF Strong Rehabilitation Centre, 4255 Laurel Street, Vancouver, BC, Canada, 1 604 714 4108, bill.miller@ubc.ca %K COVID-19 %K longitudinal study %K spinal cord injury %K disability %K adult %K occupational disruption %K stroke %K older adults %D 2021 %7 1.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has led to wide-scale changes in societal organization. This has dramatically altered people’s daily activities, especially among families with young children, those living with disabilities such as spinal cord injury (SCI), those who have experienced a stroke, and older adults. Objective: We aim to (1) investigate how COVID-19 restrictions influence daily activities, (2) track the psychosocial effects of these restrictions over time, and (3) identify strategies to mitigate the potential negative effects of these restrictions. Methods: This is a longitudinal, concurrent, mixed methods study being conducted in British Columbia (BC), Canada. Data collection occurred at four time points, between April 2020 and February 2021. The first three data collection time points occurred within phases 1 to 3 of the Province of BC’s Restart Plan. The final data collection coincided with the initial distribution of the COVID-19 vaccines. At each time point, data regarding participants’ sociodemographics, depressive and anxiety symptoms, resilience, boredom, social support, instrumental activities of daily living, and social media and technology use were collected in an online survey. These data supplemented qualitative videoconference interviews exploring participants’ COVID-19–related experiences. Participants were also asked to upload photos representing their experience during the restriction period, which facilitated discussion during the final interview. Five groups of participants were recruited: (1) families with children under the age of 18 years, (2) adults with an SCI, (3) adults who experienced a stroke, (4) adults with other types of disabilities, and (5) older adults (>64 years of age) with no self-reported disability. The number of participants we could recruit from each group was limited, which may impact the validity of some subgroup analyses. Results: This study was approved by the University of British Columbia Behavioural Research Ethics Board (Approval No. H20-01109) on April 17, 2020. A total of 81 participants were enrolled in this study and data are being analyzed. Data analyses are expected to be completed in fall 2021; submission of multiple papers for publication is expected by winter 2021. Conclusions: Findings from our study will inform the development and recommendations of a new resource guide for the post–COVID-19 period and for future public health emergencies. International Registered Report Identifier (IRRID): DERR1-10.2196/28337 %M 34292163 %R 10.2196/28337 %U https://www.researchprotocols.org/2021/9/e28337 %U https://doi.org/10.2196/28337 %U http://www.ncbi.nlm.nih.gov/pubmed/34292163 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e27669 %T Variations in Patients’ Overall Assessment of Their Health Across and Within Disease Groups Using the EQ-5D Questionnaire: Protocol for a Longitudinal Study in the Swedish National Quality Registers %A Teni,Fitsum Sebsibe %A Rolfson,Ola %A Devlin,Nancy %A Parkin,David %A Nauclér,Emma %A Burström,Kristina %A , %+ Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, SE-171 77, Sweden, 46 764027138, fitsum.teni@ki.se %K EQ-5D %K EQ VAS %K experience-based values %K health-related quality of life (HRQoL) %K hypothetical values %K patient values %K Swedish National Quality Registers %K health state valuation %D 2021 %7 27.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: EQ-5D is one of the most commonly used questionnaires to measure health-related quality of life. It is included in many of the Swedish National Quality Registers (NQRs). EQ-5D health states are usually summarized using “values” obtained from members of the general public, a majority of whom are healthy. However, an alternative, which remains to be studied in detail, is the potential to use patients’ self-reported overall health on the visual analog scale (VAS) as a means of capturing experience-based perspective. Objective: The aim of this study is to assess EQ VAS as a valuation method with an experience-based perspective through comparison of its performance across and within patient groups, and with that of the general population in Sweden. Methods: Data on nearly 700,000 patients from 12 NQRs covering a variety of diseases/conditions and nearly 50,000 individuals from the general population will be analyzed. The EQ-5D-3L data from the 12 registers and EQ-5D-5L data from 2 registers will be used in the analyses. Longitudinal studies of patient-reported outcomes among different patient groups will be conducted in the period from baseline to 1-year follow-up. Descriptive statistics and analyses comparing EQ-5D dimensions and observed self-assessed EQ VAS values across and within patient groups will be performed. Comparisons of the change in health state and observed EQ VAS values at 1-year follow-up will also be undertaken. Regression models will be used to assess whether EQ-5D dimensions predict observed EQ VAS values to investigate patient value sets in each patient group. These will be compared across the patient groups and with the existing Swedish experience-based VAS and time trade-off value sets obtained from the general population. Results: Data retrieval started in May 2019 and data of patients in the 12 NQRs and from the survey conducted among the general population have been retrieved. Data analysis is ongoing on the retrieved data. Conclusions: This research project will provide information on the differences across and within patient groups in terms of self-reported health status through EQ VAS and comparison with the general population. The findings of the study will contribute to the literature by exploring the potential of self-assessed EQ VAS values to develop value sets using an experience-based perspective. Trial Registration: ClinicalTrials.gov NCT04359628; https://clinicaltrials.gov/ct2/show/NCT04359628. International Registered Report Identifier (IRRID): DERR1-10.2196/27669 %M 34448726 %R 10.2196/27669 %U https://www.researchprotocols.org/2021/8/e27669 %U https://doi.org/10.2196/27669 %U http://www.ncbi.nlm.nih.gov/pubmed/34448726 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28273 %T Improving Physical Activity Levels in Prevocational Students by Student Participation: Protocol for a Cluster Randomized Controlled Trial %A Van de Kop,Huib %A Toussaint,Huub %A Janssen,Mirka %A Busch,Vincent %A Verhoeff,Arnoud %+ Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dr. Meurerlaan 8, Amsterdam, 1067 SM, Netherlands, 31 0 621158166, j.h.van.de.kop@hva.nl %K physical activity %K participatory %K adolescents %K protocol %K assets %K school-based %K students %K participation %K school-age children %K teenagers %K exercise %D 2021 %7 28.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: A consistent finding in the literature is the decline in physical activity during adolescence, resulting in activity levels below the recommended guidelines. Therefore, promotion of physical activity is recommended specifically for prevocational students. Objective: This protocol paper describes the background and design of a physical activity promotion intervention study in which prevocational students are invited to participate in the design and implementation of an intervention mix. The intervention is expected to prevent a decline in physical activity in the target group. Methods: The effectiveness of the intervention was evaluated in a two-group cluster randomized controlled trial with assessments at baseline and 2-year follow-up. A simple randomization was applied, allocating 11 schools to the intervention group and 11 schools to the control group, which followed the regular school curriculum. The research population consisted of 3003 prevocational students, aged 13-15 years. The primary outcome measures were self-reported physical activity levels (screen time, active commuting, and physical activity). As a secondary outcome, direct assessment of physical fitness (leg strength, arm strength, hip flexibility, hand speed, abdominal muscle strength, BMI, and body composition) was included. An intervention-control group comparison was presented for the baseline results. The 2-year interventions began by mapping the assets of the prevocational adolescents of each intervention school using motivational interviewing in the structured interview matrix and the photovoice method. In addition, during focus group sessions, students, school employees, and researchers cocreated and implemented an intervention plan that optimally met the students’ assets and opportunities in the school context. The degree of student participation was evaluated through interviews and questionnaires. Results: Data collection of the SALVO (stimulating an active lifestyle in prevocational students) study began in October 2015 and was completed in December 2017. Data analyses will be completed in 2021. Baseline comparisons between the intervention and control groups were not significant for age (P=.12), screen time behavior (P=.53), nonschool active commuting (P=.26), total time spent on sports activities (P=.32), total physical activities (P=.11), hip flexibility (P=.22), maximum handgrip (P=.47), BMI (P=.44), and sum of skinfolds (P=.29). Significant differences between the intervention and control groups were found in ethnicity, gender, active commuting to school (P=.03), standing broad jump (P=.02), bent arm hang (P=.01), 10× 5-m sprint (P=.01), plate tapping (P=.01), sit-ups (P=.01), and 20-m shuttle run (P=.01). Conclusions: The SALVO study assesses the effects of a participatory intervention on physical activity and fitness levels in prevocational students. The results of this study may lead to a new understanding of the effectiveness of school-based physical activity interventions when students are invited to participate and cocreate an intervention. This process would provide structured health promotion for future public health. Trial Registration: ISRCTN Registry ISRCTN35992636; http://www.isrctn.com/ISRCTN35992636 International Registered Report Identifier (IRRID): DERR1-10.2196/28273 %M 34121666 %R 10.2196/28273 %U https://www.researchprotocols.org/2021/7/e28273 %U https://doi.org/10.2196/28273 %U http://www.ncbi.nlm.nih.gov/pubmed/34121666 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e26739 %T Adolescent Levers for a Diet and Physical Activity Intervention Across Socioecological Levels in Kenya, South Africa, Cameroon, and Jamaica: Mixed Methods Study Protocol %A Odunitan-Wayas,Feyisayo A %A Wadende,Pamela %A Mogo,Ebele R I %A Brugulat-Panés,Anna %A Micklesfield,Lisa K %A Govia,Ishtar %A Mapa-Tassou,Clarisse %A Mukoma,Gudani %A Smith,Joanne A %A Motlhalhedi,Molebogeng %A Wasnyo,Yves %A Were,Vincent %A Assah,Felix %A Okop,Kufre J %A Norris,Shane A %A Obonyo,Charles %A Mbanya,Jean Claude %A Tulloch-Reid,Marshall K %A King,Abby C %A Lambert,Estelle V %A Oni,Tolu %+ Health Through Physical Activity, Lifestyle and Sport Research Centre, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, 3rd Floor, Sports Science Institute of South Africa, Boundary Road, Newlands, South Africa, Cape Town, 7725, South Africa, 27 843686276, feyi.odunitan-wayas@uct.ac.za %K adolescent %K food intake %K foodways %K physical activity %K noncommunicable diseases %K socioecological levers %K low and middle income countries %K health outcomes %D 2021 %7 13.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increasing burden of noncommunicable diseases that are prevalent in low- and middle-income countries (LMICs) is largely attributed to modifiable behavioral risk factors such as unhealthy diets and insufficient physical activity (PA). The adolescent stage, defined as 10 to 24 years of age, is an important formative phase of life and offers an opportunity to reduce the risk of noncommunicable diseases across the life course and for future generations. Objective: The aim of this paper is to describe a protocol for a study using a convergent mixed methods design to explore exposures in the household, neighborhood, school, and the journey from home to school that may influence diet and PA behaviors in adolescents from LMICs. Methods: Male and female adolescents (n≥150) aged between 13 and 24 years will be recruited from selected high schools or households in project site countries to ensure the socioeconomic diversity of perspectives and experiences at the individual, home, and neighborhood levels. The project will be conducted at 5 sites in 4 countries: Kenya, Cameroon, Jamaica, and South Africa (Cape Town and Johannesburg). Data on anthropometric measures, food intake, and PA knowledge and behavior will be collected using self-report questionnaires. In addition, a small number of learners (n=30-45) from each site will be selected as citizen scientists to capture data (photographs, audio notes, text, and geolocations) on their lived experiences in relation to food and PA in their homes, the journey to and from school, and the school and neighborhood environments using a mobile app, and for objective PA measurements. In-depth interviews will be conducted with the citizen scientists and their caregivers to explore household experiences and determinants of food intake and foodways, as well as the PA of household members. Results: The study described in this protocol paper was primarily funded through a UK National Institute for Health Research grant in 2017 and approved by the relevant institutional ethics review boards in the country sites (South Africa, Cameroun, and Jamaica in 2019, and Kenya in 2020). As of December 23, 2020, we had completed data collection from adolescents (n≥150) in all the country sites, except Kenya, and data collection for the subgroup (n=30-45) is ongoing. Data analysis is ongoing and the output of findings from the study described in this protocol is expected to be published by 2022. Conclusions: This project protocol contributes to research that focuses on adolescents and the socioecological determinants of food intake and PA in LMIC settings. It includes innovative methodologies to interrogate and map the contexts of these determinants and will generate much-needed data to understand the multilevel system of factors that can be leveraged through upstream and downstream strategies and interventions to improve health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/26739 %M 34255729 %R 10.2196/26739 %U https://www.researchprotocols.org/2021/7/e26739 %U https://doi.org/10.2196/26739 %U http://www.ncbi.nlm.nih.gov/pubmed/34255729 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e15641 %T A Smart Shoe Insole to Monitor Frail Older Adults’ Walking Speed: Results of Two Evaluation Phases Completed in a Living Lab and Through a 12-Week Pilot Study %A Piau,Antoine %A Steinmeyer,Zara %A Charlon,Yoann %A Courbet,Laetitia %A Rialle,Vincent %A Lepage,Benoit %A Campo,Eric %A Nourhashemi,Fati %+ Gerontopole, University Hospital of Toulouse, 24 rue du pont St Pierre, Toulouse, 31400, France, 33 561323010, antoinepiau@hotmail.com %K frail older adults %K walking speed %K outpatient monitoring %K activity tracker %K shoe insert %D 2021 %7 5.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent World Health Organization reports propose wearable devices to collect information on activity and walking speed as innovative health indicators. However, mainstream consumer-grade tracking devices and smartphone apps are often inaccurate and require long-term acceptability assessment. Objective: Our aim is to assess the user acceptability of an instrumented shoe insole in frail older adults. This device monitors participants’ walking speed and differentiates active walking from shuffling after step length calibration. Methods: A multiphase evaluation has been designed: 9 older adults were evaluated in a living lab for a day, 3 older adults were evaluated at home for a month, and a prospective randomized trial included 35 older adults at home for 3 months. A qualitative research design using face-to-face and phone semistructured interviews was performed. Our hypothesis was that this shoe insole was acceptable in monitoring long-term outdoor and indoor walking. The primary outcome was participants' acceptability, measured by a qualitative questionnaire and average time of insole wearing per day. The secondary outcome described physical frailty evolution in both groups. Results: Living lab results confirmed the importance of a multiphase design study with participant involvement. Participants proposed insole modifications. Overall acceptability had mixed results: low scores for reliability (2.1 out of 6) and high scores for usability (4.3 out of 6) outcomes. The calibration phase raised no particular concern. During the field test, a majority of participants (mean age 79 years) were very (10/16) or quite satisfied (3/16) with the insole's comfort at the end of the follow-up. Participant insole acceptability evolved as follows: 63% (12/19) at 1 month, 50% (9/18) at 2 months, and 75% (12/16) at 3 months. A total of 9 participants in the intervention group discontinued the intervention because of technical issues. All participants equipped for more than a week reported wearing the insole every day at 1 month, 83% (15/18) at 2 months, and 94% (15/16) at 3 months for 5.8, 6.3, and 5.1 hours per day, respectively. Insole data confirmed that participants effectively wore the insole without significant decline during follow-up for an average of 13.5 days per 4 months and 5.6 hours per day. For secondary end points, the change in frailty parameters or quality of life did not differ for those randomly assigned to the intervention group compared to usual care. Conclusions: Our study reports acceptability data on an instrumented insole in indoor and outdoor walking with remote monitoring in frail older adults under real-life conditions. To date, there is limited data in this population set. This thin instrumentation, including a flexible battery, was a technical challenge and seems to provide an acceptable solution over time that is valued by participants. However, users still raised certain acceptability issues. Given the growing interest in wearable health care devices, these results will be useful for future developments. Trial Registration: ClinicalTrials.gov NCT02316600; https://clinicaltrials.gov/ct2/show/NCT02316600 %M 36260404 %R 10.2196/15641 %U https://mhealth.jmir.org/2021/7/e15641 %U https://doi.org/10.2196/15641 %U http://www.ncbi.nlm.nih.gov/pubmed/36260404 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25794 %T A Web-Based Time-Use Application to Assess Diet and Movement Behavior in Asian Schoolchildren: Development and Usability Study of My E-Diary for Activities and Lifestyle (MEDAL) %A Chia,Airu %A Chew,Muhammad Naeem Jia Sheng %A Tan,Sarah Yi Xuan %A Chan,Mei Jun %A T Colega,Marjorelee %A Toh,Jia Ying %A Natarajan,Padmapriya %A Lança,Carla %A Shek,Lynette P %A Saw,Seang-Mei %A Müller-Riemenschneider,Falk %A Chong,Mary Foong-Fong %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore, 65 6516 4969, mary_chong@nus.edu.sg %K time use %K web-based %K diet %K movement behaviors %K usability %K schoolchildren %D 2021 %7 9.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based time-use diaries for schoolchildren are limited, and existing studies focus mostly on capturing physical activities and sedentary behaviors but less comprehensively on dietary behaviors. Objective: This study aims to describe the development of My E-Diary for Activities and Lifestyle (MEDAL)—a self-administered, web-based time-use application to assess diet and movement behavior—and to evaluate its usability in schoolchildren in Singapore. Methods: MEDAL was developed through formative research and an iterative user-centric design approach involving small groups of schoolchildren (ranging from n=5 to n=15, aged 7-13 years). To test the usability, children aged 10-11 years were recruited from 2 primary schools in Singapore to complete MEDAL for 2 weekdays and 2 weekend days and complete a 10-item usability questionnaire. Results: The development process revealed that younger children (aged <9 years) were less able to complete MEDAL independently. Of the 204 participants (118/204, 57.8% boys, and 31/201, 15.4% overweight) in the usability study, 57.8% (118/204) completed 3 to 4 days of recording, whereas the rest recorded for 2 days or less. The median time taken to complete MEDAL was 14.2 minutes per day. The majority of participants agreed that instructions were clear (193/203, 95.1%), that MEDAL was easy to use (173/203, 85.2%), that they liked the application (172/202, 85.1%), and that they preferred recording their activities on the web than on paper (167/202, 82.7%). Among all the factors evaluated, recording for 4 days was the least satisfactory component reported. Compared with boys, girls reported better recall ability and agreed that the time spent on completing 1-day entry was appropriate. Conclusions: MEDAL appears to be a feasible application to capture diet and movement behaviors in children aged 10-12 years, particularly in the Asian context. Some gender differences in usability performance were observed, but the majority of the participants had a positive experience using MEDAL. The validation of the data collected through the application is in progress. %M 34106084 %R 10.2196/25794 %U https://www.jmir.org/2021/6/e25794 %U https://doi.org/10.2196/25794 %U http://www.ncbi.nlm.nih.gov/pubmed/34106084 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e23630 %T Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic: Cross-National Survey %A Manjunath,Nandi Krishnamurthy %A Majumdar,Vijaya %A Rozzi,Antonietta %A Huiru,Wang %A Mishra,Avinash %A Kimura,Keishin %A Nagarathna,Raghuram %A Nagendra,Hongasandra Ramarao %+ Swami Vivekananda Yoga Anusandhana Samsthana University, #19, Eknath Bhavan, Gavipuram Circle, KG Naga, Bengaluru, 560019, India, 91 08026995163, vijaya.majumdar@svyasa.edu.in %K health behavior %K self-report %K cross-national survey %K COVID-19 %K behavior %K perception %K lifestyle %K nutrition %K real-time %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social isolation measures are requisites to control viral spread during the COVID-19 pandemic. However, if these measures are implemented for a long period of time, they can result in adverse modification of people’s health perceptions and lifestyle behaviors. Objective: The aim of this cross-national survey was to address the lack of adequate real-time data on the public response to changes in lifestyle behavior during the crisis of the COVID-19 pandemic. Methods: A cross-national web-based survey was administered using Google Forms during the month of April 2020. The settings were China, Japan, Italy, and India. There were two primary outcomes: (1) response to the health scale, defined as perceived health status, a combined score of health-related survey items; and (2) adoption of healthy lifestyle choices, defined as the engagement of the respondent in any two of three healthy lifestyle choices (healthy eating habits, engagement in physical activity or exercise, and reduced substance use). Statistical associations were assessed with linear and logistic regression analyses. Results: We received 3371 responses; 1342 were from India (39.8%), 983 from China (29.2%), 669 from Italy (19.8%), and 377 (11.2%) from Japan. A differential countrywise response was observed toward perceived health status; the highest scores were obtained for Indian respondents (9.43, SD 2.43), and the lowest were obtained for Japanese respondents (6.81, SD 3.44). Similarly, countrywise differences in the magnitude of the influence of perceptions on health status were observed; perception of interpersonal relationships was most pronounced in the comparatively old Italian and Japanese respondents (β=.68 and .60, respectively), and the fear response was most pronounced in Chinese respondents (β=.71). Overall, 78.4% of the respondents adopted at least two healthy lifestyle choices amid the COVID-19 pandemic. Unlike health status, the influence of perception of interpersonal relationships on the adoption of lifestyle choices was not unanimous, and it was absent in the Italian respondents (odds ratio 1.93, 95% CI 0.65-5.79). The influence of perceived health status was a significant predictor of lifestyle change across all the countries, most prominently by approximately 6-fold in China and Italy. Conclusions: The overall consistent positive influence of increased interpersonal relationships on health perceptions and adopted lifestyle behaviors during the pandemic is the key real-time finding of the survey. Favorable behavioral changes should be bolstered through regular virtual interpersonal interactions, particularly in countries with an overall middle-aged or older population. Further, controlling the fear response of the public through counseling could also help improve health perceptions and lifestyle behavior. However, the observed human behavior needs to be viewed within the purview of cultural disparities, self-perceptions, demographic variances, and the influence of countrywise phase variations of the pandemic. The observations derived from a short lockdown period are preliminary, and real insight could only be obtained from a longer follow-up. %M 33900928 %R 10.2196/23630 %U https://formative.jmir.org/2021/6/e23630 %U https://doi.org/10.2196/23630 %U http://www.ncbi.nlm.nih.gov/pubmed/33900928 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e27668 %T STAR Duodecim eHealth Tool to Recognize Chronic Disease Risk Factors and Change Unhealthy Lifestyle Choices Among the Long-Term Unemployed: Protocol for a Mixed Methods Validation Study %A Kuhlberg,Henna %A Kujala,Sari %A Hörhammer,Iiris %A Koskela,Tuomas %+ Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland, 358 504488439, henna.kuhlberg@gmail.com %K eHealth %K risk assessment %K long-term unemployed %K expected age of death %K online intervention %K risk factors %K chronic illnesses %K primary prevention %K online health check %K long-term %K multimorbidity %K health care services %K examination %K evaluation %K lifestyle %D 2021 %7 1.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Lifestyle choices and socioeconomic status have a significant impact on the expected onset of diseases, age of death, and risk factors concerning long-term illnesses and morbidity. STAR is an online health examination tool, which gives users a report that includes an evaluation of their life expectancy and an estimated risk for developing common long-term illnesses based on questions about health, characteristics, lifestyle, and quality of life. Objective: The goals of this study are to (1) review the capacity of STAR to recognize morbidity risks in comparison to a traditional nurse-led health examination and patient-reported health challenges; (2) evaluate the user experience and usability of STAR; and (3) assess the potential impact of STAR on the health confidence and motivation of patients to make healthier lifestyle choices. Methods: This mixed methods validation study will consist of a quantitative part (questionnaires) and a qualitative part (phone interviews and open-ended questions from the questionnaires). The participants will include 100 long-term unemployed individuals attending a health check for the unemployed. The participants will be recruited from three Finnish public health centers in Espoo, Hämeenlinna, and Tampere. At the health centers, the participants will use STAR and attend a nurse’s health check. Surveys with multiple-choice and open-ended questions will be collected from the participants, the nurse, and a study assistant. The questionnaires include questions about the participant’s background and health challenges from the patient and nurse points of view, as well as questions about how well the health challenges matched the STAR report. The questionnaires also gather data about user experience, health confidence, and usability of STAR. A study assistant will fill out an observer’s form containing questions about use time and possible problems encountered while using STAR. A sample of the unemployed participants will be interviewed by telephone subsequently. For the quantitative data, descriptive statistics and a reliability analysis will be performed, and mean sum scores will be computed for the study variables. Thematic analysis of the qualitative data will be performed. Results: This study was approved by the Ethics Committee of the Expert Responsibility Area of Tampere University Hospital in June 2020 (ETL Code R20067). Data collection will begin in June 2021 and will take approximately 3-6 months. Conclusions: Online health examinations can improve the effectiveness of primary prevention in health care by supporting efficient evidence-based morbidity risk estimation and motivating patients to change unhealthy behaviors. A multimethod approach is used to allow for assessment of the tool’s usefulness from the points of view of both professionals and patients. This study will further provide a rich understanding of how the tool can be used as part of routine health checks, and how and why the tool may or may not motivate users for making healthier lifestyle choices. International Registered Report Identifier (IRRID): PRR1-10.2196/27668 %M 34061041 %R 10.2196/27668 %U https://www.researchprotocols.org/2021/6/e27668 %U https://doi.org/10.2196/27668 %U http://www.ncbi.nlm.nih.gov/pubmed/34061041 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e25771 %T User Experience With Dynamic Difficulty Adjustment Methods for an Affective Exergame: Comparative Laboratory-Based Study %A Darzi,Ali %A McCrea,Sean M %A Novak,Domen %+ Department of Electrical and Computer Engineering, University of Wyoming, 1000 E University Avenue, Dept 3295, Laramie, WY, 82071, United States, 1 307 766 2279, dnovak1@uwyo.edu %K affective computing %K dynamic difficulty adaptation %K exergames %K physiological measurements %K task performance %K personality characteristics %K psychophysiology %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: In affective exergames, game difficulty is dynamically adjusted to match the user’s physical and psychological state. Such an adjustment is commonly made based on a combination of performance measures (eg, in-game scores) and physiological measurements, which provide insight into the player’s psychological state. However, although many prototypes of affective games have been presented and many studies have shown that physiological measurements allow more accurate classification of the player’s psychological state than performance measures, few studies have examined whether dynamic difficulty adjustment (DDA) based on physiological measurements (which requires additional sensors) results in a better user experience than performance-based DDA or manual difficulty adjustment. Objective: This study aims to compare five DDA methods in an affective exergame: manual (player-controlled), random, performance-based, personality-performance–based, and physiology-personality-performance–based (all-data). Methods: A total of 50 participants (N=50) were divided into five groups, corresponding to the five DDA methods. They played an exergame version of Pong for 18 minutes, starting at a medium difficulty; every 2 minutes, two game difficulty parameters (ball speed and paddle size) were adjusted using the participant’s assigned DDA method. The DDA rules for the performance-based, personality-performance–based, and all-data groups were developed based on data from a previous open-loop study. Seven physiological responses were recorded throughout the sessions, and participants self-reported their preferred changes to difficulty every 2 minutes. After playing the game, participants reported their in-game experience using two questionnaires: the Intrinsic Motivation Inventory and the Flow Experience Measure. Results: Although the all-data method resulted in the most accurate changes to ball speed and paddle size (defined as the percentage match between DDA choice and participants’ preference), no significant differences between DDA methods were found on the Intrinsic Motivation Inventory and Flow Experience Measure. When the data from all four automated DDA methods were pooled together, the accuracy of changes in ball speed was significantly correlated with players’ enjoyment (r=0.38) and pressure (r=0.43). Conclusions: Although our study is limited by the use of a between-subjects design and may not generalize to other exergame designs, the results do not currently support the inclusion of physiological measurements in affective exergames, as they did not result in an improved user experience. As the accuracy of difficulty changes is correlated with user experience, the results support the development of more effective DDA methods. However, they show that the inclusion of physiological measurements does not guarantee a better user experience even if it yields promising results in offline cross-validation. %M 34057423 %R 10.2196/25771 %U https://games.jmir.org/2021/2/e25771 %U https://doi.org/10.2196/25771 %U http://www.ncbi.nlm.nih.gov/pubmed/34057423 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25663 %T Physical Activity Patterns and Neighborhood Characteristics of First-Generation Latina Immigrants Living in Arizona: Cross-sectional Study %A Joseph,Rodney P %A Vega-López,Sonia %A Han,SeungYong %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N 3rd St, Phoenix, AZ, 85004, United States, 1 6024960772, rodney.joseph@asu.edu %K emigrants and immigrants %K physical activity %K exercise %K residence characteristics %K female %K metabolic disease %K Latina %K immigrants %K emigrants %K health outcomes %D 2021 %7 17.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Metabolic diseases, including obesity and type 2 diabetes, are a major health concern for Latina immigrants. Performing regular aerobic physical activity (PA) is a lifestyle behavior associated with the prevention and control of these conditions. However, PA levels of most Latina immigrants are below national guidelines. Neighborhood environmental factors may influence the PA levels of adults, but limited research has explored associations between the neighborhood environment and PA levels among Latina immigrants. Objective: The objective of this study was to explore the PA patterns of first-generation US Latina immigrants and how neighborhood environmental factors are related to those PA patterns. Methods: Using a cross-sectional study design, 50 first-generation Latina immigrants completed the International Physical Activity Questionnaire (IPAQ) and the Neighborhood Scales Questionnaire, which assessed 6 perceived neighborhood factors: (1) walking environment, (2) aesthetic quality, (3) safety, (4) violence, (5) social cohesion, and (6) activities with neighbors. Median self-reported metabolic equivalent (MET)-minutes/week of PA were used to summarize domain-specific (ie, work, domestic/household, leisure, and transportation) and intensity-specific (ie, walking, moderate, vigorous, moderate to vigorous) PA patterns. Logistic regression examined associations between neighborhood factors and engaging in leisure-time PA (ie, dichotomous outcome of some versus no leisure-time PA), transportation PA (ie, dichotomous outcome of some versus no transportation PA), and meeting national PA guidelines (ie, dichotomous outcome of meeting versus not meeting guidelines). Results: Preliminary analyses showed that 10 participants reported excessively high PA levels and 1 participant had incomplete PA data; these women were excluded from analyses based on IPAQ scoring guidelines. The remaining 39 participants (mean age 40.5 years; mean length of US residency 4.6 years) reported a median of 4512 MET-minutes/week of total PA. The majority of PA was acquired through domestic activities (median 2160 MET-minutes/week), followed by leisure-time PA (median 396 MET-minutes/week), transportation PA (median 198 MET-minutes/week), and work PA (0 MET-minutes/week). Intensity-specific PA patterns showed a median of 594 MET-minutes/week of walking activity and 3500 MET-minutes/week of moderate-to-vigorous PA. Logistic regression models indicated that the neighborhood factors of walking environment, aesthetic quality, and safety were positively associated with engaging in leisure-time PA (odds ratios of 5.95, 95% CI 1.49-23.74; 2.45, 95% CI 1.01-5.93; and 3.30, 95% CI 1.26-8.67, respectively) and meeting national PA guidelines (odds ratios of 4.15, 95% CI 1.13-15.18; 6.43, 95% CI 1.45-28.39; and 2.53, 95% CI 1.00-6.36, respectively). The neighborhood factors of violence, social cohesion, and activities with neighbors were not significantly associated with PA outcomes. Conclusions: Although most participants met national PA guidelines (ie, ≥500 MET-minutes/week of moderate-to-vigorous PA), the majority of their PA was achieved through domestic activities, with limited leisure, transportation, and work PA. Given that leisure-time PA in particular plays a significant role in improving health outcomes, findings suggest that many Latina immigrants could benefit from a leisure-time PA intervention. Such interventions should consider neighborhood environmental influences, as these factors may serve as determinants of PA. %M 33999003 %R 10.2196/25663 %U https://formative.jmir.org/2021/5/e25663 %U https://doi.org/10.2196/25663 %U http://www.ncbi.nlm.nih.gov/pubmed/33999003 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 2 %P e25371 %T A Handheld Metabolic Device (Lumen) to Measure Fuel Utilization in Healthy Young Adults: Device Validation Study %A Lorenz,Kent Arnold %A Yeshurun,Shlomo %A Aziz,Richard %A Ortiz-Delatorre,Julissa %A Bagley,James Robert %A Mor,Merav %A Kern,Marialice %+ Department of Kinesiology, San Francisco State University, 1600 Holloway Ave, GYM 101, San Francisco, CA, 94132, United States, 1 4153382244, kalorenz@sfsu.edu %K resting metabolic rate %K Lumen %K ParvoMedics TrueOne 2400 %K validation %K respiratory exchange ratio %K metabolism %K fuel utilization %K indirect calorimetry %K breath %K lung %K respiratory %K young adult %K measurement %K testing %D 2021 %7 17.5.2021 %9 Original Paper %J Interact J Med Res %G English %X Background: Metabolic carts measure the carbon dioxide (CO2) produced and oxygen consumed by an individual when breathing to assess metabolic fuel usage (carbohydrates versus fats). However, these systems are expensive, time-consuming, and only available in health care laboratory settings. A small handheld device capable of determining metabolic fuel usage via CO2 from exhaled air has been developed. Objective: The aim of this study is to evaluate the validity of a novel handheld device (Lumen) for measuring metabolic fuel utilization in healthy young adults. Methods: Metabolic fuel usage was assessed in healthy participants (n=33; mean age 23.1 years, SD 3.9 years) via respiratory exchange ratio (RER) values obtained from a metabolic cart as well as % CO2 from the Lumen device. Measurements were performed at rest in two conditions: fasting, and after consuming 150 grams of glucose, in order to determine changes in metabolic fuel usage. Reduced major axis regression and simple linear regression were performed to test for agreement between RER and Lumen % CO2. Results: Both RER and Lumen % CO2 significantly increased after glucose intake (P<.001 for both) compared with fasting conditions, by 0.089 and 0.28, respectively. Regression analyses revealed an agreement between the two measurements (F1,63=18.54; P<.001). Conclusions: This study shows the validity of Lumen for detecting changes in metabolic fuel utilization in a comparable manner with a laboratory standard metabolic cart, providing the ability for real-time metabolic information for users under any circumstances. %M 33870899 %R 10.2196/25371 %U https://www.i-jmr.org/2021/2/e25371 %U https://doi.org/10.2196/25371 %U http://www.ncbi.nlm.nih.gov/pubmed/33870899 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e21763 %T Smartphone and Tablet Software Apps to Collect Data in Sport and Exercise Settings: Cross-sectional International Survey %A Shaw,Matthew Peter %A Satchell,Liam Paul %A Thompson,Steve %A Harper,Ed Thomas %A Balsalobre-Fernández,Carlos %A Peart,Daniel James %+ Sports, Physical Activity and Food, Western Norway University of Applied Sciences, Røyrgata 6, Sogndal, 6856, Norway, 47 57676391, matthew.shaw@hvl.no %K mobile apps %K sports %K smartphone %K mobile phone %K questionnaire %K survey %D 2021 %7 13.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in smartphone technology have facilitated an increase in the number of commercially available smartphone and tablet apps that enable the collection of physiological and biomechanical variables typically monitored in sport and exercise settings. Currently, it is not fully understood whether individuals collect data using mobile devices and tablets, independent of additional hardware, in their practice. Objective: This study aims to explore the use of smartphone and tablet software apps to collect data by individuals working in various sport and exercise settings, such as sports coaching, strength and conditioning, and personal training. Methods: A total of 335 practitioners completed an electronic questionnaire that surveyed their current training practices, with a focus on 2 areas: type of data collection and perceptions of reliability and validity regarding app use. An 18-item questionnaire, using a 5-point Likert scale, evaluated the perception of app use. Results: A total of 204 respondents reported using apps to directly collect data, with most of them (196/335, 58.5%) collecting biomechanical data, and 41.2% (138/335) respondents reported using at least one evidence-based app. A binomial general linear model determined that evidence accessibility (β=.35, 95% CI 0.04-0.67; P=.03) was significantly related to evidence-based app use. Age (β=−.03, 95% CI −0.06 to 0.00; P=.03) had a significant negative effect on evidence-based app use. Conclusions: This study demonstrates that practitioners show a greater preference for using smartphones and tablet devices to collect biomechanical data such as sprint velocity and jump performance variables. When it is easier to access information on the quality of apps, practitioners are more likely to use evidence-based apps. App developers should seek independent research to validate their apps. In addition, app developers should seek to provide clear signposting to the scientific support of their software in alternative ways. %M 33983122 %R 10.2196/21763 %U https://mhealth.jmir.org/2021/5/e21763 %U https://doi.org/10.2196/21763 %U http://www.ncbi.nlm.nih.gov/pubmed/33983122 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e23806 %T Consumer-Based Activity Trackers as a Tool for Physical Activity Monitoring in Epidemiological Studies During the COVID-19 Pandemic: Development and Usability Study %A Henriksen,André %A Johannessen,Erlend %A Hartvigsen,Gunnar %A Grimsgaard,Sameline %A Hopstock,Laila Arnesdatter %+ Department of Community Medicine, UiT The Arctic University of Norway, Postboks 6050 langnes, Tromsø, 9037, Norway, 47 77645214, andre.henriksen@uit.no %K COVID-19 %K energy expenditure %K steps %K smart watch %K fitness tracker %K actigraphy %K public health %K lockdown %K SARS-CoV-2 %K pandemic %K wearables %D 2021 %7 23.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Consumer-based physical activity trackers have increased in popularity. The widespread use of these devices and the long-term nature of the recorded data provides a valuable source of physical activity data for epidemiological research. The challenges include the large heterogeneity between activity tracker models in terms of available data types, the accuracy of recorded data, and how this data can be shared between different providers and third-party systems. Objective: The aim of this study is to develop a system to record data on physical activity from different providers of consumer-based activity trackers and to examine its usability as a tool for physical activity monitoring in epidemiological research. The longitudinal nature of the data and the concurrent pandemic outbreak allowed us to show how the system can be used for surveillance of physical activity levels before, during, and after a COVID-19 lockdown. Methods: We developed a system (mSpider) for automatic recording of data on physical activity from participants wearing activity trackers from Apple, Fitbit, Garmin, Oura, Polar, Samsung, and Withings, as well as trackers storing data in Google Fit and Apple Health. To test the system throughout development, we recruited 35 volunteers to wear a provided activity tracker from early 2019 and onward. In addition, we recruited 113 participants with privately owned activity trackers worn before, during, and after the COVID-19 lockdown in Norway. We examined monthly changes in the number of steps, minutes of moderate-to-vigorous physical activity, and activity energy expenditure between 2019 and 2020 using bar plots and two-sided paired sample t tests and Wilcoxon signed-rank tests. Results: Compared to March 2019, there was a significant reduction in mean step count and mean activity energy expenditure during the March 2020 lockdown period. The reduction in steps and activity energy expenditure was temporary, and the following monthly comparisons showed no significant change between 2019 and 2020. A small significant increase in moderate-to-vigorous physical activity was observed for several monthly comparisons after the lockdown period and when comparing March-December 2019 with March-December 2020. Conclusions: mSpider is a working prototype currently able to record physical activity data from providers of consumer-based activity trackers. The system was successfully used to examine changes in physical activity levels during the COVID-19 period. %M 33843598 %R 10.2196/23806 %U https://publichealth.jmir.org/2021/4/e23806 %U https://doi.org/10.2196/23806 %U http://www.ncbi.nlm.nih.gov/pubmed/33843598 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26330 %T Physical Activity, Nutritional Habits, and Sleeping Behavior in Students and Employees of a Swiss University During the COVID-19 Lockdown Period: Questionnaire Survey Study %A Taeymans,Jan %A Luijckx,Eefje %A Rogan,Slavko %A Haas,Karin %A Baur,Heiner %+ Department of Health Professions, Bern University of Applied Sciences, Murtenstr. 10, Bern, 3008, Switzerland, 41 31 848 35 56, slavko.rogan@bfh.ch %K COVID-19 %K healthy lifestyle %K pandemics %K public health %K universities %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The new coronavirus SARS-CoV-2 led to the COVID-19 pandemic starting in January 2020. The Swiss Federal Council prescribed a lockdown of nonessential businesses. Students and employees of higher education institutions had to install home offices and participate in online lectures. Objective: The aim of this survey study was to evaluate lifestyle habits, such as physical activity (PA), sitting time, nutritional habits (expressed as median modified Mediterranean Diet Score [mMDS]), alcohol consumption habits, and sleeping behavior during a 2-month period of confinement and social distancing due to the COVID-19 pandemic. Survey participants were students and employees of a Swiss university of applied sciences. Methods: All students and employees from Bern University of Applied Sciences, Department of Health Professions (ie, nursing, nutrition and dietetics, midwifery, and physiotherapy divisions) were invited to complete an anonymous online survey during the COVID-19 confinement period. Information on the lifestyle dimensions of PA, sitting time, nutritional and alcohol consumption habits, and sleep behavior was gathered using adaptations of validated questionnaires. Frequency analyses and nonparametric statistical methods were used for data analysis. Significance was set at 5% α level of error. Results: Prevalence of non-health-enhancing PA was 37.1%, with participants of the division of physiotherapy showing the lowest prevalence. Prevalence of long sitting time (>8 hours/day) was 36.1%. The median mMDS was 9, where the maximal score was 15, with participants of the division of nutrition and dietetics being more adherent to a Mediterranean diet as compared to the other groups. Prevalence of nonadherence to the Swiss alcohol consumption recommendations was 8.3%. Prevalence of low sleeping quality was 44.7%, while the median sleeping duration was 8 hours, which is considered healthy for adult populations. Conclusions: In the group analysis, differences in PA, sitting time, and mMDS were observed between different divisions of health professions as well as between Bachelor of Science students, Master of Science students, and employees. Therefore, public health messages regarding healthy lifestyle habits during home confinement should be more group specific. The results of this study may provide support for the implementation of group-specific health promotion interventions at universities in pandemic conditions. Trial Registration: ClinicalTrials.gov NCT04502108; https://www.clinicaltrials.gov/ct2/show/NCT04502108 %M 33630747 %R 10.2196/26330 %U https://publichealth.jmir.org/2021/4/e26330 %U https://doi.org/10.2196/26330 %U http://www.ncbi.nlm.nih.gov/pubmed/33630747 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e18777 %T Uncovering the Bone-Muscle Interaction and Its Implications for the Health and Function of Older Adults (the Wellderly Project): Protocol for a Randomized Controlled Crossover Trial %A Smith,Cassandra %A Lin,Xuzhu %A Scott,David %A Brennan-Speranza,Tara C %A Al Saedi,Ahmed %A Moreno-Asso,Alba %A Woessner,Mary %A Bani Hassan,Ebrahim %A Eynon,Nir %A Duque,Gustavo %A Levinger,Itamar %+ Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC, Australia, 61 399195343, itamar.levinger@vu.edu.au %K acute exercise %K clinical trial %K bone %K adult %K aging %K osteocalcin %K muscles %K sarcopenia %K progenitor cells %K stem cells %D 2021 %7 9.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Bone and muscle are closely linked anatomically, biochemically, and metabolically. Acute exercise affects both bone and muscle, implying a crosstalk between the two systems. However, how these two systems communicate is still largely unknown. We will explore the role of undercarboxylated osteocalcin (ucOC) in this crosstalk. ucOC is involved in glucose metabolism and has a potential role in muscle maintenance and metabolism. Objective: The proposed trial will determine if circulating ucOC levels in older adults at baseline and following acute exercise are associated with parameters of muscle function and if the ucOC response to exercise varies between older adults with low muscle quality and those with normal or high muscle quality. Methods: A total of 54 men and women aged 60 years or older with no history of diabetes and warfarin and vitamin K use will be recruited. Screening tests will be performed, including those for functional, anthropometric, and clinical presentation. On the basis of muscle quality, a combined equation of lean mass (leg appendicular skeletal muscle mass in kg) and strength (leg press; one-repetition maximum), participants will be stratified into a high or low muscle function group and randomized into the controlled crossover acute intervention. Three visits will be performed approximately 7 days apart, and acute aerobic exercise, acute resistance exercise, and a control session (rest) will be completed in any order. Our primary outcome for this study is the effect of acute exercise on ucOC in older adults with low muscle function and those with high muscle function. Results: The trial is active and ongoing. Recruitment began in February 2018, and 38 participants have completed the study as of May 26, 2019. Conclusions: This study will provide novel insights into bone and muscle crosstalk in older adults, potentially identifying new clinical biomarkers and mechanistic targets for drug treatments for sarcopenia and other related musculoskeletal conditions. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618001756213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375925. International Registered Report Identifier (IRRID): DERR1-10.2196/18777 %M 33835038 %R 10.2196/18777 %U https://www.researchprotocols.org/2021/4/e18777 %U https://doi.org/10.2196/18777 %U http://www.ncbi.nlm.nih.gov/pubmed/33835038 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e18591 %T Recruitment and Retention Strategies for Community-Based Longitudinal Studies in Diverse Urban Neighborhoods %A Ferris,Emily B %A Wyka,Katarzyna %A Evenson,Kelly R %A Dorn,Joan M %A Thorpe,Lorna %A Catellier,Diane %A Huang,Terry T-K %+ Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th St Room 80, New York, NY, 10027, United States, 1 646 364 0247, terry.huang@sph.cuny.edu %K community-based %K participant engagement %K natural experiment %K built environment intervention %K health disparities %K study adaptations %D 2021 %7 24.3.2021 %9 Viewpoint %J JMIR Form Res %G English %X Longitudinal, natural experiments provide an ideal evaluation approach to better understand the impact of built environment interventions on community health outcomes, particularly health disparities. As there are many participant engagement challenges inherent in the design of large-scale community-based studies, adaptive and iterative participant engagement strategies are critical. This paper shares practical lessons learned from the Physical Activity and Redesigned Community Spaces (PARCS) study, which is an evaluation of the impact of a citywide park renovation initiative on physical activity, psychosocial health, and community well-being. The PARCS study, although ongoing, has developed several approaches to improve participant engagement: building trust with communities, adapting the study protocol to meet participants’ needs and to reflect their capacity for participation, operational flexibility, and developing tracking systems. These strategies may help researchers anticipate and respond to participant engagement challenges in community-based studies, particularly in low-income communities of color. %M 33759799 %R 10.2196/18591 %U https://formative.jmir.org/2021/3/e18591 %U https://doi.org/10.2196/18591 %U http://www.ncbi.nlm.nih.gov/pubmed/33759799 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e17993 %T A Rest Quality Metric Using a Cluster-Based Analysis of Accelerometer Data and Correlation With Digital Medicine Ingestion Data: Algorithm Development %A Heidary,Zahra %A Cochran,Jeffrey M %A Peters-Strickland,Timothy %A Knights,Jonathan %+ Otsuka Pharmaceutical Development & Commercialization, Inc, 508 Carnegie Center Dr, Princeton, NJ, 08540, United States, 1 609 524 6788, jeffrey.cochran@otsuka-us.com %K serious mental illness %K rest quality %K actimetry %K behavioral health %K digital medicine %K accelerometer %K medication adherence %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adherence to medication regimens and patient rest are two important factors in the well-being of patients with serious mental illness. Both of these behaviors are traditionally difficult to record objectively in unsupervised populations. Objective: A digital medicine system that provides objective time-stamped medication ingestion records was used by patients with serious mental illness. Accelerometer data from the digital medicine system was used to assess rest quality and thus allow for investigation into correlations between rest and medication ingestion. Methods: Longest daily rest periods were identified and then evaluated using a k-means clustering algorithm and distance metric to quantify the relative quality of patient rest during these periods. This accelerometer-derived quality-of-rest metric, along with other accepted metrics of rest quality, such as duration and start time of the longest rest periods, was compared to the objective medication ingestion records. Overall medication adherence classification based on rest features was not performed due to a lack of patients with poor adherence in the sample population. Results: Explorations of the relationship between these rest metrics and ingestion did seem to indicate that patients with poor adherence experienced relatively low quality of rest; however, patients with better adherence did not necessarily exhibit consistent rest quality. This sample did not contain sufficient patients with poor adherence to draw more robust correlations between rest quality and ingestion behavior. The correlation of temporal outliers in these rest metrics with daily outliers in ingestion time was also explored. Conclusions: This result demonstrates the ability of digital medicine systems to quantify patient rest quality, providing a framework for further work to expand the participant population, compare these rest metrics to gold-standard sleep measurements, and correlate these digital medicine biomarkers with objective medication ingestion data. %M 33650981 %R 10.2196/17993 %U https://formative.jmir.org/2021/3/e17993 %U https://doi.org/10.2196/17993 %U http://www.ncbi.nlm.nih.gov/pubmed/33650981 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e21911 %T Effects of the Active Choices Program on Self-Managed Physical Activity and Social Connectedness in Australian Defence Force Veterans: Protocol for a Cluster-Randomized Trial %A Gilson,Nicholas D %A Papinczak,Zoe E %A Mielke,Gregore Iven %A Haslam,Catherine %A Fooken,Jonas %A McKenna,Jim %A Brown,Wendy J %+ School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Brisbane, 4072, Australia, 61 (07) 3365 6114, n.gilson1@uq.edu.au %K military service veterans %K self-managed physical activity %K behavioral support program %K psychological well-being %K social connectedness %K health service utilization %K health service costs %K physical activity %K well-being %K health professional %K veterans %K behavioral %K support program %D 2021 %7 24.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: A stepped-down program is one in which clients transition from the care of a health professional to self-managed care. Very little is known about the effectiveness of stepped-down physical activity (PA) programs for military service veterans. Objective: This study will test Active Choices, a stepped-down behavioral support program designed to help Australian Defence Force veterans and their dependents who are clients of the Department of Veterans’ Affairs, transition from treatment by an exercise physiologist or physiotherapist to self-managed PA. Methods: The study is a parallel-group, randomized trial, with city-based exercise physiology or physiotherapy practices that recruit eligible Department of Veterans’ Affairs clients assigned to Active Choices or a comparison program. The study aims to recruit 52 participants (26 in each group). The Active Choices program will consist of 2 face-to-face (Weeks 1, 12) and 2 telephone (Weeks 4 and 8) consultations. During these sessions, the participant and Active Choices consultant will utilize an evidence-based resource booklet to review the key benefits of an active lifestyle, build an action plan for PA preferences, set and review goals, self-monitor progress relative to set goals, and discuss strategies to overcome PA barriers. Linking participants to local PA communities to overcome social isolation will be a program priority. The comparison program will consist of 2 consultations (Weeks 1 and 12) and use fewer behavioral support strategies (education, self-monitoring, and action planning only) than Active Choices. Outcome measures will be administered at baseline, end-intervention (12 weeks), and follow-up (24 weeks) to assess changes in moderate intensity self-managed PA, psychological well-being, and social connectedness. We will also measure health service utilization and costs as well as PA choices across the intervention period. End-intervention interviews will capture participant experiences. Results: Due to the impacts of the COVID-19 pandemic on human research activities in Australia, participant recruitment will commence when it is safe and feasible to do so. Conclusions: Findings will provide valuable pilot data to support up-scaling of the program and larger effectiveness trials with regional and rural as well as city-based Australian Defence Force veterans and their dependents. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000559910; https://www.anzctr.org.au/ACTRN12620000559910.aspx International Registered Report Identifier (IRRID): PRR1-10.2196/21911 %M 33625365 %R 10.2196/21911 %U https://www.researchprotocols.org/2021/2/e21911 %U https://doi.org/10.2196/21911 %U http://www.ncbi.nlm.nih.gov/pubmed/33625365 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e24806 %T Wrist-Worn Activity Trackers in Laboratory and Free-Living Settings for Patients With Chronic Pain: Criterion Validity Study %A Sjöberg,Veronica %A Westergren,Jens %A Monnier,Andreas %A Lo Martire,Riccardo %A Hagströmer,Maria %A Äng,Björn Olov %A Vixner,Linda %+ School of Education, Health and Social Studies, Dalarna University, Högskolegatan 2, Falun, SE-791 88, Sweden, 46 23 77 87 57, vsj@du.se %K chronic pain %K energy expenditure %K heart rate %K physical activity %K step count %K validity %K wearable devices %K wearable %K pain %K rehabilitation %D 2021 %7 12.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity is evidently a crucial part of the rehabilitation process for patients with chronic pain. Modern wrist-worn activity tracking devices seemingly have a great potential to provide objective feedback and assist in the adoption of healthy physical activity behavior by supplying data of energy expenditure expressed as metabolic equivalent of task units (MET). However, no studies of any wrist-worn activity tracking devices’ have examined criterion validity in estimating energy expenditure, heart rate, or step count in patients with chronic pain. Objective: The aim was to determine the criterion validity of wrist-worn activity tracking devices for estimations of energy expenditure, heart rate, and step count in a controlled laboratory setting and free-living settings for patients with chronic pain. Methods: In this combined laboratory and field validation study, energy expenditure, heart rate, and step count were simultaneously estimated by a wrist-worn activity tracker (Fitbit Versa), indirect calorimetry (Jaeger Oxycon Pro), and a research-grade hip-worn accelerometer (ActiGraph GT3X) during treadmill walking at 3 speeds (3.0 km/h, 4.5 km/h, and 6.0 km/h) in the laboratory setting. Energy expenditure and step count were also estimated by the wrist-worn activity tracker in free-living settings for 72 hours. The criterion validity of each measure was determined using intraclass and Spearman correlation, Bland-Altman plots, and mean absolute percentage error. An analysis of variance was used to determine whether there were any significant systematic differences between estimations. Results: A total of 42 patients (age: 25-66 years; male: 10/42, 24%; female: 32/42, 76%), living with chronic pain (duration, in years: mean 9, SD 6.72) were included. At baseline, their mean pain intensity was 3.5 (SD 1.1) out of 6 (Multidimensional Pain Inventory, Swedish version). Results showed that the wrist-worn activity tracking device (Fitbit Versa) systematically overestimated energy expenditure when compared to the criterion standard (Jaeger Oxycon Pro) and the relative criterion standard (ActiGraph GT3X). Poor agreement and poor correlation were shown between Fitbit Versa and both Jaeger Oxycon Pro and ActiGraph GT3X for estimated energy expenditure at all treadmill speeds. Estimations of heart rate demonstrated poor to fair agreement during laboratory-based treadmill walks. For step count, the wrist-worn devices showed fair agreement and fair correlation at most treadmill speeds. In free-living settings; however, the agreement for step count between the wrist-worn device and waist-worn accelerometer was good, and the correlation was excellent. Conclusions: The wrist-worn device systematically overestimated energy expenditure and showed poor agreement and correlation compared to the criterion standard (Jaeger Oxycon Pro) and the relative criterion standard (ActiGraph GT3X), which needs to be considered when used clinically. Step count measured with a wrist-worn device, however, seemed to be a valid estimation, suggesting that future guidelines could include such variables in this group with chronic pain. %M 33433391 %R 10.2196/24806 %U http://mhealth.jmir.org/2021/1/e24806/ %U https://doi.org/10.2196/24806 %U http://www.ncbi.nlm.nih.gov/pubmed/33433391 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e22090 %T Comparison of the Physical Activity Measured by a Consumer Wearable Activity Tracker and That Measured by Self-Report: Cross-Sectional Analysis of the Health eHeart Study %A Beagle,Alexander J %A Tison,Geoffrey H %A Aschbacher,Kirstin %A Olgin,Jeffrey E %A Marcus,Gregory M %A Pletcher,Mark J %+ Department of Medicine, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, United States, 1 9098165831, alexanderjbeagle@gmail.com %K exercise %K body mass index %K overweight %K obesity %K fitness trackers %K self-report %K adult %K mHealth %K public health %K cardiovascular diseases %D 2020 %7 29.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Commercially acquired wearable activity trackers such as the Fitbit provide objective, accurate measurements of physically active time and step counts, but it is unclear whether these measurements are more clinically meaningful than self-reported physical activity. Objective: The aim of this study was to compare self-reported physical activity to Fitbit-measured step counts and then determine which is a stronger predictor of BMI by using data collected over the same period reflecting comparable physical activities. Methods: We performed a cross-sectional analysis of data collected by the Health eHeart Study, a large mobile health study of cardiovascular health and disease. Adults who linked commercially acquired Fitbits used in free-living conditions with the Health eHeart Study and completed an International Physical Activity Questionnaire (IPAQ) between 2013 and 2019 were enrolled (N=1498). Fitbit step counts were used to quantify time by activity intensity in a manner comparable to the IPAQ classifications of total active time and time spent being sedentary, walking, or doing moderate activities or vigorous activities. Fitbit steps per day were computed as a measure of the overall activity for exploratory comparisons with IPAQ-measured overall activity (metabolic equivalent of task [MET]-h/wk). Measurements of physical activity were directly compared by Spearman rank correlation. Strengths of associations with BMI for Fitbit versus IPAQ measurements were compared using multivariable robust regression in the subset of participants with BMI and covariates measured. Results: Correlations between synchronous paired measurements from Fitbits and the IPAQ ranged in strength from weak to moderate (0.09-0.48). In the subset with BMI and covariates measured (n=586), Fitbit-derived predictors were generally stronger predictors of BMI than self-reported predictors. For example, an additional hour of Fitbit-measured vigorous activity per week was associated with nearly a full point reduction in BMI (–0.84 kg/m2, 95% CI –1.35 to –0.32) in adjusted analyses, whereas the association between self-reported vigorous activity measured by IPAQ and BMI was substantially smaller in magnitude (–0.17 kg/m2, 95% CI –0.34 to –0.00; P<.001 versus Fitbit) and was dominated by the Fitbit-derived predictor when compared head-to-head in a single adjusted multivariable model. Similar patterns of associations with BMI, with Fitbit dominating self-report, were seen for moderate activity and total active time and in comparisons between overall Fitbit steps per day and IPAQ MET-h/wk on standardized scales. Conclusions: Fitbit-measured physical activity was more strongly associated with BMI than self-reported physical activity, particularly for moderate activity, vigorous activity, and summary measures of total activity. Consumer-marketed wearable activity trackers such as the Fitbit may be useful for measuring health-relevant physical activity in clinical practice and research. %M 33372896 %R 10.2196/22090 %U http://mhealth.jmir.org/2020/12/e22090/ %U https://doi.org/10.2196/22090 %U http://www.ncbi.nlm.nih.gov/pubmed/33372896 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e16303 %T Ambiguity in Communicating Intensity of Physical Activity: Survey Study %A Kim,Hyeoneui %A Kim,Jaemin %A Taira,Ricky %+ School of Nursing, Duke University, 307 Trent Drive, Durham, NC, 27710, United States, 1 919 684 7534, hyeoneui.kim@duke.edu %K exercise %K health communication %K exercise intensity %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Communicating physical activity information with sufficient details, such as activity type, frequency, duration, and intensity, is vital to accurately delineate the attributes of physical activity that bring positive health impact. Unlike frequency and duration, intensity is a subjective concept that can be interpreted differently by people depending on demographics, health status, physical fitness, and exercise habits. However, activity intensity is often communicated using general degree modifiers, degree of physical exertion, and physical activity examples, which are the expressions that people may interpret differently. Lack of clarity in communicating the intensity level of physical activity is a potential barrier to an accurate assessment of exercise effect and effective imparting of exercise recommendations. Objective: This study aimed to assess the variations in people’s perceptions and interpretations of commonly used intensity descriptions of physical activities and to identify factors that may contribute to these variations. Methods: A Web-based survey with a 25-item questionnaire was conducted using Amazon Mechanical Turk, targeting adults residing in the United States. The questionnaire included questions on participants’ demographics, exercise habits, overall perceived health status, and perceived intensity of 10 physical activity examples. The survey responses were analyzed using the R statistical package. Results: The analyses included 498 responses. The majority of respondents were females (276/498, 55.4%) and whites (399/498, 79.9%). Numeric ratings of physical exertion after exercise were relatively well associated with the 3 general degree descriptors of exercise intensity: light, moderate, and vigorous. However, there was no clear association between the intensity expressed with those degree descriptors and the degree of physical exertion the participants reported to have experienced after exercise. Intensity ratings of various examples of physical activity differed significantly according to respondents’ characteristics. Regression analyses showed that those who reported good health or considered regular exercise was important for their health tended to rate the intensity levels of the activity examples significantly higher than their counterparts. The respondents’ age and race (white vs nonwhite) were not significant predictors of the intensity rating. Conclusions: This survey showed significant variations in how people perceive and interpret the intensity levels of physical activities described with general severity modifiers, degrees of physical exertion, and physical activity examples. Considering that these are among the most widely used methods of communicating physical activity intensity in current practice, a possible miscommunication in assessing and promoting physical activity seems to be a real concern. We need to adopt a method that represents activity intensity in a quantifiable manner to avoid unintended miscommunication. %M 32348256 %R 10.2196/16303 %U http://publichealth.jmir.org/2020/2/e16303/ %U https://doi.org/10.2196/16303 %U http://www.ncbi.nlm.nih.gov/pubmed/32348256 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15458 %T Associations Between Parent Self-Reported and Accelerometer-Measured Physical Activity and Sedentary Time in Children: Ecological Momentary Assessment Study %A de Brito,Junia N %A Loth,Katie A %A Tate,Allan %A Berge,Jerica M %+ Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street SE, Suite 400, Minneapolis, MN, 55414, United States, 1 612 625 0931, nogue013@umn.edu %K ecological momentary assessment %K accelerometry %K mobile devices %K physical activity %K sedentary behavior %K children %D 2020 %7 19.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Retrospective self-report questionnaires are the most common method for assessing physical activity (PA) and sedentary behavior (SB) in children when the use of objective assessment methods (eg, accelerometry) is cost prohibitive. However, self-report measures have limitations (eg, recall bias). The use of real-time, mobile ecological momentary assessment (EMA) has been proposed to address these shortcomings. The study findings will provide useful information for researchers interested in using EMA surveys for measuring PA and SB in children, particularly when reported by a parent or caregiver. Objective: This study aimed to examine the associations between the parent’s EMA report of their child’s PA and SB and accelerometer-measured sedentary time (ST), light-intensity PA (LPA), and moderate-to-vigorous–intensity PA (MVPA) and to examine if these associations differed by day of week, sex, and season. Methods: A total of 140 parent-child dyads (mean child age 6.4 years, SD 0.8; n=66 girls; n=21 African American; n=24 American Indian; n=25 Hispanic/Latino; n=24 Hmong; n=22 Somali; and n=24 white) participated in this study. During an 8-day period, parents reported child PA and SB via multiple daily signal contingent EMA surveys, and children wore a hip-mounted accelerometer to objectively measure ST, LPA, and MVPA. Accelerometer data was matched to the time period occurring before parent EMA-report of child PA and SB. Generalized estimating equations with interaction-term analyses were performed to determine whether the relationship between parent-EMA report of child PA and SB and accelerometer-measured ST and LPA and MVPA outcomes differed by day of the week, sex and season. Results: The parent’s EMA report of their child’s PA and SB was strongly associated with accelerometer-measured ST, LPA, and MVPA. The parent’s EMA report of their child’s PA was stronger during the weekend than on weekdays for accelerometer-measured ST (P≤.001) and LPA (P<.001). For the parent’s EMA report of their child’s SB, strong associations were observed with accelerometer-measured ST (P<.001), LPA (P=.005), and MVPA (P=.008). The findings related to sex-interaction terms indicated that the association between the parent-reported child’s PA via EMA and the accelerometer-measured MVPA was stronger for boys than girls (P=.02). The association between the parent’s EMA report of their child’s PA and SB and accelerometer-measured ST and PA was similar across seasons in this sample (all P values >.31). Conclusions: When the use of accelerometry-based methods is not feasible and in contexts where the parent is able to spend more proximate time observing the child’s PA and SB, the parent’s EMA report might be a superior method for measuring PA and SB in young children relative to self-report, given the EMA’s strong associations with accelerometer-measured PA and ST. %M 32348283 %R 10.2196/15458 %U http://mhealth.jmir.org/2020/5/e15458/ %U https://doi.org/10.2196/15458 %U http://www.ncbi.nlm.nih.gov/pubmed/32348283 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14969 %T A Social Group-Based Information-Motivation-Behavior Skill Intervention to Promote Acceptability and Adoption of Wearable Activity Trackers Among Middle-Aged and Older Adults: Cluster Randomized Controlled Trial %A Liao,Jing %A Xiao,Hai-Yan %A Li,Xue-Qi %A Sun,Shu-Hua %A Liu,Shi-Xing %A Yang,Yung-Jen %A Xu,Dong (Roman) %+ Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, #135 Xingang West Road, Guangzhou, 510275, China, 86 84112657, xudong5@mail.sysu.edu.cn %K mobile health %K group exercise %K social influence %K behavior change %K cluster randomized controlled trial %D 2020 %7 9.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers offer potential to optimize behavior and support self-management. To assist older adults in benefiting from mobile technologies, theory-driven deployment strategies are needed to overcome personal, technological, and sociocontextual barriers in technology adoption. Objective: To test the effectiveness of a social group–based strategy to improve the acceptability and adoption of activity trackers by middle-aged and older adults. Methods: A cluster randomized controlled trial was conducted among 13 groups of middle-aged and older adults (≥45 years) performing group dancing (ie, square dancing) as a form of exercise in Guangzhou from November 2017 to October 2018. These dancing groups were randomized 1:1 into two arms, and both received wrist-worn activity trackers and instructions at the baseline face-to-face assessment. Based on the Information-Motivation-Behavior Skill framework, the intervention arm was also given a tutorial on the purpose of exercise monitoring (Information), encouraged to participate in exercise and share their exercise records with their dancing peers (Motivation), and were further assisted with the use of the activity tracker (Behavior Skill). We examined two process outcomes: acceptability evaluated by a 14-item questionnaire, and adoption assessed by the uploaded step count data. Intention-to-treat analysis was applied, with the treatment effects estimated by multilevel models. Results: All dancing groups were followed up for the postintervention reassessment, with 61/69 (88%) participants of the intervention arm (7 groups) and 56/80 (70%) participants of the control arm (6 groups). Participants’ sociodemographic characteristics (mean age 62 years, retired) and health status were comparable between the two arms, except the intervention arm had fewer female participants and lower cognitive test scores. Our intervention significantly increased the participants’ overall acceptability by 6.8 points (95% CI 2.2-11.4), mainly driven by promoted motivation (adjusted group difference 2.0, 95% CI 0.5-3.6), increased usefulness (adjusted group difference 2.5, 95% CI 0.9-4.1), and better perceived ease of use (adjusted group difference 1.2, 95% CI 0.1-2.4), whereas enjoyment and comfort were not increased (adjusted group difference 0.9, 95% CI –0.4-2.3). Higher adoption was also observed among participants in the intervention arm, who were twice as likely to have valid daily step account data than their controlled counterparts (adjusted incidence relative risk [IRR]=2.0, 95% CI 1.2-3.3). The average daily step counts (7803 vs 5653 steps/day for the intervention and control, respectively) were similar between the two arms (adjusted IRR=1.4, 95% CI 0.7-2.5). Conclusions: Our social group–based deployment strategy incorporating information, motivation, and behavior skill components effectively promoted acceptability and adoption of activity trackers among community-dwelling middle-aged and older adults. Future studies are needed to examine the long-term effectiveness and apply this social engagement strategy in other group settings or meeting places. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOC-17013185; https://tinyurl.com/vedwc7h. %M 32271151 %R 10.2196/14969 %U https://mhealth.jmir.org/2020/4/e14969 %U https://doi.org/10.2196/14969 %U http://www.ncbi.nlm.nih.gov/pubmed/32271151 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e11281 %T Features, Behavioral Change Techniques, and Quality of the Most Popular Mobile Apps to Measure Physical Activity: Systematic Search in App Stores %A Simões,Patrícia %A Silva,Anabela G %A Amaral,João %A Queirós,Alexandra %A Rocha,Nelson P %A Rodrigues,Mário %+ School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro, 3810-193, Portugal, 351 234401558 ext 27120, asilva@ua.pt %K behavioral change techniques %K mobile phone app %K physical activity %K quality %K technical features %K mobile phone %D 2018 %7 26.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It is estimated that 23% of adults and 55% of older adults do not meet the recommended levels of physical activity. Thus, improving the levels of physical activity is of paramount importance, but it requires the use of low-cost resources that facilitate universal access without depleting the health system. The high number of apps available constitutes an opportunity, but it also makes it quite difficult for the layperson to select the most appropriate app. Furthermore, the information available in the app stores is often insufficient, lacks quality, and is not evidence based, and the systematic reviews fail to assess app quality using standardized and validated instruments. Objective: The objective of this study was to systematically assess the features, content, and quality of the most popular apps that can be used to measure and, potentially, promote physical activity. Methods: Systematic searches were conducted on Apple App Store, Google Play, and Windows Phone Store between December 2017 and January 2018. Apps were included if their primary objective was to assess the aspects of physical activity, if they had a user rating of at least 4, if their number of ratings was ≥100, and if they were free. Apps meeting these criteria were independently assessed by two reviewers regarding their general and technical information, aspects of physical activity, presence of behavioral change techniques, and quality. Data were analyzed using means and SDs or frequencies and percentages. Results: Of 51 apps included, none specified the age of the target group and only one mentioned the involvement of health professionals. Most apps offered the possibility to work in background (n=50) and allowed data sharing (n=40). Regarding physical activity, most apps measured steps and distance (n=11) or steps, distance, and time (n=17). Only 18 apps, all of which measured number of steps, followed the guidelines on recommendations for physical activity. On average, 5.5 (SD 1.8) behavioral change techniques were identified per app; the most frequently used techniques were “provide feedback on performance” (n=50) and “prompt self-monitoring of behavior” (n=50). The overall quality score was 3.88 (SD 0.34). Conclusions: Although the overall quality of the apps was moderate, the quality of their content, particularly the use of international guidelines on physical activity, should be improved. Additionally, a more in-depth assessment of apps should be performed before releasing them for public use, particularly regarding their reliability and validity. %M 30368438 %R 10.2196/11281 %U http://mhealth.jmir.org/2018/10/e11281/ %U https://doi.org/10.2196/11281 %U http://www.ncbi.nlm.nih.gov/pubmed/30368438 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e253 %T Ecological Momentary Assessment of Physical Activity: Validation Study %A Knell,Gregory %A Gabriel,Kelley Pettee %A Businelle,Michael S %A Shuval,Kerem %A Wetter,David W %A Kendzor,Darla E %+ Michael and Susan Dell Center for Healthy Living, Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center (UTHealth) at Houston, 7000 Fannin, #2528, Houston, TX, 77030, United States, 1 713 500 9678, gregory.knell@uth.tmc.edu %K accelerometry %K behavioral risk factor surveillance system %K ecological momentary assessment %K self-report %K data accuracy %D 2017 %7 18.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Ecological momentary assessment (EMA) may elicit physical activity (PA) estimates that are less prone to bias than traditional self-report measures while providing context. Objectives: The objective of this study was to examine the convergent validity of EMA-assessed PA compared with accelerometry. Methods: The participants self-reported their PA using International Physical Activity Questionnaire (IPAQ) and Behavioral Risk Factor Surveillance System (BRFSS) and wore an accelerometer while completing daily EMAs (delivered through the mobile phone) for 7 days. Weekly summary estimates included sedentary time and moderate-, vigorous-, and moderate-to vigorous-intensity physical activity (MVPA). Spearman coefficients and Lin’s concordance correlation coefficients (LCC) examined the linear association and agreement for EMA and the questionnaires as compared with accelerometry. Results: Participants were aged 43.3 (SD 13.1) years, 51.7% (123/238) were African American, 74.8% (178/238) were overweight or obese, and 63.0% (150/238) were low income. The linear associations of EMA and traditional self-reports with accelerometer estimates were statistically significant (P<.05) for sedentary time (EMA: ρ=.16), moderate-intensity PA (EMA: ρ=.29; BRFSS: ρ=.17; IPAQ: ρ=.24), and MVPA (EMA: ρ=.31; BRFSS: ρ=.17; IPAQ: ρ=.20). Only EMA estimates of PA were statistically significant compared with accelerometer for agreement. Conclusions: The mobile EMA showed better correlation and agreement to accelerometer estimates than traditional self-report methods. These findings suggest that mobile EMA may be a practical alternative to accelerometers to assess PA in free-living settings. %M 28720556 %R 10.2196/jmir.7602 %U http://www.jmir.org/2017/7/e253/ %U https://doi.org/10.2196/jmir.7602 %U http://www.ncbi.nlm.nih.gov/pubmed/28720556 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 2 %P e32 %T Understanding Environmental and Contextual Influences of Physical Activity During First-Year University: The Feasibility of Using Ecological Momentary Assessment in the MovingU Study %A Bedard,Chloe %A King-Dowling,Sara %A McDonald,Madeline %A Dunton,Genevieve %A Cairney,John %A Kwan,Matthew %+ INfant and Child Health (INCH) Lab, Department of Family Medicine, McMaster University, DBHSC, 5th Floor, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada, 1 9055259140 ext 20303, kwanmy@mcmaster.ca %K exercise %K compliance %K feasibility studies %K young adult %K students %D 2017 %7 31.05.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: It is well established that drastic declines in physical activity (PA) occur during young adults’ transition into university; however, our understanding of contextual and environmental factors as it relates to young adults’ PA is limited. Objective: The purpose of our study was to examine the feasibility of using wrist-worn accelerometers and the use of ecological momentary assessment (EMA) to assess the context and momentary correlates of PA on multiple occasions each day during first-year university. Methods: First-year university students were asked to participate in the study. The participants completed a brief questionnaire and were subsequently asked to wear an ActiGraph GT9X-Link accelerometer and respond to a series of EMA prompts (7/day) via their phones for 5 consecutive days. Results: A total of 96 first-year university students with smartphones agreed to participate in the study (mean age 18.3 [SD 0.51]; n=45 females). Overall, there was good compliance for wearing the accelerometers, with 91% (78/86) of the participants having ≥2 days of ≥10 hours of wear time (mean=3.53 valid days). Students were generally active, averaging 10,895 steps/day (SD 3413) or 1123.23 activity counts/min (SD 356.10). Compliance to EMA prompts was less desirable, with 64% (55/86) of the participants having usable EMA data (responding to a minimum of ≥3 days of 3 prompts/day or ≥4 days of 2 prompts/day), and only 47% (26/55) of these participants were considered to have excellent EMA compliance (responding to ≥5 days of 4 prompts/day or ≥ 4 days of 5 prompts/day). Conclusions: This study represents one of the first studies to use an intensive real-time data capture strategy to examine time-varying correlates of PA among first-year university students. These data will aim to describe the physical and social contexts in which PA occurs and examine the relationships between momentary correlates of PA among the first-year university students. Overall, current results suggest that wrist-worn accelerometers and EMA are feasible methods for data collection among the young adult population; however, more work is needed to understand how to improve upon compliance to a real-time data capture method such as EMA. %M 28566264 %R 10.2196/publichealth.7010 %U http://publichealth.jmir.org/2017/2/e32/ %U https://doi.org/10.2196/publichealth.7010 %U http://www.ncbi.nlm.nih.gov/pubmed/28566264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 7 %P e209 %T A Mobile Ecological Momentary Assessment Tool (devilSPARC) for Nutrition and Physical Activity Behaviors in College Students: A Validation Study %A Bruening,Meg %A van Woerden,Irene %A Todd,Michael %A Brennhofer,Stephanie %A Laska,Melissa N %A Dunton,Genevieve %+ Arizona State University, 550 N 5th Street, Phoenix, AZ, 85004, United States, 1 602 827 2266, meg.bruening@asu.edu %K validation study %K ecological momentary assessment %K nutritional status %K physical activity %K sedentary activity %K emerging adults %D 2016 %7 27.07.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The majority of nutrition and physical activity assessments methods commonly used in scientific research are subject to recall and social desirability biases, which result in over- or under-reporting of behaviors. Real-time mobile-based ecological momentary assessments (mEMAs) may result in decreased measurement biases and minimize participant burden. Objective: The aim was to examine the validity of a mEMA methodology to assess dietary and physical activity levels compared to 24-hour dietary recalls and accelerometers. Methods: This study was a pilot test of the SPARC (Social impact of Physical Activity and nutRition in College) study, which aimed to determine the mechanism by which friendship networks impact weight-related behaviors among young people. An mEMA app, devilSPARC, was developed to assess weight-related behaviors in real time. A diverse sample of 109 freshmen and community mentors attending a large southwestern university downloaded the devilSPARC mEMA app onto their personal mobile phones. Participants were prompted randomly eight times per day over the course of 4 days to complete mEMAs. During the same 4-day period, participants completed up to three 24-hour dietary recalls and/or 4 days of accelerometry. Self-reported mEMA responses were compared to 24-hour dietary recalls and accelerometry measures using comparison statistics, such as match rate, sensitivity and specificity, and mixed model odds ratios, adjusted for within-person correlation among repeated measurements. Results: At the day level, total dietary intake data reported through the mEMA app reflected eating choices also captured by the 24-hour recall. Entrées had the lowest match rate, and fruits and vegetables had the highest match rate. Widening the window of aggregation of 24-hour dietary recall data on either side of the mEMA response resulted in increased specificity and decreased sensitivity. For physical activity behaviors, levels of activity reported through mEMA differed for sedentary versus non-sedentary activity at the day level as measured by accelerometers. Conclusions: The devilSPARC mEMA app is valid for assessing eating behaviors and the presence of sedentary activity at the day level. This mEMA may be useful in studies examining real-time weight-related behaviors. %M 27465701 %R 10.2196/jmir.5969 %U http://www.jmir.org/2016/7/e209/ %U https://doi.org/10.2196/jmir.5969 %U http://www.ncbi.nlm.nih.gov/pubmed/27465701 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e108 %T The Functional Fitness MOT Test Battery for Older Adults: Protocol for a Mixed-Method Feasibility Study %A de Jong,Lex D %A Peters,Andy %A Hooper,Julie %A Chalmers,Nina %A Henderson,Claire %A Laventure,Robert ME %A Skelton,Dawn A %+ Glasgow Caledonian University, Institute for Applied Health Research, School of Health and Life Sciences, Cowcaddens Road, Glasgow, G4 0BA, United Kingdom, 44 3318792, Dawn.Skelton@gcu.ac.uk %K physical activity %K physical fitness %K physical therapists %K aged %K health behavior %K health services for the aged %K feasibility studies %D 2016 %7 20.06.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Increasing physical activity (PA) brings many health benefits, but engaging people in higher levels of PA after their 60s is not straightforward. The Functional Fitness MOT (FFMOT) is a new approach which aims to raise awareness about the importance of components of fitness (strength, balance, flexibility), highlight benefits of PA, engages older people in health behavior change discussions, and directs them to local activity resources. This battery of tests combined with a brief motivational interview has not been tested in terms of feasibility or effectiveness. Objective: To assess whether the FFMOT, provided in a health care setting, is appealing to older patients of a community physiotherapy service and to understand the views and perceptions of the older people undergoing the FFMOT regarding the intervention, as well as the views of the physiotherapy staff delivering the intervention. Secondary aims are to assess the feasibility of carrying out a phase 2 pilot randomized controlled trial of the FFMOT, in the context of a community physiotherapy service, by establishing whether enough patients can be recruited and retained in the study, and enough outcome data can be generated. Methods: A mixed-methods feasibility study will be conducted in two physiotherapy outpatient clinics in the United Kingdom. A total of 30 physically inactive, medically stable older adults over the age of 60 will be provided with an individual FFMOT, comprising a set of six standardized, validated, age-appropriate tests aimed at raising awareness of the different components of fitness. The results of these tests will be used to provide the participants with feedback on performance in comparison to sex and age-referenced norms. This will be followed by tailored advice on how to become more active and improve fitness, including advice on local opportunities to be more active. Subsequently, participants will be invited to attend a focus group to discuss barriers and motivators to being more active, health behavior change, and the scope for individuals to improve their PA levels. To inform the design of a future trial, descriptive (eg, recruitment and retention rates), quantitative (Community Healthy Activities Model Program for Seniors; CHAMPS physical activity questionnaire), and qualitative data (focus group discussions, semi-structured staff interviews) will be collected. Results: Recruitment and enrolment for the trial started in September 2015. Follow-up will be completed in June 2016. Results are expected to be available at the end of 2016. Discussion: Allied health professionals play a key role in encouraging older adults to increase their PA, but with little evidence on how best to do this within their clinical practice. The purpose of this feasibility study is to examine the introduction of a new service: The FFMOT. The views and perceptions of the older people undergoing the FFMOT and relating to its delivery in clinical practice will be explored. Data, which will inform the feasibility of a randomized controlled trial of effectiveness of the FFMOT in promoting improved PA, will be reported. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN38950042; http://www.isrctn.com/ISRCTN38950042 %M 27324114 %R 10.2196/resprot.5682 %U http://www.researchprotocols.org/2016/2/e108/ %U https://doi.org/10.2196/resprot.5682 %U http://www.ncbi.nlm.nih.gov/pubmed/27324114 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 5 %N 2 %P e20 %T Relationship Between Difficulties in Daily Activities and Falling: Loco-Check as a Self-Assessment of Fall Risk %A Akahane,Manabu %A Maeyashiki,Akie %A Yoshihara,Shingo %A Tanaka,Yasuhito %A Imamura,Tomoaki %+ Faculty of Medicine, Department of Public Health, Health Management and Policy, Nara Medical University, Shijo 840, Kashihara, Nara 6348521, Japan, 81 744 22 3051 ext 2224, makahane@naramed-u.ac.jp %K accidental falls %K disability evaluation %K self-assessment %K activity of daily living %D 2016 %7 20.06.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: People aged 65 years or older accounted for 25.1% of the Japanese population in 2013, and this characterizes the country as a “super-aging society.” With increased aging, fall-related injuries are becoming important in Japan, because such injuries underlie the necessity for nursing care services. If people could evaluate their risk of falling using a simple self-check test, they would be able to take preventive measures such as exercise, muscle training, walking with a cane, or renovation of their surroundings to remove impediments. Loco-check is a checklist measure of early locomotive syndrome (circumstances in which elderly people need nursing care service or are at high risk of requiring the service within a short time), prepared by the Japanese Orthopaedic Association (JOA) in 2007, but it is unclear if there is any association between this measure and falls. Objective: To investigate the association between falls during the previous year and the 7 “loco-check” daily activity items and the total number of items endorsed, and sleep duration. Methods: We conducted an Internet panel survey. Subjects were 624 persons aged between 30 and 90 years. The general health condition of the participants, including their experience of falling, daily activities, and sleep duration, was investigated. A multivariate analysis was carried out using logistic regression to investigate the relationship between falls in the previous year and difficulties with specific daily activities and total number of difficulties (loco-check) endorsed, and sleep duration, adjusting for sex and age. Results: One-fourth of participants (157 persons) experienced at least one fall during the previous year. Fall rate of females (94/312: 30.1%) was significantly higher than that of males (63/312: 20.2%). Fall rate of persons aged more than 65 years (80/242: 33.1%) was significantly higher than that of younger persons (77/382: 20.2%). Logistic regression analysis revealed that daily activities such as “impossibility of getting across the road at a crossing before the traffic light changes” are significantly related to falling. Logistic regression analysis also demonstrated a relationship between the number of items endorsed on loco-check and incidence of falling, wherein persons who endorsed 4 or more items appear to be at higher risk for falls. However, logistic regression found no significant relationship between sleep duration and falling. Conclusions: Our study demonstrated a relationship between the number of loco-check items endorsed and the incidence of falling in the previous year. Endorsement of 4 or more items appeared to signal a high risk for falls. The short self-administered checklist can be a valuable tool for assessing the risk of falling and for initiating preventive measures. %M 27323871 %R 10.2196/ijmr.5590 %U http://www.i-jmr.org/2016/2/e20/ %U https://doi.org/10.2196/ijmr.5590 %U http://www.ncbi.nlm.nih.gov/pubmed/27323871 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 2 %P e14 %T A Comparison of Self-Reported and Objective Physical Activity Measures in Young Australian Women %A Hartley,Stefanie %A Garland,Suzanne %A Young,Elisa %A Bennell,Kim Louise %A Tay,Ilona %A Gorelik,Alexandra %A Wark,John Dennis %+ The Royal Women's Hospital, Department of Molecular Microbiology & Infectious Diseases, Locked Bag 3000, Parkville, 3052, Australia, 61 3 8345 3670, suzanne.garland@thewomens.org.au %K physical activity %K exercise %K women’s health %K questionnaires %D 2015 %7 05.10.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The evidence for beneficial effects of recommended levels of physical activity is overwhelming. However, 70% of Australians fail to meet these levels. In particular, physical activity participation by women falls sharply between ages 16 to 25 years. Further information about physical activity measures in young women is needed. Self-administered questionnaires are often used to measure physical activity given their ease of application, but known limitations, including recall bias, compromise the accuracy of data. Alternatives such as objective measures are commonly used to overcome this problem, but are more costly and time consuming. Objective: To compare the output between the Modified Active Australia Survey (MAAS), the International Physical Activity Questionnaire (IPAQ), and an objective physical activity measure—the SenseWear Armband (SWA)—to evaluate the test-retest reliability of the MAAS and to determine the acceptability of the SWA among young women. Methods: Young women from Victoria, Australia, aged 18 to 25 years who had participated in previous studies via Facebook advertising were recruited. Participants completed the two physical activity questionnaires online, immediately before and after wearing the armband for 7 consecutive days. Data from the SWA was blocked into 10-minute activity times. Follow-up IPAQ, MAAS, and SWA data were analyzed by comparing the total continuous and categorical activity scores, while concurrent validity of IPAQ and MAAS were analyzed by comparing follow-up scores. Test-retest reliability of MAAS was analyzed by comparing MAAS total physical activity scores at baseline and follow-up. Participants provided feedback in the follow-up questionnaire about their experience of wearing the armband to determine acceptability of the SWA. Data analyses included graphical (ie, Bland-Altman plot, scatterplot) and analytical (ie, canonical correlation, kappa statistic) methods to determine agreement between MAAS, IPAQ, and SWA data. Results: A total of 58 participants returned complete data. Comparisons between the MAAS and IPAQ questionnaires (n=52) showed moderate agreement for both categorical (kappa=.48, P<.001) and continuous data (r=.69, P<.001). Overall, the IPAQ tended to give higher scores. No significant correlation was observed between SWA and IPAQ or MAAS continuous data, for both minute-by-minute and blocked SWA data. The SWA tended to record lower scores than the questionnaires, suggesting participants tended to overreport their amount of physical activity. The test-retest analysis of MAAS showed moderate agreement for continuous outcomes (r=.44, P=.001). However, poor agreement was seen for categorical outcomes. The acceptability of the SWA to participants was high. Conclusions: Moderate agreement between the MAAS and IPAQ and moderate reliability of the MAAS indicates that the MAAS may be a suitable alternative to the IPAQ to assess total physical activity in young women, due to its shorter length and consequently lower participant burden. The SWA, and likely other monitoring devices, have the advantage over questionnaires of avoiding overreporting of self-reported physical activity, while being highly acceptable to participants. %M 27227132 %R 10.2196/publichealth.4259 %U http://publichealth.jmir.org/2015/2/e14/ %U https://doi.org/10.2196/publichealth.4259 %U http://www.ncbi.nlm.nih.gov/pubmed/27227132