Clinical Trial of a Mobile Health Intervention for Simultaneous versus Sequential Diet and Activity Change Bonnie Spring, PhD. Director, Center for Behavior and Health Northwestern University FSM, Chicago, Illinois [email protected]AHA Sessions Late Breaking Clinical Trial, Orlando, FL, 11/15
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Clinical Trial of a Mobile Health Intervention for Simultaneous versus Sequential Diet and Activity Change Bonnie Spring, PhD. Director, Center for Behavior.
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Clinical Trial of a Mobile Health Intervention for Simultaneous versus Sequential Diet and Activity Change
Bonnie Spring, PhD.Director, Center for Behavior and HealthNorthwestern University FSM, Chicago, [email protected]
AHA Sessions Late Breaking Clinical Trial, Orlando, FL, 11/15
The Make Better Choices (MBC) Randomized Clinical Trials
(MVPA) =< 60 min/day4. high sedentary leisure screen time (Sed) =
>120 min/day.
• Outcome: composite z healthy diet + activity improvement weighting all behaviors equally
• Compared ↑healthy/↓unhealthy X eating/activity
• Mobile self-monitoring tool (PDA) with feedback• Data transmitted to telephone coach
• Paid $175 to reach 50% goal by 1 week; maintain 100% goal for 2 weeks
04/21/23
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Diet and activity CVD risk behaviors are prevalent & co-occurring. Does intervening on multiple behaviors simultaneously produce positive synergies or negative overwhelm?
Both Sequential and Simultaneous Treatments Produced Large Magnitude, Sustained Healthy Change in Diet and Activity
¥
* * *
Effects of the 3 interventions on changes in each behavior (expressed in natural units)
04/21/23
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9m M diff: 5.9 day 95% CI [4.5, 7.2]
9m M diff: 126.9 min/day, 95% CI [-153.4, -100.3]
9m M diff: -3.7%, 95% CI [-5.4, -2.1]
6m M diff: 15.8 min/day MVPA, 95% CI [0.7, 30.9]
* Trt vs. C¥ Sim vs Seq
* ** * *
¥
AdherenceSequential Simultaneous Control Significance
9 mo. Lost to Follow-Up
15/84 = 18% 16/84 = 19% 7/44 = 16% n.s.
Attends 3-Month Assessment
84% 82% 75% n.s
Attends 9-Month Assessment
65% 63% 59% n.s.
3 Month arcsin % Days Self-Monitored
1.11 (77%) 1.03 (75%) .79 (59%) n.s.
6 Month arcsin % Days Self-Monitored
.97 (68%) .91 (65%) .73 (52%) n.s.
9 Months arcsin % Days Self-Monitored
.83 (58%) .73 (56%) .66 (46%) n.s.
04/21/23
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Conclusions
• ITT analyses using linear mixed effects models showed that, even without large financial incentives for behavior change, Sequential and Simultaneous interventions produced sustained diet and activity improvement compared to Control (p<.001), and their effects were comparable.
• Attrition and adherence were similar across treatments and control.
• Both simultaneous and sequential intervention produced large magnitude composite diet and improvement, compared to control, that was sustained at 6 and 9 months.
• Both treatments increased fruit/vegetable intake, decreased sedentary leisure screen time and decreased saturated fat intake at 6 and 9 months. Both treatments increased MVPA at 6 months; the difference from control no longer reached significance at 9 months.
• Simultaneous or sequential treatment of multiple diet and activity risk behaviors using mobile technologies and remote coaching may produce large, sustained diet and activity improvements. Maintenance of MVPA improvement warrants additional research.
Acknowledgements
Coauthors
Northwestern University Christine A Pellegrini, Ph.D. H. G. McFadden, B.S. Angela F Pfammatter, Ph.D. Juned Siddique, Dr.P.H.