Predicting physical activity by the personality styles of the five-factor model.

OBJECTIVE: Low neuroticism, high extraversion, and high conscientiousness are related to physical activity (PA). We tested whether the small size and heterogeneity of these relationships result because personality traits influence one another as well as because some narrow facets rather than the broad domains contain more specific variance relevant to PA. METHOD: Participants were men and women enrolled in the University of North Carolina Alumni Heart Study who completed the Revised NEO Personality Inventory (NEO-PI-R) and reported their past month's average activity on an 8-point scale. In Study 1, we examined prospective correlations between the five NEO-PI-R domains and PA. In Studies 2 and 3, we used multinomial logistic regression to examine associations between PA and trait pair combinations (personality styles) controlling for age, sex, educational achievement, relationship status, and depression. RESULTS: Study 1 revealed that lower neuroticism (N) and agreeableness (A) and higher conscientiousness (C) predicted more PA. Taken together, Studies 2 and 3 found that the combination of high Extraversion (E) and high openness (O) was related to higher PA and that combinations of low E and high A and low E and low C were related to lower PA. Study 3, which examined the activity facet of E (E4), found that E4 is an important driver of E-PA associations. CONCLUSIONS: Personality traits do not operate in isolation. They may influence how other traits are expressed and such nonadditive effects can impact PA. Assessment of personality styles could help to identify individuals at risk for PA avoidance and may be useful for developing personalized interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supporting Sustainable Health Behavior Change: The Whole is Greater Than the Sum of Its Parts.

Behavior change is the foundation for effective lifestyle prescriptions, yet such change is individualized, nonlinear and typically requires ongoing support. Health and wellness coaching (HWC) is a behavior change intervention with rapidly accruing evidence of positive impact on health behaviors such as exercise, nutrition and stress management. Furthermore, HWC enhances prevention and mitigates exacerbation of chronic lifestyle diseases, at least in the short-term (up to 6 months post intervention). Although the impact on long-term stability of behavior change remains unclear, it is evident that effective partnering with patients using key communication strategies, autonomy promotion, and flexible permissiveness can empower patients to develop healthy lifestyles. This partnership can be cultivated by clinicians as well as clinical team members including nationally board-certified coaches. Although much research is needed regarding the ongoing maintenance of lifestyle changes beyond 6 months, this article seeks to equip clinicians with current evidence, theoretical insights and practical strategies from a "coach approach" to foster more intrinsic forms of motivation which, in turn, empowers patients to adopt and maintain health-promoting behaviors.

Group Health & Wellness Coaching: development and validation of the required competencies.

BACKGROUND: As the popularity and demonstrated effectiveness of Health and Wellness Coaching (HWC) continue to grow to address chronic disease prevalence worldwide, delivery of this approach in a group format is gaining traction, particularly in healthcare. Nonetheless, very little empirical work exists on group coaching and there are currently no published competencies for Group Health and Wellness Coaching (GHWC). METHODS: We used a well-established two-phase (Development and Judgment) process to create and validate GHWC competencies with strong content validity. RESULTS: Seven highly qualified Subject Matter Experts systematically identified and proposed the GHWC competencies, which were then validated by 78 National Board Certified Health and Wellness Coaches (NBC-HWCs) currently practicing GHWC who rated the importance and use frequency of each one. The validation study led to 72 competencies which are organized into the structure and process of GHWC. CONCLUSIONS: GHWC requires not only coaching skills, but significant group facilitation skills to guide the group process to best support members in maximizing health and well-being through self-directed behavioral change. As the presence of HWC continues to grow, it is imperative that GHWC skill standards be accepted and implemented for the safety of the public, the effectiveness of the intervention, and the value analysis of the field. Such standards will guide curriculum development, allow for a more robust research agenda, and give practical guidance for health and wellness coaches to responsibly run groups. High quality standards for GHWC are particularly needed in health care, where a Level III Current Procedural Terminology (CPT®) code for GHWC has been approved in the United States since 2019 and reimbursement of such has been approved by the Centers for Medicare and Medicaid for 2024.

Network Psychometrics of the 10-Item Perceived Stress Scale Among Patients With High Cardiovascular and Type 2 Diabetes Risk Using Exploratory Graph Analysis.

BACKGROUND: No studies have explored the internal structure of the 10-item Perceived Stress Scale in patients with high cardiovascular and diabetes risk. OBJECTIVE: We scrutinized the dimensionality of the scale in this patient group using exploratory graph analysis, a technique within the developing field of network psychometrics. METHODS: Analyses were conducted on 200 primary care patients. A bootstrap version of exploratory graph analysis assessed the stability of the dimensions based on structural consistency, item stability, and network loadings. RESULTS: Exploratory graph analysis revealed a 2-dimensional structure; structural consistency of the first dimension was high (0.863), whereas that for the second was low (0.667). Items belonging to the latter dimension did not cluster consistently with each other (ie, low item stability) and were not strongly associated with any particular dimension (ie, weak network loadings). CONCLUSION: Exploratory graph analysis offers unique outputs, making it easy to assess the dimensional integrity of scales. Further research is warranted regarding the second dimension of the Perceived Stress Scale.

Glycemic outcomes of a family-focused intervention for adults with type 2 diabetes: Main, mediated, and subgroup effects from the FAMS 2.0 RCT.

AIMS: Family/friend Activation to Motivate Self-care (FAMS) is a self-care support intervention delivered via mobile phones. We evaluated FAMS' effects on hemoglobin A1c (HbA1c) and intervention targets among adults with type 2 diabetes in a 15-month RCT. METHODS: Persons with diabetes (PWDs) were randomized to FAMS or control with their support person (family/friend, optional). FAMS included monthly phone coaching and text messages for PWDs, and text messages for support persons over a 9-month intervention period. RESULTS: PWDs (N = 329) were 52 % male, 39 % reported minoritized race or ethnicity, with mean HbA1c 8.6 ± 1.7 %. FAMS improved HbA1c among PWDs with a non-cohabitating support person (-0.64 %; 95 % CI [-1.22 %, -0.05 %]), but overall mean effects were not significant. FAMS improved intervention targets including self-efficacy, dietary behavior, and family/friend involvement during the intervention period; these improvements mediated post-intervention HbA1c improvements (total indirect effect -0.27 %; 95 % CI [-0.49 %, -0.09 %]) and sustained HbA1c improvements at 12 months (total indirect effect -0.19 %; 95 % CI [-0.40 %, -0.01 %]). CONCLUSIONS: Despite improvements in most intervention targets, HbA1c improved only among PWDs engaging non-cohabitating support persons suggesting future family interventions should emphasize inclusion of these relationships. Future work should also seek to identify intervention targets that mediate improvements in HbA1c.

Demographic, Clinical, and Psychosocial Predictors of Exercise Adherence: The STRRIDE Trials.

Purpose: To identify baseline demographic, clinical, and psychosocial predictors of exercise intervention adherence in the Studies of a Targeted Risk Reduction Intervention through Defined Exercise (STRRIDE) trials. Methods: A total of 947 adults with dyslipidemia or prediabetes were enrolled into an inactive control group or one of ten exercise interventions with doses of 10-23 kcal/kg/week, intensities of 40-80% of peak oxygen consumption, and training for 6-8-months. Two groups included resistance training. Mean percent aerobic and resistance adherence were calculated as the amount completed divided by the prescribed weekly minutes or total sets of exercise times 100, respectively. Thirty-eight clinical, demographic, and psychosocial measures were considered for three separate models: 1) clinical + demographic factors, 2) psychosocial factors, and 3) all measures. A backward bootstrapped variable selection algorithm and multiple regressions were performed for each model. Results: In the clinical and demographic measures model (n=947), variables explained 16.7% of the variance in adherence (p<0.001); lesser fasting glucose explained the greatest amount of variance (partial R2 = 3.2%). In the psychosocial factors model (n=561), variables explained 19.3% of the variance in adherence (p<0.001); greater 36-Item Short Form Health Survey (SF-36) physical component score explained the greatest amount of variance (partial R2 = 8.7%). In the model with all clinical, demographic, and psychosocial measures (n=561), variables explained 22.1% of the variance (p<0.001); greater SF-36 physical component score explained the greatest amount of variance (partial R2 = 8.9%). SF-36 physical component score was the only variable to account for >5% of the variance in adherence in any of the models. Conclusions: Baseline demographic, clinical, and psychosocial variables explain approximately 22% of the variance in exercise adherence. The limited variance explained suggests future research should investigate additional measures to better identify participants who are at risk for poor exercise intervention adherence.

Well-being outcomes of a family-focused intervention for persons with type 2 diabetes and support persons: Main, mediated, and subgroup effects from the FAMS 2.0 RCT.

AIMS: Type 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friend Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons. METHODS: PWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9 months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons. RESULTS: PWDs (N = 329) were 52% male and 39% reported minoritized race or ethnicity ; 50% enrolled with elevated diabetes distress. Support persons (N = 294) were 26% male and 33% reported minoritized race or ethnicity. FAMS improved PWDs' diabetes distress (d = -0.19) and global well-being (d = 0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention (9-month) and sustained (15-month) improvements were driven by changes in PWDs' self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement. CONCLUSIONS: FAMS improved PWDs' psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.

Well-being outcomes of a family-focused intervention for persons with type 2 diabetes and support persons: Main, mediated, and subgroup effects from the FAMS 2.0 RCT.

Aims: Type 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friends Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons. Methods: PWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9-months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons. Results: PWDs (N=329) were 52% male and 39% from minoritized racial or ethnic groups; 50% enrolled with elevated diabetes distress. Support persons (N=294) were 26% male and 33% minoritized racial or ethnic groups. FAMS improved PWDs' diabetes distress ( d =-0.19) and global well-being ( d =0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention and sustained (15-month) improvements were driven by changes in PWDs' self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement. Conclusions: FAMS improved PWDs' psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.

Glycemic outcomes of a family-focused intervention for adults with type 2 diabetes: Main, mediated, and subgroup effects from the FAMS 2.0 RCT.

Aims: Family/friends Activation to Motivate Self-care (FAMS) is a self-care support intervention delivered via mobile phones. We evaluated FAMS effects on hemoglobin A1c (HbA1c) and intervention targets among adults with type 2 diabetes in a 15-month RCT. Methods: Persons with diabetes (PWDs) and their support persons (family/friend, optional) were randomized to FAMS or control. FAMS included monthly phone coaching and text messages for PWDs, and text messages for support persons over a 9-month intervention period. Results: PWDs (N=329) were 52% male, 39% from minoritized racial or ethnic groups, with mean HbA1c 8.6±1.7%. FAMS improved HbA1c among PWDs with a non-cohabitating support person (-0.64%; 95% CI [-1.22%, -0.05%]), but overall effects were not significant. FAMS improved intervention targets including self-efficacy, dietary behavior, and family/friend involvement during the intervention period; these improvements mediated post-intervention HbA1c improvements (total indirect effect -0.27%; 95% CI [-0.49%, -0.09%]) and sustained HbA1c improvements at 12 months (total indirect effect -0.19%; 95% CI [-0.40%, -0.01%]). Conclusions: Despite improvements in most intervention targets, HbA1c improved only among PWDs engaging non-cohabitating support persons suggesting future family interventions should emphasize inclusion of these relationships. Future work should also seek to identify intervention targets that mediate improvements in HbA1c.

Prerandomization withdrawals from a Type 2 diabetes self-care support intervention trial are associated with lack of available support person coparticipant.

OBJECTIVES: Dyadic interventions, involving two persons with a preexisting close relationship, offer the opportunity to activate support persons (SPs) to improve health for adults with chronic conditions. Requiring SP coparticipation can challenge recruitment and bias samples; however, the associations between voluntary SP coparticipation and recruitment outcomes across patient characteristics are unknown. METHODS: The Family/Friend Activation to Motivate Self-care 2.0 randomized controlled trial (RCT) enrolled adults with Type 2 diabetes (T2D) from an academic health system. Participants were asked-but not required-to invite an SP to coenroll. Using data from the electronic health record we sought to describe RCT enrollment in the setting of voluntary SP coparticipation. RESULTS: In a diverse sample of adults with (T2D) (48% female, 44% minoritized race/ethnicity), most participants (91%) invited SPs and (89%) enrolled with SPs. However, prerandomization withdrawal was significantly higher among participants who did not have consenting SPs than those who did. Females were less likely to invite SPs than males and more Black PWD were prerandomization withdrawals than randomized. DISCUSSION: Voluntary SP coenrollment may benefit recruitment for dyadic sampling; however, more research is needed to understand if these methods systematically bias sampling and to prevent these unintended biases.

Race and sex differences in dropout from the STRRIDE trials.

Purpose: To determine if race and sex differences exist in determinants and timing of dropout among individuals enrolled in an exercise and/or caloric restriction intervention. Methods: A total of 947 adults with dyslipidemia (STRRIDE I, STRRIDE AT/RT) or prediabetes (STRRIDE-PD) were randomized to either inactive control or to 1 of 10 exercise interventions, ranging from doses of 8-23 kcal/kg/week, intensities of 50%-75% V˙O2 peak, and durations of 6-8 months. Two groups included resistance training, and one included a dietary intervention (7% weight loss goal). Dropout was defined as an individual withdrawn from the study, with the reasons for dropout aggregated into determinant categories. Timing of dropout was defined as the last session attended and aggregated into phases (i.e., "ramp" period to allow gradual adaptation to exercise prescription). Utilizing descriptive statistics, percentages were generated according to categories of determinants and timing of dropout to describe the proportion of individuals who fell within each category. Results: Black men and women were more likely to be lost to follow-up (Black men: 31.3% and Black women: 19.6%), or dropout due to work responsibilities (15.6% and 12.5%), "change of mind" (12.5% and 8.9%), transportation issues (6.3% and 3.6%), or reported lack of motivation (6.3% and 3.6%). Women in general noted lack of time more often than men as a reason for dropout (White women: 22.4% and Black women: 22.1%). Regardless of race and sex, most participants dropped out during the ramp period of the exercise intervention; with Black women (50%) and White men (37.1%) having the highest dropout rate during this period. Conclusion: These findings emphasize the importance of targeted retention strategies when aiming to address race and sex differences that exist in determinants and timing of dropout among individuals enrolled in an exercise and/or caloric restriction intervention.

Rationale, design, and recruitment outcomes for the Family/Friend Activation to Motivate Self-care (FAMS) 2.0 randomized controlled trial among adults with type 2 diabetes and their support persons.

BACKGROUND: Self-care behaviors help reduce hemoglobin A1c (HbA1c) and prevent or delay type 2 diabetes (T2D) complications. Individualized interventions that support goal setting and self-monitoring improve self-care and HbA1c in the short-term; engaging family and friends may enhance and/or sustain effects. Family/Friend Activation to Motivate Self-care (FAMS) is a mobile phone-delivered intervention (i.e., phone coaching and text message support) based on Family Systems Theory which was successfully piloted among diverse adults with T2D. METHODS: We made improvements to FAMS and conducted iterative usability testing to finalize FAMS 2.0 before evaluation in a randomized controlled trial (RCT). Adult persons with diabetes (PWDs) who enrolled were asked to invite a support person (friend or family member) to participate alongside them. For the RCT, dyads were randomly assigned to FAMS 2.0 or enhanced treatment as usual (control) for the first 9 months of the 15-month trial. Outcomes include PWDs' HbA1c and psychosocial well-being (including diabetes distress) and support persons' own diabetes distress and support burden. RESULTS: We recruited RCT participants from April 2020 through October 2021 (N = 338 PWDs with T2D; 89% [n = 300] with a support person). PWDs were 52% male, 62% non-Hispanic White, aged 56.9 ± 11.0 years with HbA1c 8.7% ± 1.7% at enrollment; 73% cohabitated with their enrolled support person. Data collection is ongoing through January 2023. CONCLUSION: Findings will inform the utility of engaging family/friends in self-care behaviors for both PWD and support person outcomes. Using widely available mobile phone technology, FAMS 2.0, if successful, has potential for scalability. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04347291 posted April 15, 2020.

Effects of Health and Wellness Coaching With an Adult Cancer Caregiver.

Introduction Although cancer most directly affects the patient, its impact is also widely recognized to extend to those who are caring for the patient. Cancer patient caregivers endure psychological distress, have high levels of depression, and report isolation and strain. Research on targeted caregiver interventions is limited. This case report examines the use of health and wellness coaching (HWC) with a caregiver of a patient with neuroendocrine tumors, a rare, insidious type of cancer. Case Presentation We present the first known case report on using HWC with a 44-year-old woman adult cancer patient caregiver who was caring for a patient with neuroendocrine tumors. The patient had a chronically elevated body mass index, cholesterol, and stage 2 hypertension. Her primary care physician had prescribed weight loss medication (naltrexone/bupropion), which the patient hesitated to take and wanted to try HWC instead. The 10-session intervention targeted multiple components of health, including blood pressure, body mass index, cholesterol, weight loss, stress management, relationship success, and vocational progress. Outcomes were followed over a 1-year period. Conclusion This case demonstrates multiple unique aspects of the HWC process that support successful, sustainable behavioral change. The case patient's success suggests HWC may be effective in supporting beneficial physical and psychosocial outcomes with an adult cancer caregiver and should be considered a viable option for promoting health in caregivers.

Determinants of Dropout from and Variation in Adherence to an Exercise Intervention: The STRRIDE Randomized Trials.

Purpose: This study aimed to characterize the timing and self-reported determinants of exercise dropout among sedentary adults with overweight or obesity. We also sought to explore variations in adherence among individuals who completed a 6- to 8-month structured exercise intervention. Methods: A total of 947 adults with dyslipidemia [STRRIDE I, STRRIDE AT/RT] or prediabetes [STRRIDE-PD] were enrolled to either control or to one of 10 exercise interventions, ranging from doses of 8-23 kcal/kg/week; intensities of 50%-75% V̇O2 peak; and durations of 6-8 months. Two groups included resistance training and one included dietary intervention (7% weight loss goal). Dropout was defined as an individual who withdrew from the study due a variety of determinants. Timing of intervention dropout was defined as the last session attended and categorized into phases. Exercise training adherence was calculated by dividing weekly minutes or total sets of exercise completed by weekly minutes or total sets of exercise prescribed. General linear models were used to characterize the associations between timing of dropout and determinant category. Results: Compared to exercise intervention completers (n=652), participants who dropped out (n=295) were on average non-white (98% vs. 80%, p<0.01), had higher body mass index (31.0 kg/m2 vs. 30.2 kg/m2; p<0.01), and were less fit at baseline (25.0 mg/kg/min vs. 26.7 ml/kg/min, p<0.01). Of those who dropped out, 67% did so prior to the start of or while ramping up to the prescribed exercise volume and intensity. The most commonly reported reason for dropout was lack of time (40%). Notably, among individuals who completed the ramp training period, subsequent exercise intervention adherence did not waiver over the ensuing 6-8 months of training. Conclusion: These findings are some of the first to delineate associations between the timing of dropout and dropout determinants, providing guidance to future exercise interventions to better support individuals at-risk for dropout.

Health coaching and genetic risk testing in primary care: Randomized controlled trial.

OBJECTIVE: Accessible interventions are needed to prevent coronary heart disease (CHD) and Type 2 diabetes (T2D). This prospective, randomized, controlled trial evaluated remote health coaching (HC), genetic risk testing (GRT), or both added to standardized risk assessment (SRA) in at-risk military primary care patients. METHOD: Using a 2 × 2 factorial longitudinal design, 200 Air Force at-risk participants provided primary outcomes at baseline, 3-, 6- (HC endpoint), and 12-months. Secondary measures were taken less often. Per protocol analyses used linear models and logistic regression; intent-to-treat (ITT) analyses used mixed models. RESULTS: Compared with those not receiving HC, the HC group was 3.6 times more likely to report moderate to intense physical activity at 6-months (p = .0009), and 2.9 times more likely to report such at 12-months (p = .0065). ITT longitudinal model did not reach significance (p = .0885). The HC group reported lower emotional representations of illness at 6-weeks and lower depression at 6 months. There were no other significant findings. HC and GRT interacted; higher T2D risk participants receiving HC were 4.7 times more likely to report higher stage of change for exercise at 6-months, and lost 2.2 kg more by 12-months. Lower T2D risk participants receiving HC perceived greater control over CHD risk at 6-weeks, and averaged lower 6-month depression. CONCLUSIONS: Remote HC after SRA increased physical activity, which was sustained 6-months later. Incorporating GRT into SRA warrants further exploration regarding the potential to leverage HC for weight loss in elevated T2D risk participants, and for depression in lower T2D risk participants. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Latent Profile/Class Analysis Identifying Differentiated Intervention Effects.

BACKGROUND: The randomized clinical trial is generally considered the most rigorous study design for evaluating overall intervention effects. Because of patient heterogeneity, subgroup analysis is often used to identify differential intervention effects. In research of behavioral interventions, such subgroups often depend on a latent construct measured by multiple correlated observed variables. OBJECTIVES: The purpose of this article was to illustrate latent class analysis/latent profile analysis as a helpful tool to characterize latent subgroups, conduct exploratory subgroup analysis, and identify potential differential intervention effects using clinical trial data. METHODS: After reviewing different approaches for subgroup analysis, latent class analysis/latent profile analysis was chosen to identify heterogeneous patient groups based on multiple correlated variables. This approach is superior in this specific scenario because of its ability to control Type I error, assess intersection of multiple moderators, and improve interpretability. We used a case study example to illustrate the process of identifying latent classes as potential moderators based on both clinical and perceived risk scores and then tested the differential effects of health coaching in improving health behavior for patients with elevated risk of developing coronary heart disease. RESULTS: We identified three classes based on one clinical risk score and four perceived risk measures for individuals with high risk of developing coronary heart disease. Compared to other classes we assessed, individuals in the class with low clinical risk and low perceived risk benefit most from health coaching to improve their physical activity levels. DISCUSSION: Latent class analysis/latent profile analysis offers a person-centered approach to identifying distinct patient profiles that can be used as moderators for subgroup analysis. This offers tremendous opportunity to identify differential intervention effects in behavioral research.

A Network Analysis of the Association Between Depressive Symptoms and Patient Activation Among Those With Elevated Cardiovascular Risk.

Background: Network analysis provides a new method for conceptualizing interconnections among psychological and behavioral constructs. Objective: We used network analysis to investigate the complex associations between depressive symptoms and patient activation dimensions among patients at elevated risk of cardiovascular disease. Methods: This secondary analysis included 200 patients seen in primary care clinics. Depressive symptoms were assessed using the 21-item Beck Depression Inventory. Patient activation was measured using the 13-item Patient Activation Measure. Glasso networks were constructed to identify symptoms/traits that bridge depressive symptoms and patient activation and those that are central within the network. Results: "Self-dislike" and "confidence to maintain lifestyle changes during times of stress" were identified as important bridge pathways. In addition, depressive symptoms such as "punishment feelings," "loss of satisfaction," "self-dislike," and "loss of interest in people" were central in the depressive symptom-patient activation network, meaning that they were most strongly connected to all other symptoms. Conclusions: Bridge pathways identified in the network may be reasonable targets for clinical intervention aimed at disrupting the association between depressive symptoms and patient activation. Further research is warranted to assess whether targeting interventions to these central symptoms may help resolve other symptoms within the network.

The Relative Contributions of Live and Recorded Online Mindfulness Training Programs to Lower Stress in the Workplace: Longitudinal Observational Study.

BACKGROUND: Despite numerous gaps in the literature, mindfulness training in the workplace is rapidly proliferating. Many "online" or "digital mindfulness" programs do not distinguish between live teaching and recorded or asynchronous sessions, yet differences in delivery mode (eg, face-to-face, online live, online self-guided, other) may explain outcomes. OBJECTIVE: The aim of this study was to use existing data from an online mindfulness solutions company to assess the relative contribution of live and recorded mindfulness training to lower perceived stress in employees. METHODS: Perceived stress and the amount of live and recorded online mindfulness training accessed by employees were assessed during eMindful's One-Percent Challenge (OPC). The OPC is a 30-day program wherein participants are encouraged to spend 1% of their day (14 minutes) practicing mindfulness meditation on the platform. We used linear mixed-effects models to assess the relationship between stress reduction and usage of components of the eMindful platform (live teaching and recorded options) while controlling for potential reporting bias (completion) and sampling bias. RESULTS: A total of 8341 participants from 44 companies registered for the OPC, with 7757 (93.00%) completing stress assessments prior to the OPC and 2360 (28.29%) completing the postassessment. Approximately one-quarter of the participants (28.86%, 2407/8341) completed both assessments. Most of the completers (2161/2407, 89.78%) engaged in the platform at least once. Among all participants (N=8341), 8.78% (n=707) accessed only recorded sessions and 33.78% (n=2818) participated only in the live programs. Most participants engaged in both live and recorded options, with those who used any recordings (2686/8341, 32.20%) tending to use them 3-4 times. Controlling for completer status, any participation with the eMindful OPC reduced stress (B=-0.32, 95% CI -0.35 to -0.30, SE=0.01, t2393.25=-24.99, P<.001, Cohen d=-1.02). Participation in live programs drove the decrease in stress (B=-0.03, SE=0.01, t3258.61=-3.03, P=.002, d=-0.11), whereas participation in recorded classes alone did not. Regular practice across the month led to a greater reduction in stress. CONCLUSIONS: Our findings are in stark contrast to the rapid evolution of online mindfulness training for the workplace. While the market is reproducing apps and recorded teaching at an unprecedented pace, our results demonstrate that live mindfulness programs with recorded or on-demand programs used to supplement live practices confer the strongest likelihood of achieving a significant decrease in stress levels.

Amount and intensity effects of exercise training alone versus a combined diet and exercise lifestyle intervention on health-related quality of life in the STRRIDE-PD randomized trial.

INTRODUCTION: To determine the relative contributions of various amounts and intensities of exercise alone to a combined lifestyle intervention on health-related quality of life (HrQoL) measures. RESEARCH DESIGN AND METHODS: Participants (n=162) were sedentary, overweight/obese, with pre-diabetes, and randomized to one of four 6-month interventions: (1) high amount/moderate intensity exercise-energy expenditure of 16 kcal/kg of body weight/week (KKW) at 50% oxygen consumption (V̇O2) reserve; (2) high/vigorous-16 KKW at 75% V̇O2 reserve; (3) low/moderate-10 KKW at 50% V̇O2 reserve; (4) low/moderate plus diet-10 KKW at 50% V̇O2 reserve plus a calorically restricted diet. The 36-Item Short-Form Survey (SF-36) and Satisfaction with Physical Function and Appearance (SPF/SPA) survey were assessed at baseline and post-intervention. Analyses of covariance determined differences in change scores among groups (p<0.05). Paired t-tests determined significant pre-intervention versus post-intervention scores within groups (p<0.05). RESULTS: Across the intervention, all groups (p<0.05) improved the physical component, SPF, and SPA scores. Only the low/moderate/diet group (p<0.001) significantly improved the mental component score. The high/vigorous group achieved 84.5% of the low/moderate/diet group effect for change in physical component score, and the low/moderate group achieved 83.7% of the low/moderate/diet group effect for change in mental component score. CONCLUSIONS: In general, a low amount of moderate intensity exercise combined with diet was the most effective intervention for improving HrQoL. Of the exercise-only interventions, vigorous intensity exercise provided the greatest impact on changes in physical function. On the other hand, low amounts of moderate intensity exercise provided the greatest impact on mental well-being, potentially being a more attainable exercise dose for previously sedentary individuals with pre-diabetes to achieve.

Health Behavior Trajectories in High Cardiovascular Risk Populations: Secondary Analysis of a Clinical Trial.

BACKGROUND: The application of latent class growth analysis (LCGA) has been limited in behavioral studies on high-cardiovascular-risk populations. AIM: The current study aimed to identify distinct health behavior trajectories in high-cardiovascular-risk populations using LCGA. We also examined the baseline individual characteristics associated with different health behavior trajectories and determined which trajectory is associated with improved cardiovascular risk outcomes at 52 weeks. METHODS: This secondary analysis of a clinical trial included 200 patients admitted to primary care clinics. Latent class growth analysis was conducted to identify the trajectories of physical activity and dietary intake; these were measured at 4 different time points during a 52-week study period. Analysis of variance/χ2 test was used to assess the associations between baseline individual characteristics and trajectories, and logistic regression analysis was used to identify associations between trajectories and cardiovascular risk outcomes at 52 weeks. RESULTS: Three trajectories were identified for physical activity (low-, moderate-, and high-stable). Risk perception, patient activation, and depressive symptoms predicted the trajectories. High-stable trajectory for physical activity was associated with better cardiovascular risk outcomes at the 52-week follow-up. Two trajectories (low-stable and high-decreasing) were identified for percent energy from fat, but the factors that can predict trajectories were limited. CONCLUSIONS: Interventions are needed to target patients who begin with a lower physical activity level, with the goal of enhanced cardiovascular health. The predictors identified in the study may facilitate earlier and more tailored interventions.