Supporting behaviour change in sedentary adults via real-time multidimensional physical activity feedback: a mixed-methods randomized controlled trial

BACKGROUND:
Increasing physical activity (PA) behaviour remains a public health priority and wearable technology is increasingly being used to support behaviour change efforts. Using wearables to capture and provide comprehensive, visually persuasive, multidimensional feedback with real-time support may be a promising way to increase PA in inactive individuals.

OBJECTIVE:
To explore whether a six-week self-monitoring intervention using composite web-based multidimensional PA feedback with real-time daily support increased PA in adults.

METHODS:
A six-week, mixed-methods, two-armed exploratory randomized controlled trial (RCT) with six-week follow-up was used, whereby fifty-one low to moderately active (physical activity Level (PAL)<2.0) adults (mean age = 51.3 years; %female = 55) were randomly assigned to receive the self-monitoring intervention (n=36) or waiting-list control (n=15). Assessment of PA across multiple health-harnessing PA dimensions (e.g., PAL, weekly moderate-to-vigorous intensity physical activity (MVPA), sedentary time, steps), psychosocial cognitions (e.g. behavioral regulation, barrier self-efficacy, habit strength) and health were made at pre-randomisation baseline, 6 and 12 weeks. An exploratory analysis of mean difference and confidence intervals was made using the ANCOVA model. After the 12-week assessment intervention participants were interviewed to explore their views on the programme.

RESULTS:
There were no notable differences in any PA outcome immediately post-intervention, but at 12-weeks moderate-to-large effects were observed with a mean (95% CI) difference in PAL of 0.09 (0.02 to 0.15), effect size (Hedges' g)=0.8; daily moderate-intensity PA of 24 minutes (0 to 45), g=0.6; weekly MVPA of 195 minutes (58 to 331), g=0.8; and steps of 1545 (581 to 2553), g=0.7. Descriptive analyses suggested the differences in PA at 12 weeks were more pronounced in females, and participants with lower baseline PA levels. Immediately post intervention there were favourable difference in autonomous motivation, controlled motivation, perceived competence for PA, and barrier self-efficacy, with the latter sustained at follow-up. Qualitative data implied that the intervention was highly informative for participants and that the real-time feedback element was particularly useful in providing tangible, daily, behavioural support.

CONCLUSIONS:
Using wearable trackers to capture and present sophisticated multidimensional PA feedback combined with discrete real-time support may be a useful way to facilitate changes in behaviour. Further investigation into the ways to optimise the use of wearables in inactive participants and test the efficacy of this approach via a robust study design is warranted.