The contribution and interplay of implicit and explicit processes on physical activity behavior: empirical testing of the physical activity adoption and maintenance (PAAM) model.

The adoption and maintenance of physical activity (PA) is an important health behavior. This paper presents the first comprehensive empirical test of the Physical Activity Adoption and Maintenance (PAAM) model, which proposes that a combination of explicit (e.g., intention) and implicit (e.g., habit,, affect) self-regulatory processes is involved in PA adoption and maintenance. Data were collected via online questionnaires in English, German, and Italian at two measurement points four weeks apart. The study included 422 participants (Mage= 25.3, SDage= 10.1; 74.2% women) from Germany, Switzerland, Italy, Canada, and the U.S. The study results largely supported the assumptions of the PAAM model, indicating that intentions and habits significantly mediate the effects of past PA on future PA. In addition, the effect of past PA on future PA was shown to be significant through a mediation chain involving affect and habit. Although the hypothesis that trait self-regulation moderates the intention-behavior relationship was not supported, a significant moderating effect of affect on the same relationship was observed. The results suggest that interventions targeting both explicit and implicit processes may be effective in promoting PA adoption and maintenance.

Do executive functions predict physical activity behavior? A meta-analysis.

BACKGROUND: Executive functions (EFs) are important determinants of health behaviors. In the present study, a meta-analysis was conducted to investigate the relationship between EFs and physical activity (PA) behavior. METHODS: Systematic searches were carried out in PsycInfo, MEDLINE, and SPORTDiscus databases throughout April 2021. Prospective empirical studies conducted with general healthy populations across the lifespan, which reported the relationship between baseline EFs and later PA behavior were selected. RESULTS: Eight studies were found eligible. Results of the multilevel meta-analysis revealed a small but significant total effect size for EFs on PA behavior of z = 0.12. High heterogeneity was observed among studies. When potential moderators were tested, residual heterogeneity remained significant and the effects of the moderators were not significant. The effect size dropped when accounted for publication bias. CONCLUSIONS: Despite limitations, the study provided evidence for EFs' determinant role on PA behavior. More research is however encouraged to inform PA promotion programs that are well-prepared for individual differences in EFs.

Study protocol for the description and evaluation of the "Habit Coach" - a longitudinal multicenter mHealth intervention for healthy habit formation in health care professionals.

BACKGROUND: The adoption of a healthy lifestyle plays a crucial role for the health and well-being of health care professionals. Previous e- and mHealth interventions relied on deliberative psychological processes (e.g., intention, planning) to target lifestyle changes, while revealing mixed efficacy. The additional potential of non-deliberative, automatic processes (i.e., habits) for behavior change has been understudied in interventions so far. The Habit Coach mHealth intervention combines deliberative and non-deliberative processes to support health care professionals in forming healthy physical activity, nutrition and mindfulness habits in daily life. The aim of this paper is to outline the study protocol including a detailed description of the mHealth intervention, evaluation plan, and study design. The purpose of this trial is to understand healthy habit formation in health care professionals over time. METHODS: A one-arm, multicenter mHealth intervention study will be conducted. Behavioral and psychosocial predictors will be collected via within-app questionnaires across a 100-day period at baseline, post, as well as at weekly assessments. To understand habit formation across time, linear mixed models will be used. DISCUSSION: This trial aims to unravel the role of motivational and volitional determinants for healthy habit formation across multiple health behaviors in health care professionals embedded in a mHealth intervention. TRIAL REGISTRATION: This trial is registered in the German Clinical Trials Register, DRKS-ID DRKS00027156. Date of registration 17 November 2021.

Self-regulation and healthy lifestyles: considering the future may increase current physical activity levels.

The present study examined whether people's consideration of consequences (future vs. immediate consequences; CFC) can predict physical activity behaviour (PAB) and, to explore key mechanisms that may underline such association. To that end, participants (N = 128) filled in standardised measures of CFC and PAB, and questionnaires of health regulatory focus, attitude and intention as mediators of the CFC-PAB association. Regression analysis revealed that CFC-immediate was negatively associated with PAB, and that health regulatory promotion focus and intention were both positively associated with PAB. Mediation analysis revealed a significant effect of CFC-future via health promotion focus, attitude, and intention on PAB. Findings are discussed considering both susceptibility and buffering hypotheses. CFC-future buffers against self-control failure because it is associated with a promotion focus and with both more positive attitudes and stronger intentions towards PAB. Interventions promoting a physically active lifestyle should foster people to value and become aware of the future consequences of their actual PAB.

Physical activity automaticity, intention, and trait self-control as predictors of physical activity behavior - a dual-process perspective.

Dual-process theories assume that physical activity (PA) behavior is regulated by two different processes: impulsive (i.e., automatic, fast) and reflective (i.e., effortful, slow) processes. In this study we examined main effects as well as the interaction of reflective (intention and trait self-control)and impulsive (automaticity)processes on PA behavior. A prospective study with two points of measurement (N = 118 university students) was conducted. At t1, age, sex, past PA behavior (control variables), PA intention, automaticity and trait self-control (predictors) were assessed with standardized questionnaires. At t2 (4 weeks later), PA behavior (dependent variable) was measured with a standardized questionnaire. Hierarchical multiple linear regression analysis revealed that automaticity was associated with PA behavior. The expected interaction effects Intention x Trait Self-control and Automaticity x Intention x Trait self-control on PA were significant. Moderation analyses revealed that PA intention has a significant positive association with PA behavior when trait self-control was higher compared to lower. Furthermore, automaticity has the strongest association with behavior when both intention and trait self-control where lower compared to higher. Our results underline the additive and interactive effects of impulsive and reflective processes in regulating PA behavior.

Predicting Physical Activity Behavior by Automatic and Reflective Self-Regulatory Processes.

In this study, we examined the interaction of automatic (i.e., automatic affective evaluations) and reflective [i.e., reflective intention and executive functions (EFs)] processes on physical activity (PA) behavior based on dual-process theories. We expected main effects as well as significant interaction effects between automatic associations, intention, and EFs on behavior. In particular, a well-controlled implicit-association-test (IAT) was applied to assess automatic affective evaluation. A prospective study with two points of measurement (N=212 students) was conducted. At t1, age, sex, PA behavior (control variables), automatic associations, EFs (shifting, updating, inhibition), and PA intention (predictors and moderators) were assessed with standardized questionnaires and tests. At t2 (4weeks later), PA behavior (dependent variable) was measured with a standardized questionnaire. A hierarchical multiple linear regression analysis including two- and three-way interactions between IAT results, intention, and EFs on PA behavior was conducted. Results showed that the interactions Intention x Shifting and IAT x Intention x Inhibition were significant. Moderation analyses revealed that participants with higher intentions and lower inhibition values (improved inhibition abilities) showed a negative association between IAT and PA, while those with lower intentions and lower inhibition values showed a positive association between IAT and PA, which was documented in a significant slope difference test between these two groups. Thus, both automatic and reflective processes contribute and interact in predicting PA. As well as fostering more positive affective evaluations towards PA, interventions to strengthen PA intentions and to improve EFs could help to increase PA behavior.

Predictors of Vaping Behavior Change in Young Adults Using the Transtheoretical Model: A Multi-Country Study.

Electronic nicotine products remain popular among college students. These products contain heavy metals, carcinogens and the addictive substance nicotine. By understanding where students are in their behavior change can help to determine and focus messages and campaigns. The aim of this study was to assess predictors of the Transtheoretical model in college-aged vaping. This study consisted of an online/Ipad delivery of a voluntary survey to 1249 young adults/college students at 5 universities (International and within the U.S.). Data was analyzed using Stata. Regression analysis was performed to assess predictors of the stages in the Transtheoretical Model of behavior change. Our study found that women tended to be further along in the stages of change as compared to their male counterparts. Additionally, the older students were more likely to be in maintenance stage as compared to the younger students. The students who vaped longer tended to not have advance into any of the stages of change besides precontemplation. Understanding where students are in the stages of change can help to inform behavioral message campaigns enabling more focused targeting of messages and efforts to reduce consumption. Electronic nicotine products are highly prevalent on college campuses, both nationally and internationally. The nicotine is addictive and may result in less of a desire or ability to quit as young adults age.

Influence of a Planning Intervention on Physical Activity Behavior: the Moderating Role of Intentions and Executive Functions in a Randomized Controlled Trial.

BACKGROUND: Planning and executive functions (EFs; inhibition, updating, shifting) are self-regulatory variables that help people to become and stay physically active. The aim of this study was to examine how and for whom a planning intervention affects physical activity (PA) behavior in the short term. Therefore, the mediating role of planning and the moderating role of intentions and EFs for the planning-behavior link were examined. METHOD: In a randomized control trial with two treatment groups (planning group vs. control group) and two points of measurement (t1 and t2, 1 week apart), n = 200 students participated in both measurements. At t1, participants filled in standardized questionnaires assessing PA behavior, intention, and planning. Computer-based tests assessed the following EFs: inhibition, updating, and shifting. At t2, planning and PA behavior were measured again. Moderated mediation analyses were conducted. RESULTS: A significant increase in PA between t1 and t2 was found for the planning group compared with the control group. Furthermore, planning cognitions significantly mediated the effect of the planning group on behavior and intention, as well as the EF updating moderated the association between planning and behavior. Forming plans was particularly beneficial for participants with high intentions and lower updating performance. CONCLUSION: Planning enhances PA behavior, particularly when PA intention is high. Poor performance in updating can be compensated by planning since encouraging people to generate plans might facilitate automatic enactment of the behavior.

An Analysis of Associations Between Electronic Nicotine Delivery System Users.

BACKGROUND: Electronic nicotine-delivery systems have been increasing in prevalence among young adults. Although these devices are marketed to aid in quit smoking, young adults who do not smoke traditional cigarettes are using these devices. This study explored associations between individuals' quit type (ie, no plans to quit, plans to quit, or quit > 6 months ago) and perceived health status, perception of harm compared to cigarettes, perception of secondhand vapor harm, and reasons for first use. METHODS: We utilized a cross-sectional study design using a 33-item electronic survey questionnaire. The total sample size was 2,792. Out of these the ENDS users were 1,217. The survey was distributed to university students in 5 areas in 3 countries: the United States (ie, Florida, Alabama, and Illinois), Germany (ie, Hamburg) and South Africa (ie, Potchefstroom). RESULTS: Quantitative data analysis indicated that, regardless of quit status, there was a general lack of knowledge regarding secondhand vapor effects. Additionally, young adults are utilizing these products primarily due to peer influence and stress relief. Harm perception may factor into quit attempts using electronic nicotine-delivery systems. CONCLUSIONS: Education provided by respiratory therapists (and to respiratory therapy students) would be valuable as they inform patients and communities of the scholarly literature on vaping devices.

Behavioural automaticity moderates and mediates the relationship of trait self-control and physical activity behaviour.

OBJECTIVES: Trait self-control has been shown to be associated with physical activity behaviour. However, in contrast with the theoretical assumption underlying the strength model of self-control, self-control seems to be more important for automatic compared with controlled behaviours. It is argued that self-control might facilitate the formation of adaptive habits (behavioural automaticity) and therefore enhance health behaviour through an indirect effect. The credibility of this hypothesis was empirically assessed in a proof-of-concept study. METHODS: In a prospective design study with two laboratory sessions, participants (N = 124) completed standardised questionnaires assessing trait self-control and behavioural automaticity as predictors (1st session) and actual physical activity behaviour (after one week) as the dependent variable (2nd session). RESULTS: The predictive power of self-control was stronger for participants with high behavioural automaticity compared with participants with low behavioural automaticity. Furthermore, automaticity mediated the relationship between self-control and behaviour. DISCUSSION: Behavioural automaticity appears to be a helpful construct for specifying the relationship between self-control and physical activity. Our results support the approach of effortless self-control and self-control success, an extension of the strength model of self-control which assumes that self-control is helpful in creating effective routines. In future studies, causal relationships should be examined using more robust and rigorous research designs.

Executive Functions, Trait Self-Control, and the Intention-Behavior Gap in Physical Activity Behavior.

Many people fail to translate their physical activity intentions into behavior. This intention-behavior gap can be explained by (a) explicit trait self-control, (b) implicit executive functions, and (c) their interactions. In 118 participants, the intention-behavior gap was measured in a prospective design. Trait self-control was assessed via self-report questionnaires, whereas executive functioning was measured with test performance in inhibition, updating, and shifting at baseline. Regression analysis showed that (a) higher trait self-control predicts a smaller intention-behavior gap; (b) updating performance is related with this gap; and (c) behavior in tests on inhibition, updating, and shifting moderate the relation between the trait self-control and the intention-behavior gap. The present study showed that the complex pattern that modulates the relation between intended and realized physical activity behavior includes trait self-control, executive functions, as well as the combination of these cognitive components supporting dual-process approaches of self-control including implicit and explicit processing components.

Treatment of ocular rosacea with once-daily low-dose doxycycline.

PURPOSE: The aim of this study was to determine the efficacy of once-daily systemic treatment of ocular rosacea with a slow-release form of 40 mg of doxycycline. METHODS: Fifteen patients with ocular rosacea were enrolled between February 2010 and October 2012 in a retrospective observational case series. Patient complaints and clinical findings including blepharitis with telangiectasia and meibomian gland dysfunction, conjunctival redness, and fluorescein staining of the cornea were evaluated. The ocular manifestations were scored as follows: 0-absent, 1-mild, 2-moderate, and 3-severe. All measurements were repeated at the 6-week follow-up visit. The mean duration of treatment was 8 months (range, 5-12 months), and the mean duration of the follow-up was 9 months (range, 6-17 months). RESULTS: At the baseline visit, 73.3% of the patients had severe complaints, and 80% had severe blepharitis despite topical therapy with artificial tears and eyelid hygiene. After 12 weeks of systemic therapy, severe complaints and blepharitis strongly improved and were seen in only 13.3% and 20% of the patients (P = 0.01). Follow-up investigations 6 to 17 months after discontinuation of the treatment showed further significant improvement of complaints (absent or mild in 66.7% and 20% of the patients, respectively) and blepharitis (absent or mild in 26.7% and 60% of the patients, respectively). One patient had a mild stomach ache so that therapy was shortened to 5 months. CONCLUSIONS: An antiinflammatory dose of slow-release doxycycline 40 mg given daily may be an effective and safe therapy of ocular rosacea.

Regulatory fit messages and physical activity motivation.

Targeted communication about health behaviors seems to be more effective than mass communication in which undifferentiated audiences receive identical messages. Regulatory focus is psychological variable that can be used to build two target groups: promotion-focused or prevention-focused people. It is hypothesized that targeting messages to an individual's regulatory focus creates regulatory fit and is more successful to promote a physically active lifestyle than nonfit messages. Two different print messages promoting a physically active lifestyle derived from regulatory focus theory (promotion message vs. prevention message) were randomly assigned to N = 98 participants after measuring their regulatory focus. It was examined whether regulatory fit between the regulatory focus and the assigned print message would lead to more positive evaluations in the dependent variables inclination toward the message (preference for the message), intention to perform the behavior, prospective and retrospective feelings associated with the behavior (positive and negative), and perceived value of the behavior directly after reading the message. Hierarchical linear regression analyses revealed that regulatory fit led to stronger intentions in the prevention-message condition and more prospective positive and retrospective positive feelings associated with the behavior in the promotion-message condition in contrast to the nonfit conditions. Prospective positive feelings associated with the behavior mediated the effect of regulatory fit on intention. The results partly provided support for the regulatory fit concept. Matching print messages to the regulatory focus of individuals seems to be a useful approach to enhance physical activity motivation. Future studies should include an objective measure of physical activity behavior.

Treatment of ocular rosacea with 40 mg doxycycline in a slow release form.

BACKGROUND: About 30-50 % of rosacea patients have ocular involvement. The symptoms range from a foreign-body sensation to conjunctivitis or blepharitis and may even include severe corneal ulcerations. Systemic treatment is generally with tetracycline. Side effects can occur with the usual antimicrobial dose. PATIENTS AND METHODS: In a retrospective study, seven patients were evaluated who had been treated for ocular rosacea with a sub-antimicrobial dose of doxycycline 40 mg in a slow-release form (Oraycea). The responses were evaluated on the basis of clinical findings. RESULTS: Seven patients with an average age of 63 took slow release doxycycline 40 mg every day for at least two months. In five patients, other systemic drugs had already failed. All patients experienced a clear improvement in their ocular rosacea after an average of 2.29 months of treatment. One patient had complete clearance and another had almost complete clearance. None of the patients experienced side effects. CONCLUSIONS: A sub-antimicrobial dose of slow release doxycycline 40 mg daily is an effective long-term therapy for ocular rosacea. It is not associated with the side effects of long-term antibiotic therapy or the risk of resistance.