Describing Transitions in Adherence to Physical Activity Self-monitoring and Goal Attainment in an Online Behavioral Weight Loss Program: Secondary Analysis of a Randomized Controlled Trial

Abstract

Background Standard behavioral weight loss interventions often set uniform physical activity (PA) goals and promote PA self-monitoring; however, adherence remains a challenge, and recommendations may not accommodate all individuals. Identifying patterns of PA goal attainment and self-monitoring behavior will offer a deeper understanding of how individuals adhere to different types of commonly prescribed PA recommendations (ie, minutes of moderate-to-vigorous physical activity [MVPA] and daily steps) and guide future recommendations for improved intervention effectiveness. Objective This study examined weekly patterns of adherence to step-based and minute-based PA goals and self-monitoring behavior during a 6-month online behavioral weight loss intervention. Methods Participants were prescribed weekly PA goals for steps (7000-10,000 steps/day) and minutes of MVPA (50-200 minutes/week) as part of a lifestyle program. Goals gradually increased during the initial 2 months, followed by 4 months of fixed goals. PA was self-reported daily on the study website. For each week, participants were categorized as adherent if they self-monitored their PA and met the program PA goal, suboptimally adherent if they self-monitored but did not meet the program goal, or nonadherent if they did not self-monitor. The probability of transitioning into a less adherent status was examined using multinomial logistic regression. Results Participants (N=212) were predominantly middle-aged females with obesity, and 67 (31.6%) self-identified as a racial/ethnic minority. Initially, 73 (34.4%) participants were categorized as adherent to step-based goals, with 110 [51.9%] suboptimally adherent and 29 [13.7%] nonadherent, and there was a high probability of either remaining suboptimally adherent from week to week or transitioning to a nonadherent status. However, 149 (70.3%) participants started out adherent to minute-based goals (34 [16%] suboptimally adherent and 29 [13.7%] nonadherent), with suboptimally adherent seen as the most variable status. During the graded goal phase, participants were more likely to transition to a less adherent status for minute-based goals (odds ratio [OR] 1.39, 95% CI 1.31-1.48) compared to step-based goals (OR 1.24, 95% CI 1.17-1.30); however, no differences were seen during the fixed goal phase (minute-based goals: OR 1.06, 95% CI 1.05-1.08; step-based goals: OR 1.07, 95% CI 1.05-1.08). Conclusions States of vulnerability to poor PA adherence can emerge rapidly and early in obesity treatment. There is a window of opportunity within the initial 2 months to bring more people toward adherent behavior, especially those who fail to meet the prescribed goals but engage in self-monitoring. Although this study describes the probability of adhering to step- and minute-based targets, it will be prudent to determine how individual characteristics and contextual states relate to these behavioral patterns, which can inform how best to adapt interventions. Trial Registration ClinicalTrials.gov NCT02688621; https://clinicaltrials.gov/ct2/show/NCT02688621

Dose–response relations between the frequency of two types of momentary feedback prompts and daily physical activity.

“…The apparent upper limit may stem from the burden and disruptions of repeated prompting or reflect an optimal cadence for understanding progress toward daily goal attainment. Some caution is warranted when interpreting this finding because of the technical problems that led to high-frequency self-monitoring (Gavin et al, 2018;Patel et al, 2021;Stansbury et al, 2022). The high response rate to selfmonitoring prompts in this study suggests that intensive monitoring protocols may be more feasible than previously assumed.…”

“…Some caution is warranted when interpreting this finding because of the technical problems that led to high-frequency self-monitoring prompt days being under-represented in the data. Prior interventions with a self-monitoring component have typically implemented less frequent self-monitoring protocols (Gavin et al, 2018; Patel et al, 2021; Stansbury et al, 2022). The high response rate to self-monitoring prompts in this study suggests that intensive monitoring protocols may be more feasible than previously assumed.…”

“…Prior studies indicate that participants disengage from self-monitoring over time. For example, one weight loss trial found that only 67% of participants self-monitored physical activity (defined as logging in and entering data on a website at least once weekly; Stansbury et al, 2022). A second trial found that participants in a one-year weight loss intervention adhered to self-monitoring instructions for moderate-to-vigorous physical activity for an average of 101.5 days (28%) and fewer than 5% had no 1-week gaps in self-monitoring.…”