Sedentary time negatively influences health and is a risk factor for chronic low back pain (CLBP). Emerging evidence suggests breaking up prolonged sedentary behaviors may improve CLBP. This pilot trial examined the influence of decreasing sedentary behaviors on pain, mood, and quality of life in CLBP. Forty adults with CLBP and elevated depressive symptoms were randomized to wear an activity tracker with an idle alert along with receiving health coaching based on Motivational Interviewing and Habit Theory (INT) or a wait-list control condition (WLC) for eight weeks with a 12-week follow-up. Actigraphy-assessed time in total and prolonged sedentary behaviors, pain, depressed mood, quality of life, Patient Global Impression of Change (PGIC), and habits surrounding sedentary behavior were assessed at pre-intervention, post-intervention, and at follow-up. Repeated measures ANOVAs were used to examine changes in outcomes. Results demonstrated that INT reduced time spent in prolonged sedentary bouts by an average of 53 min/day (95

BACKGROUND:There is an acknowledged need to improve care for patients with persistent physical symptoms. Veterans who served in the 1990-91 Gulf War are a subpopulation of U.S. military Veterans who have been struggling with persistent physical symptoms for decades. The current study sought to characterize Veterans' historic path through the health care system and current experience of care to identify opportunities to improve care. METHODS:Analysis of interviews conducted with 31 Veterans who met criteria for Gulf War Illness (GWI) was conducted to understand Veterans' health care journeys, from symptom onset to the present. RESULTS:Early in their journey, Veterans felt uncertain about the nature of their condition and how to explain it to clinicians. Veterans described a cycle of referrals to specialists to pursue individual symptoms and subsequent return to primary care with few actionable findings. During this cycle, Veterans often felt dismissed or invalidated by clinicians. Over time, most Veterans felt care became increasingly fragmented, with multiple clinicians caring for them without a plan to manage GWI and little acknowledgement of GWI as a discrete illness. Further in their journey, some Veterans were referred to tertiary centers where they encountered a more holistic approach. CONCLUSIONS:Findings point to the need to shift care for Veterans with GWI, and similar conditions, away from overly focusing on individual symptoms. Instead, primary care clinicians need training and support, potentially from tertiary care experts, to develop and implement holistic care plans that recognize GWI as a complex chronic condition.

BACKGROUND:Medically unexplained, persistent physical symptoms and syndromes are commonly seen in primary care. These are debilitating for patients and difficult to treat, causing frustration for patients and providers. PURPOSE:This study investigates how well US military veterans with multiple persistent physical symptoms (PPS), called Gulf War illness (GWI), agree with their healthcare providers about their illness. This agreement, called perceived concordance, is hypothesized to influence veterans' satisfaction with care, adherence to care plans, and disability levels. METHODS:Participants were 230 veterans with GWI deployed to the 1990-1991 Gulf War who were recruited from Veteran Affairs primary care and War Related Illness and Injury Study Centers (WRIISCs). Veterans' GWI perceptions and perceived concordance with their providers regarding GWI were assessed at a medical visit. Veterans' self-reported satisfaction with care, adherence to care plans, and disability levels were measured at 1 week, 1 month, and 6 months post-baseline. RESULTS:Bivariate correlations indicated that veterans' GWI-related illness perceptions were related to veterans' satisfaction with care and reports of functional disability. Beyond these effects, veterans' perceived concordance with the provider regarding GWI was positively associated with satisfaction over time (e.g., fixed-effect estimate = 0.36, P < .001 for 1-week follow-up) and adherence to care plans (fixed-effect estimate averaged across all timepoints = 0.03, P = .03) but was unrelated to reported disability. CONCLUSIONS:Veterans' perceived concordance with their providers about GWI seems to be important for patient satisfaction and adherence to care plans. More research with longer-term follow-up is needed to understand how perceived concordance might influence disability levels and the outcome of care plans.

The experience of positive intrinsic rewards (enjoyment) from physical activity (PA) is known to promote PA habit formation and maintenance. Negative intrinsic rewards (stress reduction) may also be associated with PA habit, particularly during a major stressor and when individual-level anxiety is higher. Multi-level models tested the following hypotheses using weekly survey data from a convenience sample (snowball sampling) of adults (N = 580; 91% White, 77% Female, mean age = 41 years) over the 8 weeks of the first COVID-19 lockdown in the UK: negative intrinsic rewards will be independently and statistically more strongly related to PA habit strength and frequency than positive intrinsic rewards; and, the relationship between negative intrinsic rewards and PA habit strength and frequency will be stronger for those with higher anxiety. Counter to the hypotheses, positive intrinsic rewards were more strongly associated with PA habit strength over time than negative intrinsic rewards (fixed effect = 0.27, p < 0.001 versus fixed effect = -0.05, p = 0.23, respectively), and there was a main effect of anxiety (but no interaction with negative rewards) on PA habit strength (fixed effect = -0.03, p = 0.03). The findings suggest that interventions aimed at increasing and maintaining PA habit strength might best focus on cultivating positive intrinsic rewards (enjoyment) from PA, even in the presence of substantial stressors and individual-level anxiety.

Many adults with major depressive disorder (MDD) do not engage in treatment and may also not respond when current frontline treatments are completed. Resistance exercise training (RET) is an understudied behavioral treatment option, which may help with MDD management through improving cerebral blood flow that is commonly impaired in adults with MDD. The purpose of this study is to use gold-standard research methods to determine the validity (clinical efficacy) of RET for treating MDD and to determine potential cerebrovascular pathways through which RET might improve MDD symptoms. This study will be a randomized controlled trial of 200 adults with DSM-5-diagnosed MDD of at least mild severity. Participants will be randomized to 16 weeks of twice-weekly RET at either guidelines-based high dose (60 https://clinicaltrials.gov/study/NCT06110897 ).

Background Medication adherence, or how patients take their medication as prescribed, is suboptimal worldwide. Improving medication-taking habit might be an effective way to improve medication adherence. However, habit is difficult to quantify, and conventional habit metrics are self-reported, with recognized limitations. Recently, several objective habit metrics have been proposed, based on objective medication-taking data. Objective We aim to explore the correlation between objective habit metrics and objective medication adherence on a large dataset. Methods The Medication Event Monitoring System Adherence Knowledge Center, a database of anonymized electronic medication intake data from ambulant participants enrolled in past clinical studies, was used as the data source. Electronic medication intake data from participants following a once-daily regimen and monitored for 14 days or more were used. Further, two objective habit metrics were computed from each participant’s medication intake history: (1) SD of the hour of intake, representing daily variability in the timing of medication intakes, and (2) weekly cross-correlation, representing weekly consistency in the timing of medication intakes. The implementation component of medication adherence was quantified using (1) the proportion of doses taken and (2) the proportion of correct days. Results A total of 15,818 participants met the criteria. These participants took part in 108 clinical studies mainly focused on treatments for hypertension (n=4737, 30%) and osteoporosis (n=3353, 21%). The SD of the hour of intake was significantly negatively correlated with the 2 objective adherence metrics: proportion of correct days (Spearman correlation coefficient, ρS=–0.62, P<.001) and proportion of doses taken (ρS=–0.09, P<.001). The weekly cross-correlation was significantly positively correlated with the 2 objective adherence metrics: proportion of correct days (ρS=0.55, P<.001) and proportion of doses taken (ρS=0.32, P<.001). A lower daily or weekly variability in the timing of medication intakes is thus associated with better medication adherence. However, no variability is not the norm, as only 3.6% of participants have 95% of their intakes in a 1-hour window. Among the numerous factors influencing medication adherence, habit strength is an important one as it explains over 30% of the variance in medication adherence. Conclusions Objective habit metrics are correlated to objective medication adherence. Such objective habit metrics can be used to monitor patients and identify those who may benefit from habit-building support.

A healthy diet is a protective factor against a host of negative health outcomes. To maintain such a diet necessitates the consumption of at least 240 g of vegetables per day. However, most of the population fails to meet this threshold. Utilising a randomised controlled trial, the present study tested the effectiveness of a one-off higher order habit intervention aimed at shopping for a variety of vegetables and the mechanisms that may support such habit development. Specifically, participants (N = 198; 54.5% female; 20 to 74 years of age) were allocated to the intervention or control group to explore (1) how effective an action- and coping-planning intervention is at targeting the formation of vegetable-shopping higher order habits and (2) whether healthy-eater identity, intrinsic motivation and self-efficacy were mechanisms of action. Follow-up measures of habit, the mechanisms of action and behaviour were taken post-intervention, weekly for 4 weeks and at 3- and 6-month follow-ups. The intervention led to stronger higher order habit formation after 6 months and that it was particularly effective for those with low baseline higher order habits for vegetable shopping. These findings demonstrate that a simple, one-off, intervention can lead to long-lasting change in higher order habits within the nutrition domain.

OBJECTIVE:Patients with persistent physical symptom (PPS) conditions, such as Gulf War Illness (GWI), report disagreement or "non-concordance" with their providers about PPS conditions and dissatisfaction with healthcare. When patients perceive concordance with their providers about their PPS condition, they have increased satisfaction and adherence. While literature supports perceived concordance, there is a lack of research on actual concordance (i.e., the congruence of patients' and providers' perceptions of the patients' illness). METHODS:Among dyads of Veterans with GWI and their provider, we tested the hypotheses that greater actual concordance would be associated with greater Veterans' satisfaction and adherence. We also explored the relationship of actual concordance with Veterans' and providers' perceived concordance. RESULTS:Correlations suggest there is little agreement between Veterans and providers regarding GWI illness perceptions or perceptions of concordance. Polynomial regression analyses showed that actual concordance was not significantly related to Veterans' satisfaction, adherence, or perceptions of concordance, nor to providers' perceptions of concordance. CONCLUSION:Although literature finds Veterans' perceived concordance with their provider about PPS influences patients' experiences of care, our results suggest that actual concordance may have limited influence on experiences of care and either Veterans' or providers' perceived concordance. That is, the results suggest there does not need to be objective agreement between patients and providers about PPS, rather patients' perception of agreement influences their satisfaction and adherence. PRACTICE IMPLICATIONS:Our results suggest that patients with PPS and their providers may have difficulties in estimating if there is shared agreement in the relationship and demonstrate the importance of explicitly assessing patients' perceptions of concordance.

PURPOSE:Informed by the Extended Common Sense Model, this study aimed to pilot a pharmacist-led intervention to promote medication adherence through habit formation compared to standard education. PROCEDURES:Patients new to medication were recruited in two phases. During Phase 1, the pharmacist provided standard education (control). In Phase 2, the pharmacist added a habit-formation component by completing a habit worksheet with patients. Surveys measuring medication beliefs, habit strength, and adherence were completed at baseline and 100 days later. Cues from the habit worksheets were coded and analyzed. FINDINGS:The habit intervention group (N = 17) showed no significant difference from the control group (N = 16) in medication-taking habit strength (p = 0.37) or self-reported adherence (MARS-5) (p = 0.47) at follow-up. Habit strength was the only significant predictor of adherence (MARS-5)(p = 0.02), while necessity beliefs predicted missed doses (p = 0.03). CONCLUSION:High levels of habit strength and adherence may result from high baseline adherence levels. Further research should target patients with known non-adherence or without established medication routines. CLINICAL TRIAL:# NCT06230978.

Older adults face unique barriers and challenges related to physical activity (PA) participation. Motivational interviewing (MI) is a commonly used health coaching strategy to support behavior change that holds potential for older adults. Previous research on MI strategies has focused primarily on face-to-face delivery, limiting insights regarding virtual programs. Objectives: The purpose of this study was to determine if MI could be delivered telephonically with high fidelity and high acceptability in older adult participants. The study is designed to inform future trials evaluating its effectiveness in supporting virtual PA programs. Methods: This study evaluated the feasibility and acceptability of telephonic MI among older adults that enrolled in an online version of the Walk with Ease program. Results: Of 39 participants referred, 29 enrolled and 27 provided feedback. Participants were highly accepting and adherent, with 74 % of patients attending at least five of six sessions, and 96 % of participants indicating satisfaction with the MI provided. Coaches improved program enjoyment by helping set effective goals and providing ongoing accountability. Conclusions: Evaluations documented adequate fidelity and high acceptability of telephonic delivery, and motivation results revealed large, significant increases in autonomous regulation (quality of motivation). Innovation: Telephonic MI using non-healthcare professional coaches is feasibly delivered with high fidelity, and is acceptable to older adult participants. The innovative delivery format offers novel opportunities supporting virtual and telehealth interventions to reduce chronic disease risk among older adults.

Falls are the leading cause of injury related morbidity and mortality in older adults. Primary and secondary prevention strategies that address modifiable risk factors are critically important to reduce the number of falls and fall related injuries. A number of evidence-based fall prevention programs are available, but few offer potential for broad dissemination and public health impact due to implementation barriers, such as a need for trained program leaders and clinicians. The study will use a randomized controlled trial design to evaluate incorporating physical therapy exercises (primary prevention strategy) within an existing intervention called Walk with Ease. While Walk with Ease has an established evidence-base related to the management of arthritis pain and symptoms, the present study will determine the potential to also reduce falls and fall risk in community-dwelling older adults. The integrated process and outcome evaluation will determine the relative effectiveness of individually-prescribed exercises (compared to standardized exercises) as well as the potential of ‘habit training’ resources (relative to generic behavior prompts) to improve compliance with exercises in this population. The study, conducted through a local clinical-community partnership will advance both the science and practice of community-based fall prevention programming, while also informing implementation strategies needed to promote broader dissemination. ClinicalTrials.gov, NCT05693025, Registered January 20, 2023, Updated March 1, 2023.

Individuals experiencing body dissatisfaction have poorer health outcomes in part due to engaging in less physical activity. Body appreciation is protective of health behaviors and proposed to be conceptually different from body dissatisfaction. Two studies evaluated whether body appreciation and dissatisfaction represented two distinct dimensions, and whether body appreciation and dissatisfaction would interact in their effect on activity-related motivation and behavior. Study 1 (n = 313) was prospective and utilized a self-report measure of physical activity whereas Study 2 (n = 123) was prospective and used an objective measure. All hypotheses and analyses were pre-registered. A multiverse approach was taken to demonstrate the robustness of results. In exploratory factor analyses, body appreciation and dissatisfaction did not represent two distinct dimensions of body image as both loaded onto the same factor. This result was largely supported by latent profile analyses, which revealed that participants scored high, moderate, or low on both body satisfaction and appreciation. Additionally, body appreciation did not buffer the negative impact of body dissatisfaction on activity-related motivation and behavior. This study provides the first statistical evaluation of the theoretical proposition that body appreciation and dissatisfaction may be distinct constructs with distinct relationships to outcomes.

This is awork-in-progress report on the systematic reviewand a z-curve analysis on mobile interventions for physical activity. We outline the primary and secondary goals and details of the methods for this review in this presentation. The current literature does not fully explain why certain behavior change techniques (BCTs) work and do not work in mobile interventions. We use the habit instigation vs execution processes in attempt to explain the effectiveness of the BCTs.

Many adults with major depressive disorder (MDD) do not receive effective treatment. The potential benefits of resistance exercise training (RET) are understudied and may be mechanistically related to cerebral blood flow changes.PurposeTo assess feasibility, acceptability, and preliminary efficacy of a 16-week, theory-informed RET trial for the treatment of MDD and explore changes in cerebral blood flow.MethodsTen adults with DSM-5-diagnosed MDD were enrolled in a single-arm, 16-week, twice-weekly, whole-body RET intervention, consistent with US and WHO Physical Activity resistance exercise guidelines. To build intrinsic motivation and develop exercise-preparatory habits, motivators and commitment were discussed weekly. Screening, enrollment, and intervention attendance and compliance rates documented feasibility. At baseline and weeks 8, 16, and 26, current MDD diagnosis, clinician-rated, and self-reported symptom severity were evaluated along with cerebral blood flow which was assessed as middle cerebral artery (MCA) mean blood velocity, conductance, and pulsatility.ResultsNine participants completed the intervention. Strong feasibility and acceptability (98% adherence, 93% compliance, and 90% retention) were found. MDD remission was reached by 8/9 participants at week 16 and persisted through week 26. There were large decreases in clinician-rated and self-reported symptoms at each assessment (Hedges’ g=0.84-2.13). There were small-to-moderate increases in MCA velocity (g=0.32-0.57) and conductance (g=0.20-0.76) across time, with minimal changes in pulsatility (all g<0.21).ConclusionsPreliminary results suggest RET for MDD treatment is feasible and plausibly efficacious, finding large antidepressant effects. A sufficiently powered randomized controlled trial to assess RET’s efficacy for treating MDD via potential cerebrovascular mechanisms is warranted.

Interventions often fail to achieve long-term behavioral maintenance. Utilizing motivational and volitional strategies to promote behavioral maintenance factors may improve this. Using a full-factorial experiment, we tested the effects of three intervention components (focused on intrinsic motivation and identity, exercise preparation habit, and exercise instigation habit) on exercise participation over a year, among new users (N = 751; 91% identifying as female, 54% identifying as White race) of a global, online exercise class platform, run by Les Mills International Ltd, called LM+. We also tested the intervention components' theoretical mechanisms of action-habit formation, intrinsic motivation, identity, and self-efficacy. Multi-level models found some support for a main effect of the exercise preparation habit intervention component in promoting self-reported and objective exercise participation (behavioral outcomes measured via monthly surveys and the LM+ platform; mechanisms measured via monthly surveys)-in particular online exercise class frequency (fixed effect estimate = 0.84, p < 0.05, and = 0.12, p < 0.05, respectively). The preparation habit component also significantly increased preparation habit strength (0.30, p < 0.05) and instigation habit strength (0.33, p < 0.05). Other expected effects were nonsignificant. Helping individuals form an exercise preparation habit may facilitate initiating and maintaining exercise over time, in particular for attending online exercise classes, potentially through promoting greater preparation and exercise instigation habit strength.

Planning-based interventions are often used to help individuals form habits. Existing literature suggests a one-size-fits all approach to habit formation, but planning interventions may be optimized if tailored to individual differences and/or behavioral complexity. We test the hypothesis that planning to do a relatively complex behaviour (exercise) at a time that matches an individuals’ diurnal preference will facilitate behavioral engagement; whereas for a simpler behaviour (calcium supplementation), the optimal time-of-day for a new behavior will occur in the morning. Young, women volunteers (N = 317) were randomly assigned to take calcium supplements or to exercise for 4 weeks and to control (no planning) or to one of three planning interventions (morning plan; evening plan; unassigned-time plan). Participants reported diurnal preference at baseline and habit strength and behavioral frequency weekly. Fitbit Zips and Medication Event Monitoring System Caps (MEMS) were used to objectively assess behavioral engagement. Multilevel modelling found that calcium-supplementation was greatest for morning-types in the morning-cue condition, whereas exercise was greatest for morning-types with morning cues and evening-types with evening cues. Habit-formation strategies may depend on diurnal preference and behavioral complexity. Future research can evaluate the role of other individual differences.