Determinants of physical activity during cancer treatment: a longitudinal exploration of psycho-cognitive variables and physician counseling.

Individuals with cancer are recommended to engage in regular physical activity (PA) even during cancer therapy. The aim of this study was to explore how patient-reported physician PA counseling influences their PA intention and behavior in addition to psycho-cognitive determinants derived from the theory of planned behavior (TPB). A longitudinal study during cancer treatment was conducted among N = 115 patients with breast, prostate, or colorectal cancer (Mage = 58.0, SD = 11.5; 55.7% female). The median time since diagnosis was 2 months, and 19.1% were diagnosed with metastases. Participants provided information on PA counseling by their physicians and on psycho-cognitive variables of the TPB at three measurement points. Additionally, they wore accelerometers for seven days at baseline and three months later. Nearly half of participants (48%) reported basic PA counseling and 30% reported in-depth PA counseling. Patients in poorer health and with lower education reported significantly less in-depth counseling. In addition to patient self-efficacy in performing PA, only in-depth physician PA counseling, but not basic physician counseling, predicted intention for PA four weeks later. Patients' PA three months after baseline was predicted by patients' PA at baseline and their intention for PA. Overall, the PA level at baseline was identified as the most important predictor of PA three months later. Nevertheless, physicians seem to have the ability to increase their cancer patients' intention for PA by in-depth counseling.

Improving Sleep Among Teachers: an Implementation-Intention Intervention.

BACKGROUND: Insufficient sleep is common among teachers and is associated with diverse health risks. This study aimed to predict intention and sleep duration by applying the Theory of Planned Behavior (TPB) and to examine the effectiveness of an implementation-intention intervention to improve sleep duration and quality. METHOD: Sixty-nine teachers (M = 36.8 years, SD = 10.4) were assigned to an active control group (CG) or intervention group (IG). At baseline, TPB variables were assessed and participants of the IG received instructions to develop implementation intentions to reach the goal of sleeping 8 h on average. During a 3-week intervention period, all participants wore an activity tracker (Fitbit Charge HR) to measure sleep duration and kept diaries to assess sleep quality, physical activity, and stress. After 1 month, a 1-week follow-up, including a booster for the IG, was conducted. RESULTS: Forty-two percent of variance in sleep duration were explained by control variables, past behavior, perceived behavioral control, and intention. Mixed ANOVAS with baseline covariates found a large main effect with longer sleep duration in the IG. A time x group interaction suggested that only the IG slept significantly longer in the follow-up period compared to the intervention period. For sleep quality, a medium-sized main effect for study group was found and a time x group interaction indicated higher sleep quality in the IG for week 3 and the follow-up. CONCLUSION: The TPB was effective in predicting sleep intention and duration. Implementation intentions accompanied by daily monitoring and a booster appear to be promising for improving sleep.

Explaining the intention to get vaccinated against COVID-19: General attitudes towards vaccination and predictors from health behavior theories.

The goal of our study was to examine the intention to get vaccinated using predictors from the 5C Model of vaccination attitudes, the Theory of Planned Behavior (TPB) and the Health Belief Model (HBM). Between August and November 2020, an online survey was delivered to 1428 participants in the UK and Germany (mean age = 40.6; 57% women), assessing socio-demographic and health factors, general vaccination attitudes, TBP and HBM variables, and COVID-19 vaccination intention. Vaccination intentions did not differ by country or survey period. Predictors of intention with the highest explanatory power in a relative weight analysis were confidence, collective responsibility (5C) perceived behavioral control, social norms, attitudes (especially negative affect & TPB cognitions), and perceived benefits (HBM). Women reported lower intention, although the effect size was small. Predictors from the TPB and HBM were effective to explain the intention to receive COVID-19 vaccines over and above socio-demographic variables, health-related factors and general vaccination attitudes. The results are interpreted in the context of current vaccination campaigns. Messages promoting sense of autonomy and control over the decision to get vaccinated, approval from significant others and reassurance that getting vaccinated will not be associated with fear or other negative feelings are important facilitators of vaccine uptake.

Better not resting: Carving out attitudes and their associations with physical activity in people with cancer.

OBJECTIVE: Evidence on the benefits of physical activity (PA) during cancer has caused a paradigm shift from people with cancer being advised to save energy (rest paradigm) to guidelines recommending them to engage in regular PA (activity paradigm). This study examined the rest and the activity paradigm among people with cancer based on the theory of planned behaviour (TPB). METHODS: A cross-sectional survey was completed by N = 1244 people (58% women; M = 59.95 years) with breast, prostate and colorectal cancer, including 15 items on rest and activity attitudes. To explain the intention to engage in PA, hierarchical regression analyses were calculated. RESULTS: The two-dimensional structure of attitudes (rest and activity) was confirmed. The agreement with the activity paradigm (M = 4.11; SD = 0.78) was higher compared to the rest paradigm (M = 2.56; SD = 0.78, p < .001). The TPB was an appropriate model to explain the intention to engage in PA (R2 = .59), showing that the activity paradigm, but not the rest paradigm, was significantly associated with participants' intention for PA. CONCLUSION: Results indicate that the paradigm shift has successfully reached attitudes of people with cancer. Interventions focusing on the benefits of PA rather than addressing rest cognitions promise higher effectiveness in affecting PA levels. CLINICAL TRIAL REGISTRATION NUMBER: NCT02678832.

Impact and Determinants of Structural Barriers on Physical Activity in People with Cancer.

BACKGROUND: A better understanding of the role of structural barriers for physical activity (PA) after a cancer diagnosis could help to increase PA among people with cancer. Thus, the present study aimed to identify determinants of structural barriers to PA in people with cancer and investigate the association between structural barriers and insufficient post-diagnosis PA, taking different PA change patterns into account. METHODS: A total of 1299 people with breast, prostate, or colorectal cancer completed a questionnaire assessing their socio-demographic and medical characteristics, pre- and post-diagnosis PA, and perceived PA impediment by seven structural barriers. Regression analyses were used to investigate determinants of the perception of structural barriers and to examine the association between structural barriers and insufficient post-diagnosis PA, also with regard to different pre-diagnosis PA levels. RESULTS: Overall 30-60% of participants indicated to feel impeded by structural barriers. The analyses revealed a younger age, higher BMI, lower educational level, no current work activity, co-morbidities, and lacking physicians' exercise counseling as significant determinants of the perception of structural barriers. Individuals reporting stronger impediments by structural barriers were significantly less likely to be meeting PA guidelines post-diagnosis, particularly those with sufficient pre-diagnosis PA levels. CONCLUSIONS: The study highlights the need for tailored PA programs for people with cancer as well as for more guidance and support in overcoming structural barriers to improve PA behavior. The study has been registered under NCT02678832 at clinicaltrials.gov on February 10th 2016.

Using wearables to promote physical activity in old age : Feasibility, benefits, and user friendliness.

BACKGROUND: Wearables provide new opportunities to promote physical activity also among older adults but data on effectiveness and user friendliness are rare. OBJECTIVE: The effects of a comprehensive self-regulative intervention on moderate to vigorous physical activity (MVPA) and number of steps were examined using commercially available activity trackers. Acceptance regarding the devices was analysed in various domains. METHODS: In this study 80 older adults (mean = 67.03 years, standard deviation = 3.97 years; 59% women) wore a Fitbit Charge HR for 21 days including a baseline, a postintervention and a follow-up week. The intervention comprised feedback, goal setting and planning and 50% of the participants were additionally randomized to a role model component. Social cognitive predictors based on the health action process approach (HAPA) and user experience were assessed via questionnaires. RESULTS: The MVPA increased by an average of 19 min per week and steps by 1317 per day. An additional benefit of the role model component could be observed for MVPA. In the follow-up, the intervention effect was still significant for the number of steps, while MVPA dropped back to baseline. Multilevel models including HAPA variables explained small but significant amounts of variance in MVPA (8% within-person, 26% between-person) and steps (11% within-person, 12% between-person). User experience was rated as very high. CONCLUSION: Providing an intervention based on established behavior change techniques and self-monitoring via wearables seems to be effective for increasing physical activity among older adults. The HAPA variables seem to play a limited role to explain activity levels. Acceptance of wearables can be expected to be high.

The association between physicians' exercise counseling and physical activity in patients with cancer: Which roles do patients' satisfaction and previous physical activity levels play?

OBJECTIVES: The purpose of this study was to examine the association between physicians' exercise counseling and post-diagnosis physical activity (PA) in patients with cancer by investigating the mediating role of patients' satisfaction with exercise counseling as well as the moderating role of patients' previous PA. METHODS: The study sample consisted of 1002 people with cancer (503 breast, 265 prostate, and 234 colorectal cancer). Participants reported their pre- and post-diagnosis moderate-to-vigorous PA (MVPA) levels, indicated whether their physician had covered different steps of exercise counseling as defined by the 5A framework (Assess, Advise, Agree, Assist, and Arrange) and rated their satisfaction with exercise counseling. A conditional process analysis was used to determine the direct and indirect effects of counseling on post-diagnosis MVPA through satisfaction at different levels of pre-diagnosis MVPA. RESULTS: Physicians' exercise counseling was associated with post-diagnosis MVPA in patients with cancer. However, the association differed by patients' pre-diagnosis MVPA (P = .039). While counseling was directly associated with higher post-diagnosis MVPA for individuals with low pre-diagnosis MVPA (CI: 0.02-0.20, P = .014), the effect was mediated through satisfaction with exercise counseling for previously highly active individuals (Boot CI: 0.01-0.08). CONCLUSIONS: Our findings emphasize the relevance of physicians' exercise counseling for PA in patients with cancer. However, the results indicate that in order to effectively influence patients' PA, it appears important to provide a comprehensive counseling that is adjusted to the patients' exercise experiences.

Prevalence and frequency of self-management strategies among female cancer survivors: the neglected roles of social relations and conscious living.

OBJECTIVE: To assess prevalence and frequency of use of self-management strategies among female cancer survivors and to empirically identify categories of self-management. METHODS: Female cancer survivors (N=673, mean age 51 years; >90% with breast cancer; M=5 years since diagnosis) completed an Internet survey indicating the frequency (never to very often) with which they had employed each strategy since diagnosis. The survey included commonly assessed self-management strategies, such as complementary and alternative medicine (CAM), religious practices, and exercise. Additionally we assessed the use of further strategies identified from recommendations of cancer survivors shared in Internet forums. RESULTS: A principal component analysis yielded five categories: More Conscious Living, Turning to Family/Friends, CAM, Religious/Spiritual Practices, and Exercise. Prevalence rates of commonly measured strategies like CAM, Religious Practices, and Exercise were similar to previous studies. Considering frequency of use, however, revealed that only few participants reported frequent use of these strategies (<10%). In contrast, about half of the women (>50%) reported Turning to Family/Friends and engaging in More Conscious Living strategies (very) often. CONCLUSIONS: Relying on prevalence assessments of commonly investigated behaviors such as CAM or exercise may overestimate their use among cancer survivors. Cancer survivors engage in a wide range of self-management strategies. Encouraging living more consciously and cultivating social relations might be of greater relevance compared with CAM use or exercise.

Change patterns and determinants of physical activity differ between breast, prostate, and colorectal cancer patients.

PURPOSE: The purpose of this study was to examine and compare pre- to post-diagnosis change patterns of physical activity (PA) among breast, prostate, and colorectal cancer patients. Moreover, the study aimed to investigate sociodemographic and medical determinants of post-diagnosis PA and to identify patient subgroups at increased risk of inactivity. METHODS: A total of 912 cancer patients (457 breast, 241 prostate, 214 colorectal cancer) completed a questionnaire assessing their pre- and post-diagnosis PA behavior, and sociodemographic and medical variables. Age-adjusted regression and classification tree analyses were used to investigate PA determinants and detect subgroups that were most likely to meet or not meet PA guidelines. RESULTS: Across cancer types, we found that PA yet decreased from pre- to post-diagnosis, but that 54.1% of participants still reported to be meeting PA guidelines after the diagnosis. While post-diagnosis PA was strongly affected by previous PA behavior among individuals of all patient groups, other sociodemographic and medical determinants played different roles depending on cancer type. The results yielded that previously active, longer diagnosed patients with higher education levels were most likely to be meeting PA guidelines post-diagnosis, whereas specifically previously inactive prostate cancer patients had an increased likelihood of insufficient activity. CONCLUSIONS: An encouragingly high number of cancer patients indicated sufficient PA levels. For those having difficulties to maintain or adopt PA post-diagnosis, interventions should be tailored to the specific characteristics of each cancer type, as different factors are associated with PA for each patient group.

The Influence of Cancer Patient Characteristics on the Recommendation of Physical Activity by Healthcare Professionals.

BACKGROUND: Although physical activity (PA) is beneficial for patients with cancer, healthcare professionals (HCP) still scarcely recommend it. This study aimed to determine how HCP' sociodemographic and professional characteristics and their subjective assessments of patient characteristics are associated with their PA recommendations to patients with cancer. METHODS: A cross-sectional survey (paper-pencil or online) was completed by 929 HCP (159 general practitioners, 382 specialized physicians, and 388 oncology nurses). The survey collected information on HCP' sociodemographic and professional characteristics, PA recommendation frequency, and the likelihood of 13 patient characteristics influencing PA recommendations (on a 7-point Likert scale). RESULTS: Descriptive results showed that 37.6% of HCP indicated often recommending PA and 41.7% indicated routinely recommending PA. More professional experience was associated with a higher reported PA recommendation frequency among specialized physicians and oncology nurses. Patient characteristics could be assigned to three higher-level categories. Characteristics from the categories "medical side effects" and "low affinity for PA" were more frequently judged by HCP as reasons for recommending PA and characteristics belonging to "indicators of poor general health" as reasons for not recommending PA. In all professional groups, the inclusion of patient characteristics resulted in additional variance explained in the prediction of a routine PA recommendation. CONCLUSIONS: HCP in this study reported that they frequently recommend PA to patients with cancer. However, HCP consider cancer patient characteristics to influence their decision whether to recommend PA. Future research and interventions should aim to enable HCP to provide adequate PA recommendations to patients with cancer having different characteristics.

To rest or not to rest-Health care professionals' attitude toward recommending physical activity to their cancer patients.

OBJECTIVE: While in the past cancer patients were advised to rest, recent research revealed various beneficial effects of physical activity, including increased treatment tolerability during cancer treatment and prolonged survival, which has led to a paradigm shift in relevant guidelines. This study examined if this paradigm shift from rest to activity has been consolidated in health care professionals' (HCP') attitude. It was investigated if the two dimensions of attitude (rest and activity) are endorsed empirically within the theory of planned behavior (TPB). Differences between physicians and nurses were examined. METHODS: Five hundred forty seven physicians and 398 nurses treating breast, prostate, or colorectal cancer patients completed a cross-sectional questionnaire. To assess attitude toward physical activity during cancer treatment, we developed a 15-item scale, which included original statements of HCP. TPB variables were assessed. RESULTS: A factor analysis revealed the proposed distinction of attitude into two dimensions. The activity-paradigm was stronger represented in HCP' attitude compared with rest-paradigm (Mactivity-paradigm  = 4.1 versus Mrest-paradigm  = 2.7, p < 0.001). Additionally, the activity-paradigm had higher exploratory power in explaining intention to recommend physical activity in cancer patients. However, the rest-paradigm was able to explain intention to recommend physical activity over and above activity-paradigm (ΔR2  = 0.05). Nurses had higher scores on the rest-paradigm than physicians. CONCLUSIONS: The activity-paradigm has already been consolidated in HCP' minds. However, the rest-paradigm is still present in the daily routine of oncology physicians and nurses. Addressing concerns and insecurities related to supporting cancer patients in maintaining or building up a physically active lifestyle is a very important educational task.

Testing verbal quantifiers for social norms messages in cancer screening: evidence from an online experiment.

BACKGROUND: Studies have shown that presenting correct information about group norms to correct misperceptions of norms can influence health behaviours. In two online studies we investigated how different ways of communicating the current uptake of 43% of the English Bowel Scope Screening (BSS) programme affects intention among disinclined men and women. METHODS: In the first study, 202 participants were asked to interpret eight quantifiers for 43% uptake ('few', 'many', 'a considerable number', 'a large number', 'a great number', 'a lot', 'numerous' and 'nearly half') and to indicate how misleading they perceived each of them to be. In the second study, with 1245 participants, we compared the motivational impact of two quantifiers ('a large number' and 'nearly half' which were associated with the highest perceived uptake (48.9%) and considered least misleading in study 1 respectively) with a control message that did not contain any information on uptake, and a message which communicated actual uptake as a proportion (43%). RESULTS: While we found that both verbal quantifiers increased screening intentions compared with the control group (from 7.8 to 12.5%, aOR 1.72; 95%CI 1.00-2.96 in the case of 'a large number' and 14.3%, aOR 2.02; 95%CI 1.20-3.38 for 'nearly half'), simply communicating that 43% do the test, however, had no impact on intentions (9.9% vs. 7.8% aOR 1.25; 95%CI 0.73-2.16). CONCLUSION: Verbal quantifiers can be used to improve the perception of low uptake figures and avoid a demotivating effect.

Which self-management strategies do health care professionals recommend to their cancer patients? An experimental investigation of patient age and treatment phase.

This vignette based study aimed to examine recommendations of health care professionals (HCPs) in promoting self-management strategies to cancer patients. Nine-hundred-forty-two physicians and nurses were asked to (1) indicate if they would recommend self-management strategies to a vignette cancer patient, and (2) to specify those in an open format. Vignettes included a manipulation of patient age (60 vs. 75 years) and treatment phase (currently treated versus treatment completed). Six categories emerged through coding a total of 2303 recommendations: physical activity (71.8%), nutrition (64.3%), psychological support (36.7%), medical support (29.2%), conscious living (17.2%) and naturopathy (12.3%). While psychological support was particularly recommended during treatment, physical activity was more frequently recommended after completion of treatment. Results suggest that HCPs recommend a variety of self-management strategies besides standard medical treatment. Patient's treatment phase and age seem to partly influence recommendation behavior, potentially indicating insecurities regarding acute treatment situations and age-related stereotypes.

Are healthcare professionals being left in the lurch? The role of structural barriers and information resources to promote physical activity to cancer patients.

PURPOSE: Although many cancer patients benefit from physical activity (PA), healthcare professionals (HCP) still do not promote it routinely. Including different groups of HCP, this study aimed to examine how structural barriers are perceived as impeding by HCP for promoting PA to cancer patients, how the perceptions of structural barriers are associated with promoting PA, and how HCP react to information resources. METHODS: A total of 287 physicians in outpatient care, 242 physicians in inpatient care, and 388 oncology nurses completed our questionnaire (paper-pencil or online). Participants assessed nine different structural barriers (on a 4-point Likert Scale) and reported their PA promotion frequency. Further, they could request three different kinds of information resources about PA in oncological settings. RESULTS: Across professional groups, more than 70% of HCP indicated that they promoted PA to their cancer patients often or routinely. Oncology nurses indicated that they were more impeded in promoting PA by six structural barriers than physicians (all p < .01). "Not enough time per patient" and "lack of an expert contact person" were associated with a reduced PA promotion in two professional groups (all p < .05). Information resources were requested by 69.5% of the participants: mostly physicians working in outpatient care and especially by those perceiving structural barriers. CONCLUSIONS: Although a big proportion of HCP reported that they frequently promoted PA, our findings suggest that HCP still perceive structural barriers. The perception and influence of structural barriers differed between professional groups, pointing to the importance of profession specific guidance.

What hinders healthcare professionals in promoting physical activity towards cancer patients? The influencing role of healthcare professionals' concerns, perceived patient characteristics and perceived structural factors.

Despite a large body of evidence showing that physical activity (PA) is beneficial to patients with cancer, healthcare professionals (HCPs) are promoting it too scarcely. Factors that hinder HCPs from promoting PA have remained understudied so far. Using a qualitative approach, this study aimed at a comprehensive description of influencing factors for HCPs' PA promotion behaviour and at identifying the reasons and mechanisms behind them. Semi-structured interviews with 30 HCPs were undertaken with a focus on concerns, patient characteristics and structural factors. Answers were analysed using thematic analysis. Results revealed that HCPs had concerns regarding a physical overexertion and psychological stress for patients with cancer. A patient's physical condition and the assumed interest in PA, often derived from former PA, turned out to be the most crucial patient characteristics influencing if PA is addressed. Structural factors relevant for PA promotion pertained to in-house structures, HCPs' workload, timing and coordination, information material for HCPs and patients and availability of exercise programs. In conclusion, this study revealed undetected concerns of HCPs and underlined the relevance of patient characteristics and structural conditions for HCPs' PA promotion towards patients with cancer. A broader perspective is needed to assess these factors in their influence on HCPs' PA promotion.

A self-regulation-based intervention to increase physical activity in cancer patients.

The study examined whether a behavior-change intervention focusing on self-regulatory strategies and emphasizing role model support increases physical activity (PA) among insufficiently active (not meeting PA guidelines of 150 min/week) cancer patients. Ambulatory cancer patients [N = 72; 54% female; M = 56 years, SD = 12.34; most with breast or colon cancer (34, 15%)] were enrolled in the MOTIVACTION-study, a 4-week intervention (1-hr counseling, followed by weekly phone calls), with pretest (T1), posttest (T2) and a 10-week follow-up (T3). Participants were randomized to either an exercise or to a stress management intervention (active control). The exercise intervention emphasized self-regulatory strategies (e.g. action- and coping planning and self-monitoring); patients were also encouraged to contact a physically active same-sex role model as a potential exercise partner. The active control condition consisted of coping and relaxation techniques. Sixty-seven patients remained in the study and completed the SQUASH assessment of PA and a measure of perceived stress. PA was validated by Actigraph accelerometry. At T2, 46% of the patients in the exercise group and 19% of stress management patients increased their activity levels to meet PA guidelines (>150 min/week; χ(2)(1) = 5.51, p = .019). At T3, participants in the exercise intervention maintained their exercise level (46%), but also 31% of the stress management patients met the guidelines. All patients reported reductions in perceived stress. Additional analyses comparing patients in the exercise group by role model contact (63% realized contact) revealed that those who had contact with their role model were significantly more likely to adhere to the recommended guidelines (T2:50%; T3:64%) compared to those who did not have contact with a role model (T2:39%; T3:15%), suggesting the potential of mobilizing role model support to facilitate PA. In sum, cancer patients may not only benefit from an exercise intervention emphasizing self-regulation, but also from stress management, regarding both reducing stress and increasing PA.

Who makes use of Internet-delivered health information? The role of gender role self-concept in young men and women.

This study examined the contribution of gender role self-concept (expressiveness and instrumentality) on active interest in and use of Internet-delivered health information among young men and women. Four hundred and twenty university students reported health behaviours and perceived personal vulnerability regarding five diseases. We analysed active interest in receiving health-related information concerning these diseases (providing email address to receive a link to health-related websites) and actual use of provided websites two weeks afterwards. Usage of health-related information via the Internet was objectively assessed by recording log-ins on the website and obtaining individual click counts. In both sexes, higher expressiveness was independently associated with being more likely to show active interest in health-related information. Additionally, expressiveness was positively associated with website use in men independent of age, personal vulnerability and reported health behaviours. Thus, an expressive self-concept facilitates the use of health-related information, especially among men.

What explains the intention to be physically active in cancer patients? Different determinants for active and insufficiently active patients.

In a qualitative elicitation study with 61 cancer patients, a broad range of attitudes toward physical activity could be obtained, especially negative attitudes among insufficiently active patients. Based on these results, a second quantitative study was conducted; 64 patients [40 men; 42% insufficiently active (<150 minutes/week)] completed a Theory of Planned Behavior (TPB) questionnaire. Regression analyses revealed that different variables of the TPB are relevant for explaining the intention to exercise for physically active (subjective norm) and insufficiently active (attitudes) cancer patients. Health professionals should adapt their support to the special needs of insufficiently active and active cancer patients.

Increasing fruit and vegetable intake. "Five a day" versus "just one more".

The present randomized controlled intervention study tested the hypothesis that a personally adaptable and realistic "just 1 more" goal would be more effective for increasing fruits and vegetables (FV) intake compared to the common "5 a day" goal. Study participants (N=84 students, 85% female) consumed less than 4 servings of FVs per day at recruitment. During the 1-week intervention, participants randomized to the 5 a day-group were asked to eat 5 servings of FVs/day; participants of the just 1 more-group were asked to eat 1 serving more of FVs than they usually did, and participants of the control group were instructed to eat as usual. Measurements were taken before (T1), directly following (T2), and 1 week after (T3) the intervention. Participants in the 5 a day-group increased their average FV intake significantly by about one serving from 2.49 at T1 to 3.45 servings/day at T3. At T3, only the 5 a day-group-not the just 1 more-group-had a significantly higher FV intake than the control group. Contrary to the hypothesis, the "5 a day" goal was more effective than "just 1 more" for increasing FV intake. Results of our study support the rationale of the "5 a day" campaign, at least in the short term.

Effects of mental contrasting on sleep and associations with stress: A randomized controlled trial.

Mental contrasting with implementation intentions (MCII) has been successfully applied to improve health-related behaviors (e.g. exercise). We explored its effectiveness to improve sleep outcomes beyond effects of sleep hygiene (SH) information, and investigated associations with stress. Eighty university employees (mean age: 29.6, SD = 4.5) were randomized to either a MCII + SH or a SH-only condition. During a baseline-week and a post-intervention week, sleep duration (Fitbit Alta and self-report), sleep quality, and stress were assessed daily and saliva was collected to assess the cortisol awakening response (CAR). In total, self-reported sleep quality and duration increased, but there was no meaningful condition*week interaction for sleep parameters or CAR. Higher average stress was associated with shorter sleep duration and lower sleep quality. Within-person, days with higher stress were followed by nights with lower sleep quality. Despite overall improvements, effects of MCII were not confirmed. MCII might be less effective to improve behaviors which are less controllable.