@Article{info:doi/10.2196/30673,
author="Stansbury, Melissa L
and Harvey, Jean
and Krukowski, Rebecca A
and Pellegrini, Christine A
and Wang, Xuewen
and West, Delia Smith",
title="Describing Transitions in Adherence to Physical Activity Self-monitoring and Goal Attainment in an Online Behavioral Weight Loss Program: Secondary Analysis of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="28",
volume="24",
number="1",
pages="e30673",
keywords="physical activity; adherence; self-monitoring; goal attainment; lifestyle intervention",
abstract="Background: Standard behavioral weight loss interventions often set uniform physical activity (PA) goals and promote PA self-monitoring; however, adherence remains a challenge, and recommendations may not accommodate all individuals. Identifying patterns of PA goal attainment and self-monitoring behavior will offer a deeper understanding of how individuals adhere to different types of commonly prescribed PA recommendations (ie, minutes of moderate-to-vigorous physical activity [MVPA] and daily steps) and guide future recommendations for improved intervention effectiveness. Objective: This study examined weekly patterns of adherence to step-based and minute-based PA goals and self-monitoring behavior during a 6-month online behavioral weight loss intervention. Methods: Participants were prescribed weekly PA goals for steps (7000-10,000 steps/day) and minutes of MVPA (50-200 minutes/week) as part of a lifestyle program. Goals gradually increased during the initial 2 months, followed by 4 months of fixed goals. PA was self-reported daily on the study website. For each week, participants were categorized as adherent if they self-monitored their PA and met the program PA goal, suboptimally adherent if they self-monitored but did not meet the program goal, or nonadherent if they did not self-monitor. The probability of transitioning into a less adherent status was examined using multinomial logistic regression. Results: Participants (N=212) were predominantly middle-aged females with obesity, and 67 (31.6{\%}) self-identified as a racial/ethnic minority. Initially, 73 (34.4{\%}) participants were categorized as adherent to step-based goals, with 110 [51.9{\%}] suboptimally adherent and 29 [13.7{\%}] nonadherent, and there was a high probability of either remaining suboptimally adherent from week to week or transitioning to a nonadherent status. However, 149 (70.3{\%}) participants started out adherent to minute-based goals (34 [16{\%}] suboptimally adherent and 29 [13.7{\%}] nonadherent), with suboptimally adherent seen as the most variable status. During the graded goal phase, participants were more likely to transition to a less adherent status for minute-based goals (odds ratio [OR] 1.39, 95{\%} CI 1.31-1.48) compared to step-based goals (OR 1.24, 95{\%} CI 1.17-1.30); however, no differences were seen during the fixed goal phase (minute-based goals: OR 1.06, 95{\%} CI 1.05-1.08; step-based goals: OR 1.07, 95{\%} CI 1.05-1.08). Conclusions: States of vulnerability to poor PA adherence can emerge rapidly and early in obesity treatment. There is a window of opportunity within the initial 2 months to bring more people toward adherent behavior, especially those who fail to meet the prescribed goals but engage in self-monitoring. Although this study describes the probability of adhering to step- and minute-based targets, it will be prudent to determine how individual characteristics and contextual states relate to these behavioral patterns, which can inform how best to adapt interventions. Trial Registration: ClinicalTrials.gov NCT02688621; https://clinicaltrials.gov/ct2/show/NCT02688621 ",
issn="1438-8871",
doi="10.2196/30673",
url="https://www.jmir.org/2022/1/e30673",
url="https://doi.org/10.2196/30673",
url="http://www.ncbi.nlm.nih.gov/pubmed/35089159"
}