A Smartphone App to Improve Physical Activity
Condition: Sedentary Lifestyle
Study type: Interventional

Summary: 
      The purpose of this study is to develop, test, and optimize a physical activity (PA)-tracking
      smartphone app and specialty features, which are designed to facilitate older adults' PA by
      targeting common barriers in this population. For example, one feature sends messages
      throughout the day about the good things about growing older to combat negative views about
      aging which has been linked to decreased PA. Participants will include older adult smartphone
      users who are between the ages of 65 and 84 and are not very physically active. In phase one
      of the study, three groups of five older adults will be formed to test the PA-tracking app
      and one of three specialty features for a two-week period, followed by a focus group to learn
      about the older adults' experiences. In phase two, approximately 100 participants will be
      randomly assigned to one of eight groups that include various combinations of specialty
      features with the PA tracker, for the purpose of pilot testing the app for a four-month
      period. Testing will occur at the beginning and the end of the four-month intervention
      period, and will measure PA levels, sedentary activity time, self-reported PA, and functional
      mobility.
    

Detailed description: 
      In this study, we will optimize a set of tailored specialty app features designed to be
      paired with a physical activity (PA)-tracking app to boost older adults' PA. This package,
      termed the MovingUp suite, is distinct from generic fitness apps because it blends a set of
      specialized components that reflect empirically supported constructs from social cognitive
      and stereotype embodiment theory with evidence-based behavior change techniques (e.g.,
      self-regulation) foundational to basic activity monitoring. Specialty features include: (a)
      explicit and implicit messaging to promote positive aging views; (b) sedentary activity
      monitoring with motivational messaging and peer suggestions; and (c) tailored messaging to
      increase the intensity level of everyday activities and overcome barriers. We will utilize a
      highly efficient, innovative methodological approach-Multiphase Optimization Strategy
      (MOST)-to provide an experimental context for evaluating the viability of each MovingUp
      specialty feature.

      Aim 1: Assess the feasibility and acceptability of the three MovingUp specialty features. We
      will first examine MovingUp's feasibility and acceptability in three groups of five older
      adults (aged 65-84 years). A basic PA-tracking app plus one of three specialty features will
      be introduced-a different feature per group-at an orientation session. Groups will then test
      their assigned specialty feature with the PA tracker for two weeks. This step will involve
      real-time user data collection, check-ins via phone, and follow-up focus groups. Feasibility
      and acceptability will be determined by analyzing participants' usage patterns, evaluations
      of MovingUp features (based on a health technology usability scale and focus group
      interviews), and self-reported facilitators and barriers to successful app use. Our team will
      review the data and integrate changes as needed, producing an upgraded prototype to be
      assessed in Aim 2.

      Aim 2: Conduct a pilot test to examine performance characteristics and PA-relevant outcomes
      of MovingUp's specialty features. Aim 2 includes the MOST Screening Phase: theory-guided
      experimentation to identify viable components within a multifaceted preliminary intervention
      plan. Using a factorial design as specified in MOST procedures, 100 underactive older adults
      (i.e., accumulating <150 minutes of moderate intensity activity per week) will be randomly
      assigned to one of eight conditions which reflect all possible combinations of presence vs.
      absence of the three respective specialty features, given usage of a PA tracker app. At the
      end of a four-month intervention period, for each specialty feature we will examine changes
      from baseline in PA-related outcomes including: objective PA (primary outcome), sedentary
      activity time, self-reported PA, and functional mobility. We will also examine the app
      components' relationships to theoretically postulated mediating constructs (self-efficacy,
      self-regulation, outcome expectation, social support, aging self-perception, and views of
      aging). In addition, we will document usage rate, sustained usage, and perceived usefulness
      for achieving PA goals for each suite component.

      Aim 3: Synthesize information from Aim 2 to design an optimized MovingUp suite to be
      evaluated in a future RCT. Our study team will interpret and synthesize the array of
      resulting data to derive an optimized MovingUp suite. A set of pre-specified criteria will be
      used to guide selection of components in the optimized app. Using preliminary efficacy data,
      the stage will be set for a fully powered RCT of MovingUp's beneficial effects in comparison
      to alternate technologies such as web-based or mHealth solutions.

      This project will help establish a methodological foundation for future attempts to enhance
      PA apps via the addition of theoretically based component features. Moreover, it will provide
      insights into the theoretical underpinnings of successful PA interventions for older adults,
      leading to information that transcends any single technology-based solution.
    

Intervention name(s): Physical Activity (PA) Tracker App; On Your Feet; Coach Me; Proof Positive
Intervention type(s): Other; Other; Other; Other
Intervention description(s): This PA tracker app auto-monitors PA and provides a text-based summary of goal progress, thereby targeting self-regulation and outcome expectation.; On Your Feet is a specialty app feature designed to be paired with a PA tracker app and reduce sedentary activity-a health risk factor largely independent of insufficient PA. This feature utilizes self-regulatory and behavior change techniques including goal-setting, progress feedback, and prompting. Accumulated sedentary activity time is displayed alongside self-selected goals; reminders to stand are sent at a user-specified frequency; and general tips and previously compiled, older adult-identified strategies to reduce sedentary activity are texted. Additionally, messages about the benefits of reducing sedentary activity and overcoming barriers are sent.; Coach Me is a specialty app feature designed to be paired with a PA tracker app and includes daily messages that assist older adults in discovering practical ways to integrate PA into their daily routines and overcoming PA barriers. Blending PA with productive activity facilitates PA engagement in older adults. In Coach Me, suggestions on how to intensify daily activities are tailored based on user selections from an activity inventory. This app feature helps older adults become more active in a minimally intrusive way, while allowing for engagement in productive and meaningful activities. Coach Me asks users to select obstacles to PA encountered in the previous week. Based on those selections, the app sends strategies on how to overcome those barriers, thereby targeting self-efficacy.; Proof Positive is a specialty app feature designed to be paired with a PA tracker app and capitalizes on the beneficial effects that exposure to positive aging messages and stereotypes has on health and PA. When activated, users (a) receive texts describing how old age does not equate to physical inability, (b) obtain information about the benefits of growing older, and (c) are presented with a weekly positive aging stereotype task modeled after a computerized series. This last function exposes users to blocks of "positive priming words." Primers are quickly flashed to allow perception without awareness while users focus on a simple icon that represents PA. Icons are intended to provide an additional PA cue, maintain user interest, and increase the external validity.
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: Multiphase Optimization Strategy (MOST) is a recent methodology for optimizing multi-component interventions prior to performing more comprehensive testing in large RCTs. The Most Framework includes 5 steps: (1) Establish theoretical model; (2) Identify individual intervention components; (3) Conduct experiment to examine individual components; (4) Assemble beta intervention package; and (5) Confirm efficacy of optimized intervention. To our knowledge, only two prior studies have used MOST to refine a complex app with physical activity elements and disentangle the relative efficacy of specific features within a larger suite.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Other
Keywords: smartphone app, physical activity, older adults