A Wearable Activity Tracker Intervention With and Without Weekly Behavioral Support Emails to Promote Physical Activity Among Women Who Are Overweight or Obese: Randomized Controlled Trial

Abstract

Background Physical activity (PA) plays a fundamental role in combating the current obesity epidemic; however, most women who are overweight or obese are generally physically inactive. Wearable activity tracker interventions can help increase the PA levels in this population. Supplementing such interventions with behavioral support emails may further improve their effectiveness, but this remains to be confirmed. Objective This study aims to determine if adding behavioral support emails to a wearable activity tracker intervention can further increase PA levels among women who are overweight or obese in comparison to a wearable activity tracker–only intervention and a control condition. Methods Women with a BMI ≥25 kg/m2 who were not meeting the Canadian PA guidelines for aerobic and strength training were randomized into 1 of 3 groups. Group 1 received 6 weekly behavioral support emails, a wearable activity tracker, and a copy of the Canadian PA guidelines. Group 2 received a wearable activity tracker and a copy of the Canadian PA guidelines, and group 3 (control condition) received a copy of the Canadian PA guidelines. Self-reported data for walking and moderate to vigorous intensity PA were collected preintervention (week 0; prerandomization), postintervention (7 weeks postrandomization), and at follow-up (21 weeks postrandomization) and analyzed as metabolic equivalent of task minutes per week. In addition, potential mechanisms of behavior change (ie, basic psychological needs satisfaction and motivational regulations) were assessed for within- and between-group differences at all 3 time points. Data were analyzed using nonparametric statistical tests. Results A total of 49 women were recruited; data from 47 women (mean age 37.57 years, SD 11.78 years; mean BMI 31.69 kg/m2, SD 5.97 kg/m2) were available for analysis. Group 1 reported a significant increase in walking from preintervention to postintervention (χ22=7.5; P=.02) but not in moderate to vigorous intensity PA (P=.24). Group 1 also reported significant increases in perceptions of competence from preintervention to follow-up (χ22=7.6; P=.02) and relatedness from preintervention to follow-up (χ22=8.7; P=.005). Increases in perceived autonomy were observed for group 2 (χ22=7.0) and group 3 (χ22=10.6). There were no significant changes in the motivational regulations within the groups. The difference between the groups was not significant for any outcome variable. Conclusions The results suggest that adding behavioral support emails to a wearable activity tracker intervention may help to increase time spent walking and perceptions of competence and relatedness for PA among women who are overweight or obese. Trial Registration ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663

A theory-driven intervention delivered by email to promote physical activity in women who are overweight or obese: Participants’ perspectives on acceptability and usability within the context of a three-arm parallel group randomized controlled trial

“…This study explored the acceptability of a theory-driven, email-delivered intervention within the context of a larger, single centre, unblinded, three-arm parallel group RCT; the effects of the intervention were compared to a very low-contact intervention (i.e., wearable activity tracker only) and a control condition to promote PA in women who were overweight or obese and insufficiently active (see Table 1 for an overview of the three arms, and (7) for further description). Specifically, the objectives of the larger trial were to: (a) assess changes in PA within each group and determine if there were significant differences in changes in PA between groups, and (b) explore changes in PA-related basic psychological needs satisfaction and motivational regulations within and between groups to gain more insight into any observed changes (or lack thereof) in PA. As reported by Black and Brunet (7), women randomized to the main intervention reported a significant increase in walking and in perceptions of competence and relatedness, though not in moderate-to-vigorous intensity PA, nor in perceptions of autonomy and motivation. Participants' responses could have been influenced by their subjective perceptions of the intervention, as well as their measurable sustained engagement with the intervention.…”

“…A complete description the primary (i.e., PA behaviour) and secondary outcome measures (i.e., PA-related basic psychological needs satisfaction and motivational regulations), including how and when they were used, is available in Black and Brunet (45). Results of analyses performed for primary and secondary outcomes are reported elsewhere (7). Pertinent to the current study, participants self-reported sociodemographic and health information (e.g., age, marital status, ethnicity, education, work status, smoking status) at baseline within an online survey using the platform SurveyMonkey.…”

“…As previously outlined (7), the sample size for the trial was determined a priori based on the primary objective (i.e., to determine whether there were significant within-group changes in PA and significant between-group differences in change in PA). As the objective of the current study was to explore participants' acceptability of a theory-driven, email-delivered intervention, only those assigned to the main intervention arm were included herein.…”

“…Despite the well-documented health benefits of PA (3,4), general adherence to PA guidelines is modest (5). Indeed, the most recent Canadian Health Measures Survey (N=2,372; age range=18-79 years) revealed that less than 40% of adults were meeting the Canadian PA guidelines based on objectively-measured PA. Also, research in Canada (5) and around the world (6) indicates that women, especially those who are overweight or obese (i.e., body mass index (7) >25 kg/m 2 ), are less likely to adhere to PA guidelines than men (8), posing a significant threat to women's long-term health. Whilst increasing women's awareness of PA guidelines is important so they have a PA target in mind (i.e., the primary behavioural outcome), it is critical to provide women strategies to increase compliance because the existence of PA guidelines alone is insufficient to change PA behaviour (9).…”

Testing Behavioral Nudges and Prompts in Digital Courses for the Self-guided Treatment of Depression and Anxiety: Protocol for a 3-Arm Randomized Controlled Trial

“…The utility of behavioral economics is vast, and digital health has leveraged the discipline, allowing researchers to investigate how people use digital health programs and obtain insights on the characteristics of people who use them. Several digital health studies have investigated the use of several strategies, including the use of cooperative games and incentives [ 25 ], gamification [ 26 , 27 ], serious games [ 28 , 29 ], and positive behavioral support [ 30 , 31 ].…”