Adams Marc A, Todd Michael, Angadi Siddhartha S, Hurley Jane C, Stecher Chad, Berardi Vincent, Phillips Christine B, McEntee Mindy L, Hovell Melbourne F, Hooker Steven P
College of Health Solutions, Arizona State University, Phoenix, Arizona.
Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona.
Am J Prev Med. 2022 Feb;62(2):e57-e68. doi: 10.1016/j.amepre.2021.09.014. Epub 2021 Dec 8.
Potent lifestyle interventions to increase moderate-to-vigorous physical activity are urgently needed for population-level chronic disease prevention. This trial tested the independent and joint effects of a mobile health system automating adaptive goal setting and immediate financial reinforcement for increasing daily walking among insufficiently active adults.
Participants were randomized into a 2 (adaptive versus static goal setting) X 2 (immediate versus delayed financial incentive timing) condition factorial trial to increase walking.
SETTINGS/PARTICIPANTS: Participants (N=512 adults) were recruited between 2016 and 2018 and were 64.5% female, aged 18-60 years, 18.8% Hispanic, 6.1% African American, and 83% White.
Principles of reinforcement and behavioral economics directed intervention design.
Participants wore accelerometers daily (133,876 day-level observations) that remotely measured moderate-to-vigorous physical activity bout minutes of ≥3 minutes/day for 1 year. Primary outcomes were between-condition differences in (1) engaging ≥1 bout of moderate-to-vigorous physical activity on each day and (2) on days with ≥1 bout, daily total moderate-to-vigorous physical activity minutes.
Mixed-effects hurdle models tested treatment group X phase (time) interactions using an intent-to-treat approach in 2021. Engaging in any ambulatory moderate-to-vigorous physical activity was greater for Adaptive than for Static Goal groups (OR=2.34, 95% CI=2.10, 2.60 vs OR=1.66, 95% CI=1.50, 1.84; p<0.001) and for Immediate than for Static Reinforcement groups (OR=2.16 95% CI=1.94, 2.40 vs OR=1.77, 95% CI=1.59, 1.97; p<0.01). The Immediate Reinforcement group increased by 16.54 moderate-to-vigorous physical activity minutes/day, whereas the Delayed Reinforcement group increased by 9.91 minutes/day (p<0.001). The combined Adaptive Goals + Immediate Reinforcement group increased by 16.52 moderate-to-vigorous physical activity minutes/day, significantly more than that of either Delayed Reinforcement group.
This study offers automated and scalable-behavior change strategies for increasing walking among adults most at-risk for chronic diseases attributed to sedentary lifestyles.
This study is registered at www.clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT02717663).
为了在人群层面预防慢性病，迫切需要采取有效的生活方式干预措施来增加中等到剧烈强度的身体活动。本试验测试了一种移动健康系统的独立和联合效果，该系统可自动设置适应性目标并提供即时经济激励，以增加缺乏运动的成年人的每日步行量。
参与者被随机分为2（适应性目标设定与静态目标设定）×2（即时经济激励时机与延迟经济激励时机）析因试验，以增加步行量。
设置/参与者：参与者（N = 512名成年人）于2016年至2018年招募，其中64.5%为女性，年龄在18 - 60岁之间，18.8%为西班牙裔，6.1%为非裔美国人，83%为白人。
强化原则和行为经济学指导干预设计。
参与者每天佩戴加速度计（共133,876天级观测数据），远程测量1年中每天≥3分钟的中等到剧烈强度身体活动时长。主要结局包括以下方面的组间差异：（1）每天进行≥1次中等到剧烈强度身体活动；（2）在有≥1次活动的日子里，每日中等到剧烈强度身体活动的总时长。
2021年采用意向性分析方法，通过混合效应障碍模型测试治疗组×阶段（时间）交互作用。适应性目标组进行任何动态中等到剧烈强度身体活动的情况比静态目标组更优（比值比[OR]=2.34，95%置信区间[CI]=2.10, 2.60，对比OR = 1.66，95% CI = 1.50, 1.84；p < 0.001），即时强化组比延迟强化组更优（OR = 2.16，95% CI = 1.94, 2.40，对比OR = 1.77，95% CI = 1.59, 1.97；p < 0.01）。即时强化组每天中等到剧烈强度身体活动时长增加了16.54分钟，而延迟强化组增加了9.91分钟（p < 0.001）。适应性目标 + 即时强化联合组每天中等到剧烈强度身体活动时长增加了16.52分钟，显著多于延迟强化组中的任何一组。
本研究为增加因久坐生活方式而患慢性病风险最高的成年人的步行量提供了自动化且可扩展的行为改变策略。
