Abstract Background Sleep, physical activity, and diet are key determinants of health, each independently associated with chronic disease risk and mortality. These behaviors also interact: insufficient sleep can impair physical activity and dietary choices, while regular exercise and healthy diet promote better sleep. Although lifestyle interventions commonly target physical activity and diet, few simultaneously address sleep. Emerging evidence suggests that even small improvements across all three behaviors can reduce all-cause mortality, highlighting the potential of multi-behavior approaches. However, the effects of a lifestyle intervention simultaneously targeting sleep, physical activity, and diet on quality of life and physical activity levels in inactive adults remain largely unexplored. Methods The SPIRAL+ study is a single-center, randomized controlled trial conducted in France, among non-exercising adults aged 18–80 years. Participants (n = 201) will be randomized to one of three groups: (1) lifestyle intervention (physical activity and diet) (2), lifestyle plus sleep intervention, or (3) control. Assessments will be conducted at baseline, 6 months (post-intervention), and 12 months. The primary outcomes are health-related quality of life (EQ-5D-5 L) and daily step count (measured by accelerometer) assessed immediately after the 6-month intervention. Secondary outcomes include whether intervention effects are sustained at 12 months, along with markers of physical fitness (cardiorespiratory fitness, body composition, handgrip strength), physical activity and sedentary behavior (accelerometry), and sleep (home-based sleep test, actigraphy, and validated questionnaires). Additional self-reported outcomes will cover diet, mental wellbeing, motivation, quality of life, and psychological constructs related to health behavior change. A qualitative component will explore barriers and facilitators to adherence through semi-structured interviews. Discussion This trial will evaluate whether adding a sleep component to a lifestyle intervention improves quality of life and physical activity levels in inactive adults. If effective, the findings will support the integration of sleep into multi-behavior interventions to enhance health outcomes and inform future public health strategies. Trial registration Clinical Trials NCT06424847.

Although several determinants of travel mode choices have been identified, most research has adopted a mono-disciplinary perspective. This study simultaneously investigated individual, socio-spatial (at the national and local level), and sociodemographic factors of active and sustainable mobility (walking, biking, and public transportation) to better understand their relationships. A mixed-methods was used, combining an online quantitative survey (N = 538, 54.83% women), three focus groups (n = 9, three women), and eight individual interviews (five women). The survey examined the facilitators and barriers of active and sustainable mobility (ASM) during a typical week using multiple linear regressions. Interviews and focus groups, with mobility experts and car users wishing to reduce their car use in Grenoble, were analyzed through reflexive thematic analysis. Quantitative results highlighted socio-spatial (e.g., having a transport pass, trip chain complexity), sociodemographic (having children aged 12+), and individual factors (e.g., car attitudes, ASM habits, perceived health) as independent predictors of ASM. Moreover, intention toward ASM interacted with bike and transport pass ownership. Qualitative findings revealed local-specific factors, such as living in mountainous areas. These results emphasize the importance of studying behavior as part of a complex system with multi-level factors and using both national and local samples to better identify facilitators and barriers.

Health-protecting behaviors such as physical activity are crucial for health, yet positive behavior changes are often accompanied by setbacks and relapses. Previous research suggests that critical fluctuations in behavioral time series might foreshadow relapses as early warning signals. This study examines the association between critical fluctuations, quantified as dynamic complexity (DC), and impending sudden changes in physical activity, here walking behavior. We analyzed step count data from 21,425 participants during enrollment in a digital physical activity intervention, covering a total of 5,474,501 person-days. Step counts were recorded via smartphones or wearables. Generalized multilevel models revealed a positive association between DC and impending sudden losses in walking (odds ratios [OR] 1.93–1.32). In contrast, the association between DC and impending sudden gains was weaker and less consistent (OR = 1.10–0.89). These findings provide evidence for the role of critical fluctuations as early warning signals for sudden losses in walking behavior and highlight their potential in designing timely and targeted interventions, notably just-in-time adaptive interventions.

Health-protecting behaviors such as walking are crucial for health, yet positive behavior changesare often accompanied by setbacks and relapses. Previous research suggests that critical fluctuations in behavioral time series might foreshadow relapses as early warning signals. This study examines the association between critical fluctuations, quantified as dynamic complexity(DC), and impending sudden changes in walking behavior. We analyzed step count data from 21,425 participants during enrollment in a digital physical activity intervention, covering a total of 5,474,501 person-days. Step counts were recorded via smartphones or wearables. Generalized multilevel models revealed a positive association between DC and impending sudden losses in walking (odds ratios [OR] 1.93 - 1.32). In contrast, the association between DC and impending sudden gains was weaker and less consistent (OR = 1.10 - 0.89). These findings provide evidence for the role of critical fluctuations as early warning signals for sudden losses in walking behaviorand highlight their potential in designing timely and targeted interventions.

Background: Despite the promising efficacy of gamified digital interventions in promoting physical activity, we currently have limited evidence on the theory-based mechanisms responsible for effects of these interventions on behavior change. Objectives: As part of the DIPPAO intervention randomized controlled trial, we examined the effects of a digital, gamified adapted physical activity program (KiplinTM) on autonomous motivation and weight stigma processes among obese patients with type 2 diabetes and tested candidate psychological mechanisms underlying these effects based on self-determination theory and the social identity approach. Methods: Participants (N = 50, M age = 47.90 years, SD = 12.49; 74% female) were randomized to either the KiplinTM digital intervention program or a usual care control group and followed the program for three months. Outcome measures of device-assessed physical activity and psychological variables (motivation, need satisfaction, in-group identification, weight stigma) were assessed at baseline and 6-month follow-up. Data were analyzed using mixed-effects models and partial least squares structural equation modeling. Results: Autonomous motivation increased significantly in both groups, but with no significant between-group differences. Structural equation modeling did not support the proposed theory-based mechanisms for intervention effects. Conclusion: Current data do not support motivation and weight stigma changes as potential mechanisms for the efficacy of the digital intervention over traditional programs. Future research should investigate additional candidate psychological mechanisms that account for program effects using designs with adequate statistical power and sufficiently sensitive measures, consider psychological mediators representing reflective and automatic behavioral determinants, and employ appropriate control or comparison groups. Trial Registration: ClinicalTrials.gov NCT04887077; https://clinicaltrials.gov/study/NCT04887077

Girls and women are consistently less active than boys and men across the lifespan. One reason is the widespread belief that sport is a “naturally” masculine domain. This commentary argues that the scientific literature on sex differences reinforces such stereotypes through methodological biases at all stages of research. Decisions in data collection (e.g., failure to account for training status, hormonal cycles, or body composition), statistical analysis (e.g., reliance on binary significance testing), and data representation (e.g., bar plots emphasizing group means over variability) tend to accentuate between-sex differences while obscuring within-sex diversity. Such approaches mirror the mechanisms through which stereotypes operate. Yet, evidence from endurance sports and prepubertal populations shows contexts where performance differences are minimal or even reversed. We call for greater methodological vigilance, including more nuanced sampling, analyses, and visualization tools (e.g., violin, beeswarm or density plots) to better represent variability. Rethinking research practices is essential to dismantle stereotypes and promote gender equity in sport and physical activity.

This scoping review examines the impact of age-based stereotypes on older adults' physical performance within the stereotype threat theory. While research has shown that cognitive performance declines in various populations after negative stereotype induction, studies on older adults' physical performance remain scarce and present mixed results. The review aimed to map existing research, analyse methodologies, and synthesise findings to provide a clearer understanding of the literature. Two independent reviewers screened 11,475 articles, resulting in a total of 14 eligible studies. This review finds inconsistent effects of age-based stereotypes on older adults' physical performance, with mostly no effect observed, but occasionally negative or even positive effects. This divergence may be attributed to several methodological factors related to the variability of task difficulty and nature, of stereotype manipulations, and of the characteristics of the older adults recruited. However, it appears that certain psychological factors are impacted more importantly. We argue that it is premature to draw definitive conclusions about age-based stereotype threat effects on physical performance, as not all of the necessary conditions to validate or refute these effects have yet been met. Based on these findings, a number of recommendations are proposed.Pre-registration: https://doi.org/10.17605/OSF.IO/7496S.

OBJECTIVE:Regular physical activity benefits cardiometabolic health, fitness, neurocognition and quality of life in people with schizophrenia (pwSCZ). However, pwSCZ exhibit high levels of physical inactivity and poor adherence to exercise programs. This study investigated physical activity facilitators and barriers in stable pwSCZ in long-term psychosocial rehabilitation. METHODS:Forty-three pwSCZ (age = 29 (12) years; n = 12 female) of a French rehabilitation centre underwent semi-structured interviews and rated pre-identified physical activity barriers and facilitators on a 5-point scale. RESULTS:Two facilitator classifications (conventional and motivation-based) and one barrier classification emerged. Frequent facilitators included weight loss, improving well-being, enjoyment of activity and self-pride. Main barriers were fatigue, low motivation, lack of time or competing priorities, social difficulties, and addictive substance use. CONCLUSIONS:While most factors are shared with other severe mental illnesses, social difficulties, addictive substance consumption and feelings of self-pride emerged more specifically in our sample. The motivational classification highlighted the prevalence of autonomous motivation, which supports durable behaviours. Barriers reflected schizophrenia-related symptoms not addressed by antipsychotics, underlining the need for multidisciplinary care, especially as some of them are not specific to physical activity uptake. Psychosocial rehabilitation settings could use our findings to adapt physical activity promotion in pwSCZ.

Sleep plays a pivotal role in athletes’ recovery and performance, yet research consistently shows that many athletes experience suboptimal sleep. Existing screening questionnaires typically rely on cut-off scores to classify athletes (e.g., good vs. poor sleepers), offering a limited and often simplistic view of sleep quality. By moving beyond these arbitrary thresholds, the present study adopts a person-centred approach to uncover distinct sleep profiles among elite athletes and explores how these profiles relate to well-being and ill-being. A total of 528 elite athletes (273 women) completed questionnaires assessing sleep, well-being, and ill-being. Sleep characteristics were measured using the Athens Insomnia Scale and the Pittsburgh Sleep Quality Index. Well-being was assessed using the Athlete Satisfaction Questionnaire subdimension for individual performance satisfaction, while ill-being was measured using the Burnout Assessment Tool short form adapted to the sport context. Latent profile analysis was then conducted to identify distinct sleep profiles, and multilinear regression analyses examined their associations with well-being and ill-being outcomes. Six distinct sleep profiles emerged. Two profiles, characterized by mean sleep durations of less than seven hours per night, were associated with significantly higher levels of ill-being and lower levels of well-being compared to other profiles. These findings highlight the importance of sleep duration, specifically the 7 h-threshold, in athletes’ psychological health. Sleep profiling offers a more nuanced and practical approach than conventional cut-off-based classifications, supporting individualised monitoring and interventions in elite sport.

Western societies preach slimness. However, overweight and obesity are increasing. Overweight individuals often face weight discrimination. No studies have investigated the salience of body weight in the impression formation. This study aims to examine the salience of the overweight attribute in shaping first impressions. Forty-nine participants (Mage = 25.82 years, SD = 13.44; 19 women) were asked to describe fictitious characters who differed in age, gender, skin color, and weight. Overweight targets (i.e., five overweight characters) constituted the experimental condition. Non-overweight targets formed the control condition (i.e., five non-overweight characters). Multilevel analyses showed that weight-related words were more used to describe the overweight target than the non-overweight target (25.41% vs 11.83%; OR=1.56, 95% CI 1.24–1.96, p<0.01). Moreover, the probability of using a weight-related word to describe overweighted targets was significantly higher for the earlier words, than for the later words – (OR=3.82, 95% CI 2.36–6.20, p<0.001 for the first, OR=2.44, 95% CI 1.78–3.33 for the second, OR=1.62, 95% CI 1.24–2.12, p<0.001 for the third, and fourth OR=1.08, 95% CI 0.73–1.60, p=0.695 words used to describe the character). These findings support that the overweight characteristics of individuals is salient in the impression formation process.

Adapted physical activity (PA) programs benefit patients with non‑communicable diseases, but access barriers limit reach. Hybrid programs mixing in‑person and telehealth sessions may overcome these constraints. The purpose of this study was to evaluate the acceptability and effectiveness of a 3‑month hybrid APA program compared with usual face‑to‑face care and to examine whether benefits persist up to 36 months. Twenty patients with chronic diseases completed an APA program that began onsite and transitioned to videoconference plus home exercises. A historical cohort of 100 patients who received the standard onsite program and matched baseline characteristics served as controls. Changes in self-reported PA, physical capacities, and body composition of patients from both programs were measured at baseline and 3, 6, 12, 4, 36 months and analyzed using random-effect models. Adherence and satisfaction were also evaluated. Participants in the hybrid program showed high adherence and acceptability to the program, significant improvements in cardiorespiratory capacity, and reported increased PA levels. Overall effect sizes between the two groups were small. Importantly, the effects of both programs on these variables persisted 3 months after the end of the program with meaningful effect sizes and up to 33 months after the end of the program for 6 MWT. However, dropout rates during follow-up were high. Despite high acceptability and adherence for most patients of the hybrid group, some patients demonstrated lower participation. In conclusion, a hybrid program including telehealth was feasible, well‑accepted, and produced durable, clinically meaningful gains in cardiorespiratory fitness, and physical activity that matched conventional rehabilitation. Larger randomized trials are warranted to confirm these findings.

Background:Digital health interventions and gamification hold promise for managing chronic diseases, but evidence comparing their efficacy, long-term effectiveness, and cost-efficiency with those of usual care is limited. Moreover, there is a growing need for randomized controlled trials (RCTs) evaluating digital physical activity interventions to incorporate idiographic approaches and intensive longitudinal assessments that capture individual variability and the dynamic nature of behavior change. Objective:This 2-arm parallel RCT with embedded N-of-1 analyses examined whether a digital intervention integrating gamification and telecoaching (Kiplin program) outperformed a supervised, face-to-face, adapted physical activity program (usual care) in improving physical activity, clinical outcomes, and cost-effectiveness among adults with obesity and type 2 diabetes (T2D). Methods:We randomized (1:1) 50 patients with obesity or T2D (mean age 47.90, SD 12.49 years; 37/50, 74% female) referred to the University Hospital of Clermont-Ferrand, France, to either the Kiplin digital program or the usual care group. Both programs lasted 3 months, with a 6-month follow-up. The Kiplin intervention included 2 face-to-face and 20 online supervised sessions and 3 mobile app games, whereas the control group completed a standard hospital-based adapted physical activity (APA) program with 3 individual face-to-face, supervised sessions per week (36 sessions). The primary outcome was the change in daily step count, measured objectively and continuously via wearable devices from baseline to the end of the intervention. Secondary outcomes included changes in accelerometer-assessed physical activity, quality of life, body composition, physical capacities, and daily steps over 9 months. Program adherence was also evaluated. Mixed-effects models and generative additive models were conducted to analyze both between- and within-person evolutions in physical activity. A cost-utility analysis was computed to compare the cost-effectiveness of the programs. Results:Compared with usual care, Kiplin participants achieved greater increases in daily steps during both the 3-month intervention (+1085 steps/day) and follow-up (+1775 steps/day), with sustained effects over time. Idiographic analyses revealed marked heterogeneity, showing substantial between- and within-person variability, with 9 participants exhibiting nonlinear patterns and divergent individual trajectories, with some participants showing no improvement. No significant group differences were observed in secondary clinical outcomes, except for change in moderate-to-vigorous physical activity, in favor of the Kiplin group. Cost-utility analyses showed no significant difference between programs. Kiplin participants attended an average of 14.68 of 22 possible APA sessions and engaged in an average of 2.6 games. In contrast, usual care patients attended an average of 30.27 of 36 APA sessions. Conclusions:This study demonstrates the potential of digital gamified interventions to promote and sustain physical activity, offering an alternative to face-to-face programs. However, individual heterogeneity in the response to the intervention highlights the need for screening tools and tailored approaches. Further large-scale studies are warranted to evaluate the long-term clinical and economic impact of such interventions.

This study aims to investigate the fear or failure (FoF) in Brazilian runners of both sex, performance levels and age categories, as well as to verify the relationship between FoF and socioeconomic status (SES). Sample size as composed by 916. Age, sex, body height, body weight, SES, and running pace were self-reported. The Multidimensional Questionnaire of FoF was applied in an online platform. Running pace, and SES were categorized and processed through multivariate analysis and Spearman correlations, with the p-value set at 0.05. Female runners with better performance (2.13 ± 0.74) and younger (2.16 ± 0.80), as a well as male runners with worse performance (2.04 ± 0.69) and older (2.04 ± 0.89) presented the highest values of FoF. Among women, SES was negatively associated with FoF (r = -0.144; p = 0.006), while a positive association between running pace and SES was observed among men (r = 0.290; p < 0.001). Non-professional Brazilian runners presented low values of FoF.

Lower economic status (ES) is associated with a less adaptive experience of school and physical activity. However, empirical evidence supporting the detrimental association of lower ES on the affective and motivational experience in Physical Education (PE) remains scarce. Using a large sample (n = 10392) of adolescents from six countries (i.e., Greece, Spain, Italy, Portugal, England, Turkey), this cross-sectional study tested whether students’ ES was associated with the satisfaction of their basic psychological needs in PE, and in turn with motivational and affective outcomes in PE and their out-of-school physical activity intention. We further explored whether gender moderated the abovementioned relationship. Multigroup structural equation modelling showed that, in five of six countries (i.e., Greece, Spain, Italy, Portugal, England), a lower ES was associated with lower basic needs satisfaction (β = .10, p < .001), which in turn was associated with lower enjoyment (β = .75, p < .001), lower autonomous motivation (β = .83, p < .001), and weaker out-of-school physical activity intention (β = .36, p < .001), higher displeasure (β = -.51, p < .001), higher controlled motivation (β = -19, p < .001) and stronger amotivation in PE (β = -.28, p < .001). Exploratory analyses suggested that the relationship between lower ES and the less adaptative outcomes was amplified among girls. At the crossroad between psychology and sociology, this study provides new insights into how family lower ES and gender might interact to predict less adaptative motivational and affective experiences and outcomes in PE.

Background. Behaviour change interventions (BCIs) have been widely used to promote health in communities. However, health practitioners rarely carry out the whole procedure of BCIs. Training health promoters might have the potential to change practitioners’ practices which ultimately might lead to behaviour change in the real world.Objective. To evaluate the effects of a ten-module training about behaviour change on practicioners’ knowledge, self-efficacy and intention towards using behaviour change interventions.Methods. A theoretical and practical training on how to elaborate, implement and evaluate theory- and evidence-based behaviour change interventions was delivered to Health Promotion Technicians (N=40) working in Paraguay (2022) and Bangladesh (2024). Knowledge about BCIs was assessed by using a multiple-choice test. Moreover, self-efficacy and intention towards elaborating and evaluating BCIs were assessed by using scales, four times for the participants in Paraguay and twice for Bangladesh. Multilevel analysis was used to analyse the data.Results. Knowledge (b = 4.95, CI [3.73, 6.17], p < .001), self-efficacy towards using BCIs (b = 0.65, CI [0.35, 0.94], p < .001) and intention towards using BCIs (b = 0.36, CI [0.12, 0.60], p = .005) significantly increased over the time of the training.Conclusions. The training seems to increase the health technicians’ knowledge, self-efficacy and intention towards using BCIs. Further studies and further collaborations with non-governmental organizations working with often neglected communities (e.g., minorities, people living in rural areas) should assess the effectiveness of the training and assess changes in actual community health.

Intergenerational contact offers an under-explored strategic approach to challenging age stereotypes and positively influencing health behaviors in older adults and children. It is postulated that through the application of the constructs of Contact Theory, an effective platform for change could be established. Using an instrumental case study, the experiential effects of the intergenerational contact phenomenon were pragmatically explored from the perspective of a single familial dyad (61-year-old woman; 9-year-old boy). Semi-structured interviews were conducted with each participant, both during and following engagement with a remote, 12-week, technology-driven physical activity intervention focused on using daily step counts (acquired via any activity of their choice, using physical activity trackers) to collaboratively complete virtual walk routes during the COVID-19 pandemic. Through reflexive thematic analysis and interpretation of the data in line with the study’s aim and propositions, four core themes were identified: Reciprocal Encounter; Opportunity for Reflection and Re-evaluation; Platform for Change; and COVID-19. In addition to the perceived positive effects on targeted health outcomes (physical activity, sedentary behavior, health-related quality of life), facilitating intergenerational contact through virtual methods could also, through opportunities to nurture and build relationships, challenge age stereotypes.

Robust evidence supports the role of physical activity and exercise in increasing longevity, decreasing morbidity and helping older adults maintain the highest quality of life attainable. However, the majority of older adults are not sufficiently physically active and interventions are needed to change their behaviors. Familial or intergenerational contact has been positively linked to health and well-being in older adults. Therefore, this study aimed to i) establish acceptability and test the functionality and useability of a novel technology-driven intergenerational intervention targeting physical activity and age stereotypes, and ii) identify any potential issues with recruitment and retention. Four familial dyads (adult ≥ 65 and child 7-11 years) engaged with the intervention. Working collaboratively during a four-week trial, they combined daily step-counts (acquired via any activity of their choice, using PA trackers) to complete a virtual walk route using online platform World Walking. Thematic analysis of three post-intervention focus groups (one older adult; one child; one additional parental cohort) identified eight subthemes: Engagement; Provision of a Positive Experience; Participant Stimuli; Generated Outcomes; Operationality; Limitations; Mediators; Facilitators, and Perceptions. Participants enjoyed and successfully engaged with the intervention; when designing behaviour change interventions for older adults, flexibility within pre-established routines, individual choice, and avoiding rigidly imposed structures, is important. Strategies to challenge negative perceptions of older adults' engagement with technology and PA should be integrated into recruitment processes.

BackgroundDigital interventions integrating gamification features hold promise to promote daily steps. However, results regarding the effectiveness of this type of intervention are heterogeneous and not yet confirmed in real-life contexts. ObjectiveThis study aims to examine the effectiveness of a gamified intervention and its potential moderators in a large sample using real-world data. Specifically, we tested (1) whether a gamified intervention enhanced daily steps during the intervention and follow-up periods compared to baseline, (2) whether this enhancement was higher in participants in the intervention than in nonparticipants, and (3) what participant characteristics or intervention parameters moderated the effect of the program. MethodsData from 4819 individuals who registered for a mobile health Kiplin program between 2019 and 2022 were retrospectively analyzed. In this intervention, participants could take part in one or several games in which their daily step count was tracked, allowing individuals to play with their overall activity. Nonparticipants were people who registered for the program but did not take part in the intervention and were considered as a control group. Daily step counts were measured via accelerometers embedded in either commercial wearables or smartphones of the participants. Exposure to the intervention, the intervention content, and participants’ characteristics were included in multilevel models to test the study objectives. ResultsParticipants in the intervention group demonstrated a significantly greater increase in mean daily steps from baseline than nonparticipants (P<.001). However, intervention effectiveness depended on participants’ initial physical activity. The daily steps of participants with <7500 baseline daily steps significantly improved from baseline both during the Kiplin intervention (+3291 daily steps) and the follow-up period (+945 daily steps), whereas participants with a higher baseline had no improvement or significant decreases in daily steps after the intervention. Age (P<.001) and exposure (P<.001) positively moderated the intervention effect. ConclusionsIn real-world settings and among a large sample, the Kiplin intervention was significantly effective in increasing the daily steps of participants from baseline during intervention and follow-up periods compared to nonparticipants. Interestingly, responses to the intervention differed based on participants’ initial steps, with the existence of a plateau effect. Drawing on the insights of self-determination theory, we can assume that the effect of gamification could depend of the initial motivation and activity of participants.