Applying a Stress Framework to Health Behavior Change: A Fitbit Study
Condition: Adult Disease
Study type: Interventional

Summary: 
      The current study aims to counteract perceived stress-related barriers to implementation and
      maintenance of positive health behavior change (i.e., increasing physical activity), by
      providing an individually tailored and comprehensive informational support program. This
      translates into an intervention that, in addition to behavior monitoring (low informational
      support), will provide comprehensive informational support by combining advice and
      suggestions on how to achieve positive physical activity change with information on the
      health effects of such a change (high informational support). The latter will be achieved by
      providing information on general health benefits of increasing physical activity as well as
      on how physical activity change is linked to individual changes in health-relevant outcomes
      (i.e., mood and sleep quality changes). Specifically, it is hypothesized that:

        -  Higher chronic stress levels in general as well as stress perceived by the anticipated
           task of improving physical activity will be negatively associated with physical activity
           changes.

        -  Participants receiving informational support will show decreases in task-related stress.

        -  Furthermore, participants who receive comprehensive informational support will show
           larger physical activity improvements than participants who do not receive informational
           support.

        -  Initial stress will act as a moderator of the effects of informational support on
           physical activity, such that higher initial stress will reduce the positive effects of
           informational support.

      Importantly, the proposed intervention is specifically designed to support the subsequent
      development of an intervention program that is not only feasible, but easy to implement by
      individuals motivated to achieve a positive health behavior change. A key factor will be the
      insights gained into stress as a mechanism that counteracts implementation and maintenance of
      behavior change. This is especially important given the central role of stress in negative
      health outcomes associated with lack of physical activity, such as poor sleep, negative mood,
      and chronic low-grade inflammation.
    

Detailed description: 
      Research to date has not fully addressed the role of stress in behavior change. Stress is
      implicated in many negative health outcomes, including poor sleep, depressive mood, and
      health problems related to chronic low-grade inflammation, such as hypertension, diabetes,
      and obesity. These negative health outcomes can lead an individual to form intentions to
      change health behavior. However, while stress-related negative health outcomes may motivate
      the attempt to change behavior, the simple intention or very attempt to change behavior may
      induce stress. Thus, a vicious cycle is started in which stress contributes to health
      conditions that necessitate and motivate behavior change attempts, while simultaneously
      immobilizing one from successfully implementing behavior change.

      The multiple pathways through which stress can influence health behaviors may become
      especially apparent in middle-aged and older adults. Not only does poor health increase the
      urgency for behavior change and thus present a perceived threat, but the lack of resources,
      such as knowledge of how to implement change, and presence of barriers, such as limited time
      due to stressful jobs, fear of negative effects, potential to fail, or uncertainty of
      beneficial outcomes, all contribute to making behavior change a daunting and stressful
      endeavor. Conversely, many behavior change techniques can be conceptualized as stress
      management techniques. These techniques can operate by reducing threat perception and/or
      increasing access to resources, often via provision of informational support.

      The proposed study thus seeks to reduce stress in order to facilitate implementation of
      physical activity change. This will be accomplished by providing health behavior-relevant
      informational support to sedentary middle-aged and older adults. Specifically, the study's
      aims are:

        -  To determine whether providing individually tailored and comprehensive informational
           support can increase the number of daily steps in middle-aged and older adults in a
           12-week physical activity intervention setting.

        -  To assess how initial stress, initial stress perceived due to the intention to implement
           behavior change, and changes in perceived stress throughout the intervention affect
           physical activity change.

        -  To elucidate downstream effects of the intervention in terms of mental health (i.e.,
           depressive symptoms, chronic stress) and physical health outcomes (i.e., inflammatory
           status) In line with the Roybal Center Aim 1, the current study explicitly targets a
           population of sedentary middle-aged and older adults who unsuccessfully attempted to
           increase physical activity. Pressure to change behavior will in many cases stem from
           health decrements. Furthermore, participants will be recruited from the Waltham
           community, which will allow targeted advertisement to ensure a diverse sample in terms
           of socioeconomic background as well as ethnicity. Lastly, only participants who cannot
           walk for stretches of several minutes without pain will be excluded, allowing
           individuals in early stages of disability to participate. Using a stress framework to
           develop the current intervention and assessing psychological, social, and biological
           correlates will contribute to Roybal Center Aim 2, as the findings will advance theory
           and empirical findings on behavior change processes and mechanism. Lastly, the current
           study addresses Roybal Center Aim 3, as knowledge gained from the current study will
           facilitate larger-scale physical activity interventions expected to improve health and
           quality of life of older adults.
    

Intervention name(s): Fitbit One
Intervention type(s): Device
Intervention description(s): Participants will receive a Fitbit device and a detailed user manual as well as diary materials to record daily steps taken, miles walked, and flight of stairs walked for a total of 12 weeks. An in-person follow-up meeting will be scheduled 7 days after the initial meeting to establish the baseline activity level of the participant and to determine the target number of daily steps for the subsequent 5 blocks of 2 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The overall behavior change goal is defined as increasing physical activity by 15% every other week over 10 weeks based on an initial one week of activity recording establishing an individual's baseline. This will result in a doubling of the initial steps by weeks 10-11, while keeping the demands and goals comparable between individuals. After the first week, informational support will be manipulated by providing one group with information in the form of physical activity monitoring only. The second group will additionally receive individualized information on how to change behavior by providing maps of a participant's neighborhood with distances depicted in steps, lists with age- and health-status appropriate suggestions as to how to increase numbers of steps, as well as medical information linking changes in physical activity to change in health outcomes; and information on health effects of behavior change by monitoring changes in sleep in conjunction with physical activity changes.
Masking: None (Open Label)
Primary purpose: Other