Enhancing physical activity and reducing symptoms of patients with osteoarthritis of the knee: a randomized controlled trial of the PrevOP-Psychological Adherence Program.

BACKGROUND: This primary analysis evaluated the "PREVenting the impairment of primary Osteoarthritis by high-impact long-term Physical exercise regimen-Psychological Adherence Program" (PrevOP-PAP), designed to support patients with osteoarthritis of the knee (OAK) to engage in regular moderate-to-vigorous physical activity (MVPA) to reduce OAK symptoms (WOMAC scores). Theory-based on the health action process approach (HAPA), the intervention targeted volitional precursors of MVPA change: action and coping planning, maintenance and recovery self-efficacy, action control, and social network formation. We hypothesized that compared to an active control condition, increases in MVPA at the end of the 12-month intervention would translate into lower WOMAC scores at 24 months in the intervention condition. METHODS: Participants with radiographically verified moderate OAK (N = 241; 62.66% female; M(SD) = 65.60(7.61) years) were randomly assigned to the intervention (51%) or the active control condition. WOMAC scores (24 months) were the primary -, accelerometer-assessed MVPA (12 months) the key secondary outcomes. The PrevOP-PAP was a 12-month intervention with computer-assisted face-to-face and phone-based sessions designed to increase HAPA-proposed volitional precursors of MVPA change (up to 24 months; secondary outcomes). Intent-to-treat analyses included multiple regression and manifest path models. RESULTS: MVPA (12 months) did not mediate effects of the PrevOP-PAP on WOMAC scores (24 months). Compared to the active control condition, WOMAC scores (24 months) were lower in the intervention condition, but this effect did not remain stable in sensitivity analyses (b(SE) = -8.41(4.66), 95%-CI [-17.53; 0.71]). However, exploratory analyses revealed significantly stronger reductions in WOMAC-pain (24 months) in the intervention condition (b(SE) = -2.99(1.18), 95%-CI [-5.36; -0.63]). Groups did not differ in MVPA at 12 months (b(SE) = -3.78(3.42), 95%-CI [-10.80; 2.58]). Of the proposed precursors of MVPA change, action planning was higher in the intervention than in the control condition (24 months; b(SE) = 0.64(0.26), 95%-CI [0.14; 1.15]). CONCLUSIONS: Compared to an active control condition, the PrevOP-PAP did not produce reliable effects on WOMAC scores and none on preceding MVPA. Of the HAPA-proposed volitional precursors, only action planning was sustainably increased. Future interventions should use m-health applications to digitally support long-term changes in proposed volitional precursors of MVPA change. TRIAL REGISTRATION: German Clinical Trials Register; https://drks.de/search/de/trial/DRKS00009677 ; also available at http://apps.who.int/trialsearch/ ; registration number: DRKS00009677; date of registration: 26/01/2016.

Hand Washing and Related Cognitions Following a Brief Behavior Change Intervention During the COVID-19 Pandemic: a Pre-Post Analysis.

BACKGROUND: Effective hand washing (for at least 20 s, with water and soap) is one of the health behaviors protecting against infection transmissions. Behavior change interventions supporting the initiation and maintenance of hand washing are crucial to prevent infection transmissions. Based on the Health Action Process Approach, the aim of this research was to conduct a pre-post analysis of hand washing and related cognitions (i.e., intention, self-efficacy, self-monitoring), measured up to 100 days following an intervention. METHODS: A convenience sample of N = 123 participants (age: M = 23.96 years; SD = 5.82; 80% women) received a brief intervention (key behavior change techniques: information about health consequences of hand washing; action planning) and responded to daily diaries and questionnaires up to a 100-day follow-up. Two-level models were used to analyze data of n = 89 participants who provided longitudinal data. RESULTS: Hand washing and self-monitoring increased, whereas intention and self-efficacy decreased over time. Only self-monitoring was a consistent positive correlate of hand washing on a between-person level. CONCLUSIONS: Hand washing and self-monitoring considerably increased over several weeks following the intervention. Future research testing the intervention against a control condition is needed to rule out that changes in behavior and cognitions might have been prompted by completing the daily diaries. TRIAL REGISTRATION: German Clinical Trials Register;  https://www.drks.de ; registration number: DRKS00022067.

What makes a good action plan? Characteristics and enactment of fruit and vegetable plans.

BACKGROUND: One promising intervention strategy to increase fruit and vegetable (FV) consumption is action planning. However, conditions of successful plan enactment, i.e., the translation of plans into action, have rarely been studied. Therefore, the relationship between plan characteristics and plan enactment is being examined. METHODS: Secondary analyses of an existing data set were conducted, based on a larger behavioral intervention study with a baseline assessment as well as a 2-weeks and a 4-weeks follow-up. After baseline assessment, participants completed action plan calendars for the following seven days and subsequently reported on each plan's enactment. Two independent raters coded 1732 morning, noon/afternoon, and evening plans by n = 92 individuals regarding the level of specificity (unspecific vs. specific) and type of planned behavior (fruit vs. vegetable intake). To predict plan enactment, multilevel logistic regression analyses were conducted. FINDINGS: Overall specificity of plans was unrelated to plan enactment, but interacted with time of day in predicting plan enactment. Only in the morning, specific plans were more likely being enacted than unspecific plans. Overall, plan enactment decreased during the day and throughout the seven days of the plan calendar. Furthermore, fruit plans were more likely being enacted than vegetable plans. DISCUSSION: Specific morning plans were found most beneficial for the enactment of FV plans. Here, possible underlying mechanisms such as stable morning routines should be further investigated. Moreover, the nutritional choice appeared to make a difference for plan enactment: Increasing one's fruit consumption may be easier than integrating more vegetables into one's daily diet.

Plan pursuit in the context of daily fruit and vegetable consumption: The importance of cue detection and the execution of the planned behaviour for overall behaviour change.

OBJECTIVES: In action planning interventions, individuals specify and link cues with behavioural responses to implement behaviour change. To date, not much is known about how and how much the detection of the planned cue (entering and identifying the planned situation) and the execution of the planned behaviour (behavioural response exactly as planned) contribute to overall behavioural changes (changes in target behaviour) achieved by individuals. Using data from an intervention on daily fruit and vegetable (FV) action planning, this study aimed to test whether individuals' cue detection and execution of the planned behaviour are positively related to overall FV intake. DESIGN: Secondary data analyses examined diary data of the intervention condition of a randomized controlled trial. Ninety participants (80% female, aged 19-63 years) formed one FV plan and completed a 13-days post-intervention self-report diary assessing daily FV consumption and situational characteristics of each consumed FV serving. Based on these self-reports and participants' FV plan, day-to-day cue detection and the execution of the planned behaviour were coded. METHODS: With two-level models, cue detection and the execution of the planned behaviour were examined as between- and within-person predictors of daily FV intake. RESULTS: Higher between-person execution of the planned behaviour (+1.68 daily servings), higher-than-usual within-person cue detection (+0.46 daily servings), and higher-than-usual within-person execution of the planned behaviour (+0.29 daily servings) were associated with more overall FV intake. CONCLUSIONS: Detecting planned cues (within-person) and executing the planned behaviour (between- and within-person) are important for overall FV intake.

Immediate effects of a very brief planning intervention on fruit and vegetable consumption: A randomized controlled trial.

Action planning interventions can effectively promote fruit and vegetable (FV) consumption, but not much is known about the day-to-day translation of intervention planning into action. In this randomized controlled trial, immediate intervention effects of a very brief planning intervention on FV consumption during the following 13 days were investigated. After a 13-day pre-intervention diary, N = 206 participants (aged 19-66 years) were randomly allocated to a waiting-list control condition or a planning condition, where they formed one FV plan. Participants from both conditions completed a 13-day post-intervention diary. Self-reported daily FV consumption, FV-specific self-efficacy, and action control were assessed. Segmented linear mixed models estimating a discrete change (i.e. "jump") between diary phases showed a positive "jump" of FV intake and self-efficacy in the planning condition when compared to the control condition. For action control, such effects were not observed. Changes in study variables throughout the post-intervention phase did not differ between both conditions. Present findings extend previous evidence on action planning interventions by showing that increases in self-regulatory (i.e. self-efficacy) and behavioral (i.e. FV intake) outcomes can occur very rapidly and already on the first day for which behavioral increases were planned.

Selective attention to emotional cues and emotion recognition in healthy subjects: the role of mineralocorticoid receptor stimulation.

RATIONALE: Selective attention toward emotional cues and emotion recognition of facial expressions are important aspects of social cognition. Stress modulates social cognition through cortisol, which acts on glucocorticoid (GR) and mineralocorticoid receptors (MR) in the brain. OBJECTIVES: We examined the role of MR activation on attentional bias toward emotional cues and on emotion recognition. METHODS: We included 40 healthy young women and 40 healthy young men (mean age 23.9 ± 3.3), who either received 0.4 mg of the MR agonist fludrocortisone or placebo. A dot-probe paradigm was used to test for attentional biases toward emotional cues (happy and sad faces). Moreover, we used a facial emotion recognition task to investigate the ability to recognize emotional valence (anger and sadness) from facial expression in four graded categories of emotional intensity (20, 30, 40, and 80 %). RESULTS: In the emotional dot-probe task, we found a main effect of treatment and a treatment × valence interaction. Post hoc analyses revealed an attentional bias away from sad faces after placebo intake and a shift in selective attention toward sad faces compared to placebo. We found no attentional bias toward happy faces after fludrocortisone or placebo intake. In the facial emotion recognition task, there was no main effect of treatment. CONCLUSIONS: MR stimulation seems to be important in modulating quick, automatic emotional processing, i.e., a shift in selective attention toward negative emotional cues. Our results confirm and extend previous findings of MR function. However, we did not find an effect of MR stimulation on emotion recognition.