Purpose: In 2020, the coronavirus pandemic (COVID-19) caused many university campus lockdowns in which students were required to leave campus and continue their academic work as usual, remotely. The University of Vermont Wellness Environment (WE) program is a wellness behavioral change promotion program. Students who enrolled in the WE program were given an Apple Watch to track their daily physical activity (PA). The purpose of the study is to evaluate the change of PA levels in a large cohort of U.S. college students before and after the COVID-19 pandemic.  

Method: Objectively measured daily step data by Apple Watch were downloaded through healthkit. A total of 250 WE and 124 non-WE participants (291 female and 83 male) who were college freshman were included in this study. The average number of valid wear days per participant was 31 out of a possible 119 days in Spring semester 2020. The self-perceived COVID-19 disruption and COVID-19 related questions were assessed in the end of year questionnaire. Generalized linear mixed models were used to examine the change of PA level before and after COVID-19 remote learning after controlling for gender, race, and socioeconomic status. The impact of COVID-19 disruption on PA levels was also evaluated.

Results:  Apple Watch wear compliance declined from 265 students’ available data per week before COVID to 154 students wearing it per week after COVID. Students’ PA levels declined significantly after COVID-19 university shutdown (before=9283; after=6328; p<.01). Females were significantly more active than male college students before COVID but the gender difference attenuated from 1162 steps/day before to 502 steps/day afterwards (p<.01). The significant weekday vs weekend PA variation (weekday: 9355 vs weekend: 8258; p<.01) was also attenuated and reversed after COVID (weekday: 5968 vs weekend: 6430; p>.05). Male students who had higher confidence in the government handling of COVID or felt much more disrupted became more active (p<.01) but female students did not.  

Conclusion:  These findings indicate that the stay-at-home order and remote learning are associated with decreased PA among college students. Public health efforts need to be taken to help them be physically active during COVID-19 while remaining safe.

Purpose: Recent advances in wearable biosensor technology show that continued monitoring of personal biological data is increasingly accessible, laying a foundation for providing biologically based feedback. Biofeedback could be used as a behavioral change strategy to motivate physical activity (PA) engagement by demonstrating the acute impact of PA. This study examined how insufficiently active overweight/obese cancer survivors perceive glucose-based biofeedback as acceptable and helpful for promoting PA.

Methods: Sixteen insufficiently active overweight/obese cancer survivors (aged 50-74) were recruited from a local tumor registry and interviewed (between November 2019 to September 2020) across five focus groups. In each focus group, discussion started with PA-related topics (e.g., goals, benefits, barriers). Then, the moderator highlighted the acute impact of PA using a simulated website demonstrating glucose patterns in response to walking and showed a Fitbit device that can track PA and a continuous glucose monitor (CGM) that can track glucose. Participants discussed their opinions on these two wearable sensors and their feelings and preferences about sample feedback messages based on data from these devices.  Multiple coders read and analyzed the transcribed data totaling 314 pages using Braun & Clarke’s (2006) process focusing on identification, analysis, organization, description, and reports.

Results: All participants expressed the need to become more physically active, identifying lack of motivation centering on their survivorship experiences and symptom management as the most salient barrier. They indicated familiarity with activity trackers (i.e., Fitbit) and expressed interest in biosensors (i.e., CGMs) as CGMs show biological metrics in real-time. Participants reported that (1) glucose data is a relevant and important health indicator; (2) integrated messages (between Fitbit and CGMs) are useful in demonstrating how their behaviors immediately impact their body; and (3) this information is motivating for them to modify their behaviors.

Conclusions: This study supports the use of wearable biosensors and m-health interventions to promote PA in cancer survivors. Glucose-based biofeedback provides relevant and motivating information for cancer survivors regarding their daily activity levels by demonstrating the immediate effects of PA. Integrating biofeedback into PA interventions could be an effective behavioral change strategy to promote a healthy lifestyle in cancer survivors.

Purpose: The growing number of studies about mobile health (mHealth) interventions suggests their promising potential to promote a healthy lifestyle, but less is known about their effectiveness in the long term. Aim2Be is a mHealth app that strives to promote healthy behaviors among children and their families. This study aimed at evaluating changes in adiposity and health behaviours among children with overweight and obesity and their parents, after using Aim2Be for 6 months.

Methods: A single group of 107 child-parent dyads recruited through Facebook and various clinical settings across Canada, had access to the Aim2Be app for 6 months. Assessments at baseline, 3 and 6 months included self-reported health behaviours (physical activity, screen time, intakes of vegetables, fruits and sugary beverages), online 24-hour dietary recalls, steps per day assessed with a Fitbit and measured height and weight. Covariates-adjusted mixed effect models evaluated changes in outcomes at 3 and 6 months. Change over time was evaluated in relation to app use (total minutes spent in the app at 3 and 6 months) by including time by app use interaction terms.

Results: Significant time by app use interactions were identified for three outcomes. Children’s and parents’ use of Aim2Be was on average of 93(SD=135) and 76(SD=81) minutes at 3-months, increasing to 106(SD=151) and 94(SD=103) minutes at 6-months, respectively. Among children, energy from sugary beverages slightly decreased (p=0.015) from baseline to 3-months and remained unchanged at 6-months (mean 58, 53, and 54 kcal/day at baseline, 3- and 6-months, respectively). Among parents, time spent walking increased (p=0.019) from baseline to 3-months, but returned to baseline levels at 6-months (32, 40, and 30 min/day at baseline, 3- and 6-months, respectively). Finally, parents’ screen time decreased (p=0.033) at 3-months and remained unchanged at 6-months (147, 132, and 135 min/day at baseline, 3- and 6-months, respectively). No changes were observed for the other outcomes.

Conclusions: Overall, limited changes in health behaviours were observed among participants during a 6-month period of using Aim2Be. More rigorous study designs are needed to evaluate the potential efficacy of mHealth interventions for children with overweight and obesity.

Introduction: U.S. Latino men are disproportionately affected by health conditions related to low physical activity (PA). Engaging in regular PA can yield many health benefits; yet, few Latino men meet national guidelines. Moreover, there is a paucity of PA interventions developed for Latino men.

Methods: Hombres Saludables is a pilot randomized trial evaluating the efficacy of a 6-month Spanish language, individually tailored web- and text-based PA intervention for Latino men. We engaged men in 8 focus groups to adapt an evidence-based internet PA intervention originally for Latinas. The new intervention included: an interactive website with PA tracking, goal setting and individually tailored PA content; automated text messages; two check-in calls, pedometer; gym membership and access to private Facebook group. Study participants were randomized to either the PA intervention arm or attention control arm focused on nutrition and wellness.  Participants completed questionnaires at baseline and 6-months (e.g., self-efficacy, decisional balance, social and environmental PA determinants). PA was assessed via accelerometer and 7-Day PA Recall.

Results: 38 men were randomized to the Intervention (N=23) or Control (N=15).  Participants were predominantly Dominican (21%) or Guatemalan (13%), with 63% reporting at least some college education.  Average age was 38.6 years (SD=12.43) and 58% were employed full time.  Retention rates were 91.3% for Intervention and 100% for Control arms. Intervention participants increased self-reported MVPA from a median of 0 min/week (IQR=45) at baseline to 105 min/week (IQR=295) at 6m, vs. Control participants (0 min/week (IQR=60) at baseline to 30 min/week (IQR=152) at 6m).  Quantile regression models indicate a trend towards significance in 6m PA outcomes between arms controlling for baseline, p=.10.  Trends also suggest that a higher proportion of Intervention participants met ACSM PA guidelines (at least 150 min/week of MVPA) at 6m, OR=3.22, 95% CI: .95-13.69 (42.1% of intervention participants vs. 26.7% of wellness participants). Follow-up interviews indicated that the intervention was acceptable and provided ideas for future interventions.

Conclusions: Findings from this feasibility trial suggest that an individually tailored e-health intervention can successfully increase MVPA in low-active Latino men. Such interventions have the potential for broad dissemination.

Purpose: Children’s health behaviours (diet, physical activity and screen time) that are associated with obesity fall below health recommendations. Electronic health (e-health) interventions may be ideally suited for children as their use of smartphones are on the rise. However, the use of e-health apps remains low among children and little is known about what factors may promote engagement. This study explored how social support from parents and an interactive live health coach as well as app satisfaction and baseline motivation for changing health behaviours influenced children’s time spent in a lifestyle behaviour modification app (namely Aim2Be).

 Methods: A secondary analysis of 174 children-parent dyads who were provided access to the Aim2Be app for at least 3-month was conducted. Aim2Be is a gamified lifestyle behaviour medication app grounded in theories of behaviour change (developed by the Childhood Obesity Foundation, BC Canada). Online questionnaires assessed demographic characteristics of participants as well as children’s baseline motivation to change the health behaviours targeted by the app (diet, physical activity and screen time) as well as app satisfaction. Web-analytics tracked parents’ use of the app (parent support – total minutes), children’s engagement with an interactive live health coach (coach support – yes/no interaction with coach) and total minutes children spent in the app. Regressions were used to explore associations between children’s app satisfaction, baseline motivation for health behaviours, parent support and engagement with the interactive live health coach on time spent in the app. Bootstrapping techniques (5000 iterations) using full information maximum likelihood were employed to account for missing data. All models controlled for relevant covariates.

 Results: Children’s app satisfaction (β=.44), parental support (β=.24), and coach use (β=.15) were significantly associated with minutes children spent using the Aim2Be app. No significant associations between baseline motivation of health behaviours and time spent in the app were detected.

 Conclusion: The inclusion of different social components and social support within e-health apps may encourage app use among children. Increasing children’s engagement and satisfaction with e-health apps could play a key role in encouraging the adoption of health behaviours.   

Purpose: Given the increasing reliance on mobile technologies and widespread use of short messaging services (SMS) as a communication strategy, SMS provides an opportunity to improve the delivery of healthcare virtually. SMS has been shown to be an effective way to reach a broad audience engaging in physical activity and dietary interventions. However, limited evidence exists regarding the development or receptivity to SMS content. Understanding how interventions are developed is necessary for future research to implement effective SMS interventions.

 Methods: The study design consisted of two phases. 1) Evaluation: Five SSBC trainers and 13 past SSBC participants were asked to review a bank of 124 SMS messages using a 5-point Likert scale on readability, usefulness, and relevance. Each message was followed by an open text box for suggestions on improvements. 2) Refinement: an average score was calculated for each message (ranging from 3-15). Any message with a score <14 was refined using participant feedback.

 Results/findings: On average, messages received a score of 13.77/15±0.76, with SSBC trainers scoring messages 0.81 higher than did past participants. Questions received an average of 2.6 suggestions for improvement (range=0-5). 60 messages received a score <14 and were edited based on feedback from participants; 23 messages received a score >14 but had multiple suggestions so were refined based on feedback; 11 messages received consistent critique revolving around applicability to the program and were removed.

 Conclusions: This study involved the evaluation and refinement of a bank of SMS messages which are suitable for use following the SSBC program. These messages are based on behaviour change theory and have been refined based on feedback from those with lived experiences as diabetes prevention program trainers and participants. The message bank, that was positively assessed by those representative of future message senders and recipients, will prompt participants to adhere with the diet and exercise changes they made during the SSBC program.