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      Can an incentive-based intervention increase physical activity and reduce sitting among adults? the ACHIEVE (Active Choices IncEntiVE) feasibility study

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          Abstract

          Background

          Despite recent interest in the potential of incentivisation as a strategy for motivating healthier behaviors, little remains known about the effectiveness of incentives in promoting physical activity and reducing sedentary behavior, and improving associated health outcomes.

          This pre-post-test design study investigated the feasibility, appeal and effects of providing non-financial incentives for promoting increased physical activity, reduced sedentary time, and reduced body mass index (BMI) and blood pressure among inactive middle-aged adults.

          Methods

          Inactive men ( n = 36) and women ( n = 46) aged 40–65 years were recruited via a not-for-profit insurance fund and participated in a 4 month pre-post design intervention. Baseline and post-intervention data were collected on self-reported physical activity and sitting time (IPAQ-Long), BMI and blood pressure. Participants were encouraged to increase physical activity to 150 mins/week and reduce sedentary behavior by 150 mins/week in progressive increments. Incentives included clothing, recipe books, store gift vouchers, and a chance to win one of four Apple iPad Mini devices. The incentive component of the intervention was supported by an initial motivational interview and text messaging to encourage participants and provide strategies to increase physical activity and reduce sedentary behaviors.

          Results

          Only two participants withdrew during the program, demonstrating the feasibility of recruiting and retaining inactive middle-aged participants. While two-thirds of the sample qualified for the easiest physical activity incentive (by demonstrating 100 mins physical activity/week or 100 mins reduced sitting time/week), only one third qualified for the most challenging incentive. Goals to reduce sitting appeared more challenging, with 43% of participants qualifying for the first incentive, but only 20% for the last incentive. More men than women qualified for most incentives. Mean leisure-time physical activity increased by 252 mins/week (leisure-time), with 65% of the sample achieving at least 150 mins/week; and sitting time decreased by 3.1 h/day (both p < 0.001) between baseline and follow-up. BMI, systolic and diastolic (men only) blood pressure all significantly decreased. Most participants (50–85%) reported finding the incentives and other program components helpful/motivating.

          Conclusions

          Acknowledging the uncontrolled design, the large pre-post changes in behavioral and health-related outcomes suggest that the ACHIEVE incentives-based behavior change program represents a promising approach for promoting physical activity and reducing sitting, and should be tested in a randomized controlled trial.

          Trial registration

          Australian New Zealand Clinical Trials Registry IDACTRN12616000158460, registered 10/2/16.

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          Most cited references21

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          Toward a theory of motivational interviewing.

          The widely disseminated clinical method of motivational interviewing (MI) arose through a convergence of science and practice. Beyond a large base of clinical trials, advances have been made toward "looking under the hood" of MI to understand the underlying mechanisms by which it affects behavior change. Such specification of outcome-relevant aspects of practice is vital to theory development and can inform both treatment delivery and clinical training. An emergent theory of MI is proposed that emphasizes two specific active components: a relational component focused on empathy and the interpersonal spirit of MI, and a technical component involving the differential evocation and reinforcement of client change talk. A resulting causal chain model links therapist training, therapist and client responses during treatment sessions, and posttreatment outcomes.
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            The validity of consumer-level, activity monitors in healthy adults worn in free-living conditions: a cross-sectional study

            Background Technological advances have seen a burgeoning industry for accelerometer-based wearable activity monitors targeted at the consumer market. The purpose of this study was to determine the convergent validity of a selection of consumer-level accelerometer-based activity monitors. Methods 21 healthy adults wore seven consumer-level activity monitors (Fitbit One, Fitbit Zip, Jawbone UP, Misfit Shine, Nike Fuelband, Striiv Smart Pedometer and Withings Pulse) and two research-grade accelerometers/multi-sensor devices (BodyMedia SenseWear, and ActiGraph GT3X+) for 48-hours. Participants went about their daily life in free-living conditions during data collection. The validity of the consumer-level activity monitors relative to the research devices for step count, moderate to vigorous physical activity (MVPA), sleep and total daily energy expenditure (TDEE) was quantified using Bland-Altman analysis, median absolute difference and Pearson’s correlation. Results All consumer-level activity monitors correlated strongly (r > 0.8) with research-grade devices for step count and sleep time, but only moderately-to-strongly for TDEE (r = 0.74-0.81) and MVPA (r = 0.52-0.91). Median absolute differences were generally modest for sleep and steps (<10% of research device mean values for the majority of devices) moderate for TDEE (<30% of research device mean values), and large for MVPA (26-298%). Across the constructs examined, the Fitbit One, Fitbit Zip and Withings Pulse performed most strongly. Conclusions In free-living conditions, the consumer-level activity monitors showed strong validity for the measurement of steps and sleep duration, and moderate valid for measurement of TDEE and MVPA. Validity for each construct ranged widely between devices, with the Fitbit One, Fitbit Zip and Withings Pulse being the strongest performers.
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              Environmental influences on energy balance-related behaviors: A dual-process view

              Background Studies on the impact of the 'obesogenic' environment have often used non-theoretical approaches. In this journal's debate and in other papers authors have argued the necessity of formulating conceptual models for differentiating the causal role of environmental influences on behavior. Discussion The present paper aims to contribute to the debate by presenting a dual-process view on the environment – behavior relationship. This view is conceptualized in the EnRG framework (Environmental Research framework for weight Gain prevention). In the framework, behavior is postulated to be the result of a simultaneous influence of conscious and unconscious processes. Environmental influences are hypothesized to influence behavior both indirectly and directly. The indirect causal mechanism reflects the mediating role of behavior-specific cognitions in the influence of the environment on behavior. A direct influence reflects the automatic, unconscious, influence of the environment on behavior. Specific personal and behavioral factors are postulated to moderate the causal path (i.e., inducing either the automatic or the cognitively mediated environment – behavior relation). In addition, the EnRG framework applies an energy balance-approach, stimulating the integrated study of determinants of diet and physical activity. Conclusion The application of a dual-process view may guide research towards causal mechanisms linking specific environmental features with energy balance-related behaviors in distinct populations. The present paper is hoped to contribute to the evolution of a paradigm that may help to disentangle the role of 'obesogenic' environmental factors.
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                Author and article information

                Contributors
                +61 3 9251 7310 , kylie.ball@deakin.edu.au
                ruth.hunter@qub.ac.uk
                j.maple@deakin.edu.au
                marj.moodie@deakin.edu.au
                jo.salmon@deakin.edu.au
                kok-leong.ong@deakin.edu.au
                l.stephens@deakin.edu.au
                michelle.jackson@deakin.edu.au
                david.crawford@deakin.edu.au
                Journal
                Int J Behav Nutr Phys Act
                Int J Behav Nutr Phys Act
                The International Journal of Behavioral Nutrition and Physical Activity
                BioMed Central (London )
                1479-5868
                21 March 2017
                21 March 2017
                2017
                : 14
                : 35
                Affiliations
                [1 ]ISNI 0000 0001 0526 7079, GRID grid.1021.2, , Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Science, Deakin University, ; Geelong, Australia
                [2 ]ISNI 0000 0004 0374 7521, GRID grid.4777.3, UKCRC Centre of Excellence for Public Health Research Northern Ireland, , Queen’s University Belfast, ; Belfast, Northern Ireland UK
                [3 ]ISNI 0000 0001 0526 7079, GRID grid.1021.2, Deakin Health Economics, Centre for Population Health Research, Faculty of Health, , Deakin University, ; Geelong, Australia
                [4 ]ISNI 0000 0001 2342 0938, GRID grid.1018.8, La Trobe Business School, , La Trobe University, ; Bundoora, VIC Australia
                [5 ]ISNI 0000 0001 0526 7079, GRID grid.1021.2, Institute for Physical Activity and Nutrition, , Deakin University, ; 221 Burwood Highway, Burwood, 3125 VIC Australia
                Author information
                http://orcid.org/0000-0003-2893-8415
                Article
                490
                10.1186/s12966-017-0490-2
                5359829
                28320409
                d985d932-6612-437a-85b0-e4ef0d302ca9
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 October 2016
                : 8 March 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001030, National Heart Foundation of Australia;
                Award ID: 100572
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;
                Award ID: 1041020
                Award ID: 1026216
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100000272, National Institute for Health Research;
                Award ID: NA
                Funded by: HSC Research & Development Division
                Funded by: UKCRC Centre of Excellence for Public Health Research Northern Ireland
                Funded by: Australian Government Australian Postgraduate Award
                Categories
                Research
                Custom metadata
                © The Author(s) 2017

                Nutrition & Dietetics
                physical activity,sedentary behavior,intervention,incentivisation,contingency management theory,control theory,body mass index,blood pressure

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