Within-Person Associations of Accelerometer-Assessed Physical Activity With Time-Varying Determinants in Older Adults: Time-Based Ecological Momentary Assessment Study.

BACKGROUND: Despite the availability of physical activity (PA) interventions, many older adults are still not active enough. This might be partially explained by the often-limited effects of PA interventions. In general, health behavior change interventions often do not focus on contextual and time-varying determinants, which may limit their effectiveness. However, before the dynamic tailoring of interventions can be developed, one should know which time-dependent determinants are associated with PA and how strong these associations are. OBJECTIVE: The aim of this study was to examine within-person associations between multiple determinants of the capability, opportunity, motivation, and behavior framework assessed using Ecological Momentary Assessment (EMA) and accelerometer-assessed light PA, moderate to vigorous PA, and total PA performed at 15, 30, 60, and 120 minutes after the EMA trigger. METHODS: Observational data were collected from 64 healthy older adults (36/64, 56% men; mean age 72.1, SD 5.6 y). Participants were asked to answer a time-based EMA questionnaire 6 times per day that assessed emotions (ie, relaxation, satisfaction, irritation, and feeling down), the physical complaint fatigue, intention, intention, and self-efficacy. An Axivity AX3 was wrist worn to capture the participants' PA. Multilevel regression analyses in R were performed to examine these within-person associations. RESULTS: Irritation, feeling down, intention, and self-efficacy were positively associated with subsequent light PA or moderate to vigorous PA at 15, 30, 60, or 120 minutes after the trigger, whereas relaxation, satisfaction, and fatigue were negatively associated. CONCLUSIONS: Multiple associations were observed in this study. This knowledge in combination with the time dependency of the determinants is valuable information for future interventions so that suggestions to be active can be provided when the older adult is most receptive.

The variability of emotions, physical complaints, intention, and self-efficacy: an ecological momentary assessment study in older adults.

Background: Many theoretical frameworks have been used in order to understand health behaviors such as physical activity, sufficient sleep, healthy eating habits, etc. In most research studies, determinants within these frameworks are assessed only once and thus are considered as stable over time, which leads to rather 'static' health behavior change interventions. However, in real-life, individual-level determinants probably vary over time (within days and from day to day), but currently, not much is known about these time-dependent fluctuations in determinants. In order to personalize health behavior change interventions in a more dynamic manner, such information is urgently needed. Objective: The purpose of this study was to explore the time-dependent variability of emotions, physical complaints, intention, and self-efficacy in older adults (65+) using Ecological Momentary Assessment (EMA). Methods: Observational data were collected in 64 healthy older adults (56.3% men; mean age 72.1 ± 5.6 years) using EMA. Participants answered questions regarding emotions (i.e., cheerfulness, relaxation, enthusiasm, satisfaction, insecurity, anxiousness, irritation, feeling down), physical complaints (i.e., fatigue, pain, dizziness, stiffness, shortness of breath), intention, and self-efficacy six times a day for seven consecutive days using a smartphone-based questionnaire. Generalized linear mixed models were used to assess the fluctuations of individual determinants within subjects and over days. Results: A low variability is present for the negative emotions (i.e., insecurity, anxiousness, irritation, feeling down) and physical complaints of dizziness and shortness of breath. The majority of the variance for relaxation, satisfaction, insecurity, anxiousness, irritation, feeling down, fatigue, dizziness, intention, and self-efficacy is explained by the within subjects and within days variance (42.9% to 65.8%). Hence, these determinants mainly differed within the same subject and within the same day. The between subjects variance explained the majority of the variance for cheerfulness, enthusiasm, pain, stiffness, and shortness of breath (50.2% to 67.3%). Hence, these determinants mainly differed between different subjects. Conclusions: This study reveals that multiple individual-level determinants are time-dependent, and are better considered as 'dynamic' or unstable behavior determinants. This study provides us with important insights concerning the development of dynamic health behavior change interventions, anticipating real-time dynamics of determinants instead of considering determinants as stable within individuals.

Differences in park characteristic preferences for visitation and physical activity among adolescents: A latent class analysis.

In order to optimize environmental interventions, the current study aimed to investigate whether there are subgroups with different preferences regarding park characteristics for park visitation and park-based PA among adolescents (12-16 years). Furthermore, we examined whether the identified subgroups differed in socio-demographics, PA behavior, and park use characteristics (e.g. accompaniment to park, usual activities during park visitation, usual transportation to parks). Adolescents (12-16 years) were recruited via randomly selected secondary schools, located in Flanders (Belgium). Class visits were conducted between September and November 2016 and adolescents were asked to complete an online questionnaire. Latent class analyses using Sawtooth Software were used to identify possible subgroups. A final sample of 972 adolescents (mean age 13.3 ± 1.3 years) remained for analyses. Three subgroups of adolescents with similar preferences for park characteristics could be distinguished for both park visitation and park-based PA. Overall, current results indicate that park upkeep was the most important park characteristic for park visitation as well as park-based PA among at risk subgroups (i.e. adolescents with lower overall PA levels, girls, older adolescents,…) followed by the presence of a playground or outdoor fitness equipment. Among the more active adolescents, especially boys visiting the parks together with friends, the presence of a sport field (soccer and basketball) seems to be the best strategy to increase park visitation as well as park-based PA. Current results provide a starting point to advise policy makers and urban planners when designing or renovating parks that investing in good upkeep and maintenance of parks, and the provision of a playground or outdoor fitness equipment might be the best strategy to increase both park visitation and park-based PA among at risk adolescent subgroups.

Which Game Narratives Do Adolescents of Different Gameplay and Sociodemographic Backgrounds Prefer? A Mixed-Methods Analysis.

Objective: The aim of this study was to investigate which narrative elements of digital game narratives are preferred by the general adolescent population, and to examine associations with gender, socioeconomic status (SES), and gameplay frequency. Further, the study aims to discuss how results can be translated to serious digital games. Materials and Methods: Adolescents were recruited through school to complete a survey on narrative preferences in digital games. The survey included questions on sociodemographic information, frequency of gameplay, and an open-ended question on what could be an appealing narrative for them. Data were analyzed in a mixed-methods approach, using thematic analysis and chi-square analyses to determine narrative preferences and the associations between game narrative elements and player characteristics (gender, SES, and frequency of gameplay). Results: The sample consisted of 446 adolescents (12-15 years old) who described 30 narrative subthemes. Preferences included human characters as protagonists; nonhuman characters only as antagonists; realistic settings, such as public places or cities; and a strong conflict surrounding crime, catastrophe, or war. Girls more often than boys defined characters by their age, included avatars, located the narrative in private places, developed profession-related skills, and included a positive atmosphere. Adolescents of nonacademic education more often than adolescents of academic education defined characters by criminal actions. Infrequent players more often included human characters defined by their age than frequent players. After performing a Bonferroni correction, narrative preferences for several gender differences remained. Conclusion: Different narrative elements related to subgroups of adolescents by gender, SES, and frequency of gameplay. Customization of narratives in serious digital health games should be warranted for boys and girls; yet, further research is needed to specify how to address girls in particular.

Individual, social, and physical environmental factors related to changes in walking and cycling for transport among older adults: A longitudinal study.

To date, no longitudinal studies examined the change in walking and cycling for transport as distinct outcomes over time and investigated the predictors of those changes. Therefore, this present study examined the change in odds of engagement in walking and cycling for transport as distinct outcomes among Belgian older adults over a three-year follow-up period, and examined factors (i.e. socio-demographics, psychosocial, perceived social and physical environmental characteristics) related to these changes in engaging in walking and cycling for transport. Against our expectations, we found significantly higher odds of engaging in cycling for transport among older adults at follow-up compared to baseline and no significant differences in the odds of engaging in walking for transport. Interventions should assist older adults to increase their self-efficacy towards PA, their perceived benefits of PA, and their perception of land use mix diversity in their neighborhood in order to increase the engagement in walking/cycling for transport over time, or help to decrease their perceived barriers towards PA or their perception to have a lot of physical barriers to walk/cycle in their neighborhood. Future longitudinal studies with larger samples are warranted investigating interaction effects between different predictors at various levels to find out which factors can be further integrated into active transport interventions in older adults.

Insights into children's independent mobility for transportation cycling-Which socio-ecological factors matter?

OBJECTIVES: To assess the associations of socio-ecological factors with independent mobility for transportation cycling among 10-to-12-year-old boys and girls. Additionally, we examined whether associations differed across family socio-economic status (SES) and urbanization level. DESIGN: Cross-sectional survey. METHODS: Parents (n=1286) were recruited via 45 primary schools across Flanders, Belgium. They completed an online questionnaire assessing demographic and psychosocial factors, neighborhood environmental perceptions, as well as some characteristics of their child. Independent mobility was assessed as the distance children were allowed to cycle for transport without adult supervision. Multilevel gamma regression analyses stratified by gender were performed to examine the associations between the independent variables and children's independent mobility and the moderating effects of family SES and urbanization level. RESULTS: Independent mobility was higher among boys compared to girls. Perception of children's cycling and traffic skills and children's grade were positively associated with independent mobility among boys and girls. Perceptions of neighborhood traffic safety were positively associated with independent mobility among girls, but not among boys. Perceptions of cycling skills were positively associated with independent mobility among boys living in high urbanized areas, but not in low urbanized areas. Parental cycling for transport was negatively associated with independent mobility among girls with a low family SES, but not among girls with a high family SES. CONCLUSIONS: Our findings suggest that interventions targeting increases in children's cycling and traffic skills may be effective to increase independent mobility. Few differences in associations were found according to children's gender, family SES or urbanization level.

The effect of changing micro-scale physical environmental factors on an environment's invitingness for transportation cycling in adults: an exploratory study using manipulated photographs.

Previous studies have shown convincing evidence for positive relationships between transportation cycling in adults and macro-scale physical environmental factors. In contrast, relationships are less consistent for more changeable, micro-scale environmental factors. The majority of existing studies used observational study designs, which cannot determine causality. The present mixed-methods study used manipulated photographs to determine causal relationships between micro-scale environmental factors and the environment's invitingness for transportation cycling. Further, interactions among environmental factors and moderating effects of gender, age and educational level were investigated. For this study, panoramic photograph of a street was manipulated on eight environmental factors: traffic, speed bump, general upkeep, evenness of the cycle path, vegetation, separation of motorized traffic, separation with sidewalk and cycle path width. Sixty-six middle-aged adults participated in the study and sorted the manipulated panoramic photographs from least to most inviting to cycle for transportation. Participants also provided qualitative data on how they sorted the streets. Multilevel cross-classified modelling was used to analyse the relationships between the environmental manipulations and the invitingness-scores. The qualitative data were deductively categorized according to the environmental factors. All environmental factors, except for separation with sidewalk, proved to have a significant main effect on the invitingness-score for transportation cycling. Cycle path evenness appeared to have the strongest effect on the invitingness. This effect was even stronger in an environment with good compared to poorly overall upkeep. Another significant interaction effect showed that the invitingness decreased when both separations along the cycle path were present compared to only a separation with traffic. No moderating effects of the demographic factors on these relationships were found. Qualitative data confirmed the observed quantitative relationships and added depth and understanding. Current study shows that the use of manipulated photographs can be an effective way to examine environment-physical activity relationships. Our findings indicate that evenness of the cycle path may be a crucial environmental factor when aiming to increase a street's invitingness for transportation cycling among middle-aged adults. The findings of our exploratory study could be used to develop an environmental intervention to determine if our findings are applicable to real changes in cycling behavior.