Financial Incentives for Physical Activity and Sports Participation in Young People.

ABSTRACT: Physical inactivity is a global health problem. Childhood is an opportune time to establish healthy physical activity behaviors, including the participation in organized physical activity, such as sports. We hypothesize that financial incentives can improve young people's participation in physical activity and sports. The design of the incentive and the context in which it operates is crucial to its success.

Uptake of a Universal Sports Subsidy Program for School-Aged Children: A Population Data Analysis.

BACKGROUND: Around 40% of Australian children do not participate in sport. Cost is a major barrier to participation, particularly for children from low socioeconomic backgrounds. This study aimed to evaluate the uptake of a population-level children's sports subsidy scheme, including sociodemographic differences in uptake. METHODS: A state-wide cross-sectional analysis comparing sports voucher claimants (primary school-aged children with a valid Medicare or Australian visa number) from the 2019 financial year with population census data from South Australia. Chi-square was used to examine whether the percentage of eligible children who claimed a voucher differed based on age, sex, socioeconomic status (SES), and geographical remoteness. Subgroup analyses were conducted for the lowest 2 socioeconomic disadvantage deciles, split by gender. Scatterplots were used to compare sports between high and low SES children. RESULTS: A total of 74,668 children claimed sports vouchers (45.5% of eligible children). Children who were relatively younger, female, from low socioeconomic backgrounds, and from major cities were least likely to claim the voucher. The 5 most common sports were Australian rules football (30.2%), netball (13.6%), soccer (13.1%), gymnastics (10.4%), and basketball (5.7%), with the popular sports similar for high and low SES children. CONCLUSIONS: Future work is needed to understand how Sports Voucher, and sport participation rates have changed over time, and to improve voucher uptake among girls, city dwellers, and low SES children.

Trends in Well-Being Among Youth in Australia, 2017-2022.

Importance: Little is known about temporal trends in children's well-being and how the COVID-19 pandemic may have influenced the well-being of young Australians. Certain demographic groups may be more vulnerable to experiencing declines in well-being. Objective: To examine well-being trends over 6 consecutive years among South Australian students and explore the influence of sociodemographic characteristics. Design, Setting, and Participants: Longitudinal analyses of annual (2017 to 2022) cross-sectional data of students in grades 4 through 9 (n = 40 392 to 56 897 per year) attending South Australian government schools from the Well-being and Engagement Collection (WEC) census. Exposures: Calendar year (2017-2022) and sociodemographic characteristics (sex, school grade, parental education, language spoken at home, residential region) from school enrollment records. Main Outcomes and Measures: Students self-reported life satisfaction, optimism, happiness, cognitive engagement, emotional regulation, perseverance, worry, and sadness. Results: Over 6 years (2017 to 2022), a total of 119 033 students (mean [SD] age, 12.1 y; 51.4% male) participated in this study. Most well-being measures declined over time, with consistent worsening of well-being from 2020 onward. For example, compared with 2017, sadness was 0.26 (95% CI, 0.25-0.27) points higher in 2020 (standardized mean difference [SMD], 0.27) and remained elevated by more than 0.26 points (SMD, 0.27) in 2021 and 2022. At almost every time point, greatest well-being was reported by students of male sex (except cognitive engagement and perseverance), in earlier school grades, with highest parental education, speaking a language other than English at home, and residing in outer regional and remote settings (for satisfaction, optimism, and emotional regulation). Sociodemographic differences in well-being were generally consistent over time; however, sex differences widened from 2020 for all indicators except cognitive engagement and perseverance. For example, between 2017 and 2022, sadness increased by 0.27 (95% CI, 0.25-0.29) more points among females than males (SMD, 0.28). Conclusions and Relevance: In this longitudinal analysis of annual census data, there were downward trends in students' well-being, especially since 2020. The largest sociodemographic disparities were observed for students of female sex, those in later school grades, and those with lowest parental education. Urgent and equitable support for the well-being of all young people, particularly those facing disparity, is imperative.

Hashtag fitspiration: credibility screening and content analysis of Instagram fitness accounts.

BACKGROUND: Fitspiration is a social media phenomenon purported to inspire viewers to lead healthier lifestyles but can result in negative psychological outcomes such as body dissatisfaction. This study aimed to develop a tool to audit Instagram fitspiration accounts and screen for content that could have potentially negative psychological effects. METHODS: This study developed and implemented an audit tool to (1) identify credible fitspiration accounts (i.e., accounts that do not portray potentially harmful or unhealthy content) and (2) describe the content of identified accounts. The most recent 15 posts of 100 leading Instagram fitspiration accounts were audited. Accounts were deemed non-credible and were excluded if they contained fewer than four fitness-related posts or portrayed nudity or inappropriate clothing, sexualisation or objectification, extreme body types, "thinspiration", or negative messages. RESULTS: Many accounts contained fewer than four fitness-related posts (n = 41), sexualisation or objectification (n = 26), nudity or inappropriate clothing (n = 22), and/or extreme body types (n = 15). Three accounts failed on all four criteria, while 13, 10 and 33 failed on three, two, or one criterion, respectively. Therefore, only 41% of accounts were considered credible. Inter-rater reliability (percentage agreement and Brennan and Prediger's coefficient κq) was high (Stage 1: 92% agreement [95% CI 87, 97], κq 0.84 [95% CI 0.73, 0.95]; Stage 2: 93% agreement [95% CI 83, 100], κq 0.85 [95% CI 0.67, 1.00]). Account holders of credible fitspiration accounts were predominantly female (59%), aged 25-34 (54%), Caucasian (62%), and from the United States (79%). Half held a qualification related to physical activity or physical health (e.g., personal trainer, physiotherapy; 54%). Most included accounts included an exercise video (93%) and example workout (76%). CONCLUSION: While many popular Instagram fitspiration accounts offered credible content such as example workouts, many accounts contained sexualisation, objectification or promotion of unhealthy or unrealistic body shapes. The audit tool could be used by Instagram users to ensure the accounts they follow do not portray potentially harmful or unhealthy content. Future research could use the audit tool to identify credible fitspiration accounts and examine whether exposure to these accounts positively influences physical activity.

Gamification in a Physical Activity App: What Gamification Features Are Being Used, by Whom, and Does It Make a Difference?

Background: Gamification is purported to enhance engagement with health behavior apps, ultimately improving their effectiveness. This study aimed to examine (1) whether the inclusion of gamification features in a physical activity smartphone app was associated with improved app usage and goal adherence, describe (2) use of the gamification features, and (3) by whom, and determine (4) whether engagement was associated with increased physical activity. Methods: Data from community-dwelling adult participants (mean age 42.1 years, standard deviation [SD 11.9], 74% female) in the gamified (n = 134) and nongamified (n = 155) conditions from a three-group randomized controlled trial were analyzed. Physical activity was assessed at baseline and 9 months using a survey and accelerometers. App usage (number of days steps were logged), goal adherence (number of days step count was ≥10,000), and behavioral engagement with gamification features were obtained from server logs. Multilevel modeling was used to examine the study aims. Results: Participants who received the gamified app showed more days of usage than those who received the nongamified app (M = 113 days [SD 88] vs. M = 81 days [SD 54], P = 0.006), whereas goal adherence did not differ between groups. The leaderboard and "status" gamification features were the most frequently used gamification features (M = 83 [SD 114] and M = 50 [SD 67] views, respectively). Older age (P = 0.008) and lower body mass index (P = 0.004) were associated with more status views. Participants who reported higher stress symptoms sent more gifts (P = 0.04). The use of gamification features was associated with increased physical activity (P = 0.04). Conclusion: The gamified app was used substantially longer than the nongamified app. Use of gamification features was positively associated with change in physical activity. Leaderboards promoting social comparison may be a promising form of gamification. Research on different forms of gamification is warranted.

The relationships between school children's wellbeing, socio-economic disadvantage and after-school activities: a cross-sectional study.

BACKGROUND: Lower socioeconomic status is associated with poorer wellbeing among children. Identifying how children participate in after-school activities and how after-school activities are associated with wellbeing may inform interventions to improve wellbeing among children from low socioeconomic backgrounds. This study explored whether children's after-school activities varied by socioeconomic status and examined the associations between after-school activities and wellbeing in low socioeconomic status children. METHODS: This study analysed cross-sectional data from 61,759 school students in years 4 to 9 who completed the 2018 South Australian Wellbeing and Engagement Collection. Students reported the number of days per week they participated in 12 activities (after-school care, homework, music lessons or practice, youth organisations, sports, television, videogames, social media, reading, chores, arts and crafts, and socialising with friends) during the after-school period (3-6 pm) and their wellbeing (happiness, sadness, worry, engagement, perseverance, optimism, emotion regulation, and life satisfaction). Socioeconomic status was measured by parents' highest education level obtained from school enrolment data. Linear multilevel models were used to examine whether frequency of after-school activities varied by socioeconomic status. Multilevel ordered logit models were used to analyse the association between after-school activities and wellbeing amongst participants in the low socioeconomic status category. RESULTS: After-school activities differed according to socioeconomic status; high socioeconomic status children did more frequent sport, homework, and reading and low socioeconomic status children did more frequent screen-based activities (TV, videogames and social media). Among children from low socioeconomic status backgrounds, higher wellbeing was associated most consistently with more frequent sports participation, homework, reading and spending time with friends and less frequent videogames, social media and after-school care. CONCLUSIONS: Children's wellbeing is positively associated with socioeconomic status. Amongst children from disadvantaged backgrounds, participating in sport, spending time with friends and getting less screen time may be protective for wellbeing. The results suggest that programming targeted at increasing sports participation and reducing screen time amongst children from low socioeconomic status backgrounds may support their wellbeing.

Improving User Experience of Virtual Health Assistants: Scoping Review.

BACKGROUND: Virtual assistants can be used to deliver innovative health programs that provide appealing, personalized, and convenient health advice and support at scale and low cost. Design characteristics that influence the look and feel of the virtual assistant, such as visual appearance or language features, may significantly influence users' experience and engagement with the assistant. OBJECTIVE: This scoping review aims to provide an overview of the experimental research examining how design characteristics of virtual health assistants affect user experience, summarize research findings of experimental research examining how design characteristics of virtual health assistants affect user experience, and provide recommendations for the design of virtual health assistants if sufficient evidence exists. METHODS: We searched 5 electronic databases (Web of Science, MEDLINE, Embase, PsycINFO, and ACM Digital Library) to identify the studies that used an experimental design to compare the effects of design characteristics between 2 or more versions of an interactive virtual health assistant on user experience among adults. Data were synthesized descriptively. Health domains, design characteristics, and outcomes were categorized, and descriptive statistics were used to summarize the body of research. Results for each study were categorized as positive, negative, or no effect, and a matrix of the design characteristics and outcome categories was constructed to summarize the findings. RESULTS: The database searches identified 6879 articles after the removal of duplicates. We included 48 articles representing 45 unique studies in the review. The most common health domains were mental health and physical activity. Studies most commonly examined design characteristics in the categories of visual design or conversational style and relational behavior and assessed outcomes in the categories of personality, satisfaction, relationship, or use intention. Over half of the design characteristics were examined by only 1 study. Results suggest that empathy and relational behavior and self-disclosure are related to more positive user experience. Results also suggest that if a human-like avatar is used, realistic rendering and medical attire may potentially be related to more positive user experience; however, more research is needed to confirm this. CONCLUSIONS: There is a growing body of scientific evidence examining the impact of virtual health assistants' design characteristics on user experience. Taken together, data suggest that the look and feel of a virtual health assistant does affect user experience. Virtual health assistants that show empathy, display nonverbal relational behaviors, and disclose personal information about themselves achieve better user experience. At present, the evidence base is broad, and the studies are typically small in scale and highly heterogeneous. Further research, particularly using longitudinal research designs with repeated user interactions, is needed to inform the optimal design of virtual health assistants.

Effectiveness of a Lifestyle Modification Program Delivered under Real-World Conditions in a Rural Setting.

Whilst there is considerable evidence to support the efficacy of physical activity and dietary interventions in disease and death prevention, translation of knowledge into practice remains inadequate. We aimed to examine the uptake, retention, acceptability and effectiveness on physical activity, physical function, sitting time, diet and health outcomes of a Healthy Eating Activity and Lifestyle program (HEALTM) delivered under real-world conditions. The program was delivered to 430 adults living across rural South Australia. Participants of the program attended weekly 2 h healthy lifestyle education and exercise group-based sessions for 8 weeks. A total of 47 programs were delivered in over 15 communities. In total, 548 referrals were received, resulting in 430 participants receiving the intervention (78% uptake). At baseline, 74.6% of participants were female, the mean age of participants was 53.7 years and 11.1% of participants identified as Aboriginal and/or Torres Strait Islander. Follow-up assessments were obtained for 265 participants. Significant improvements were observed for walking, planned physical activity, incidental physical activity, total physical activity, 30 s chair stand, 30 s arm curl, 6 min walk, fruit consumption and vegetable consumption, sitting time and diastolic blood pressure. Positive satisfaction and favourable feedback were reported. The healthy lifestyle program achieved excellent real-world uptake and effectiveness, reasonable intervention attendance and strong program acceptability amongst rural and vulnerable communities.

Changes in diet, activity, weight, and wellbeing of parents during COVID-19 lockdown.

The COVID-19 pandemic has dramatically impacted lifestyle behaviour as public health initiatives aim to "flatten the curve". This study examined changes in activity patterns (physical activity, sedentary time, sleep), recreational physical activities, diet, weight and wellbeing from before to during COVID-19 restrictions in Adelaide, Australia. This study used data from a prospective cohort of Australian adults (parents of primary school-aged children; n = 61, 66% female, aged 41±6 years). Participants wore a Fitbit Charge 3 activity monitor and weighed themselves daily using Wi-Fi scales. Activity and weight data were extracted for 14 days before (February 2020) and 14 days during (April 2020) COVID-19 restrictions. Participants reported their recreational physical activity, diet and wellbeing during these periods. Linear mixed effects models were used to examine change over time. Participants slept 27 minutes longer (95% CI 9-51), got up 38 minutes later (95% CI 25-50), and did 50 fewer minutes (95% CI -69--29) of light physical activity during COVID-19 restrictions. Additionally, participants engaged in more cycling but less swimming, team sports and boating or sailing. Participants consumed a lower percentage of energy from protein (-0.8, 95% CI -1.5--0.1) and a greater percentage of energy from alcohol (0.9, 95% CI 0.2-1.7). There were no changes in weight or wellbeing. Overall, the effects of COVID-19 restrictions on lifestyle were small; however, their impact on health and wellbeing may accumulate over time. Further research examining the effects of ongoing social distancing restrictions are needed as the pandemic continues.

Annual rhythms in adults' lifestyle and health (ARIA): protocol for a 12-month longitudinal study examining temporal patterns in weight, activity, diet, and wellbeing in Australian adults.

BACKGROUND: Almost one in three Australian adults are now obese, and the rate continues to rise. The causes of obesity are multifaceted and include environmental, cultural and lifestyle factors. Emerging evidence suggests there may be temporal patterns in weight gain related, for example, to season and major festivals such as Christmas, potentially due to changes in diet, daily activity patterns or both. The aim of this study is to track the annual rhythm in body weight, 24 h activity patterns, dietary patterns, and wellbeing in a cohort of Australian adults. In addition, through data linkage with a concurrent children's cohort study, we aim to examine whether changes in children's body mass index, activity and diet are related to those of their parents. METHODS: A community-based sample of 375 parents aged 18 to 65 years old, residing in or near Adelaide, Australia, and who have access to a Bluetooth-enabled mobile device or a computer and home internet, will be recruited. Across a full year, daily activities (minutes of moderate to vigorous physical activity, light physical activity, sedentary behaviour and sleep) will be measured using wrist-worn accelerometry (Fitbit Charge 3). Body weight will be measured daily using Fitbit wifi scales. Self-reported dietary intake (Dietary Questionnaire for Epidemiological Studies V3.2), and psychological wellbeing (WHOQOL-BREF and DASS-21) will be assessed eight times throughout the 12-month period. Annual patterns in weight will be examined using Lowess curves. Associations between changes in weight and changes in activity and diet compositions will be examined using repeated measures multi-level models. The associations between parent's and children's weight, activity and diet will be investigated using multi-level models. DISCUSSION: Temporal factors, such as day type (weekday or weekend day), cultural celebrations and season, may play a key role in weight gain. The aim is to identify critical opportunities for intervention to assist the prevention of weight gain. Family-based interventions may be an important intervention strategy. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry, identifier ACTRN12619001430123 . Prospectively registered on 16 October 2019.

Conscientiousness, Activity Engagement, and Momentary Affect in Oldest-Old Adulthood.

OBJECTIVES: Remaining engaged with life is a hallmark of aging well and pursuing personally meaningful activities is presumably important for late-life affect. We examined how moment-to-moment variability in meaning and degree of challenge ascribed to daily activities relate to positive and negative affect in very old adults. Possible moderating effects of between-person differences in conscientiousness on meaning-affect associations were also examined. METHODS: Participants were 73 adults aged 89 years on average from the Australian Daily Life Time-Sampling module of the Australian Longitudinal Study of Aging. Participants provided self-report data on activity engagement (meaning and challenge associated with activities) and affect, on 5 occasions per day for a period of 7 consecutive days. RESULTS: Within-person associations of activity meaning with affect varied as a function of within-person challenge ratings. Specifically, gains in positive affect associated with meaningful activity were more strongly evident when activities were regarded as more challenging. In contrast, meaningful activity was associated with higher negative affect when activities were regarded as more challenging and lower negative affect when activities were regarded as less challenging. Conscientiousness did not moderate associations of activity meaning with affect. DISCUSSION: Our findings shed light on the intricate interplay between maintaining meaningful engagement and daily emotional experiences in very old age. We discuss theoretical and practical implications and consider the role of late-life conscientiousness for self- and emotion regulation.

A Process Evaluation Examining the Performance, Adherence, and Acceptability of a Physical Activity and Diet Artificial Intelligence Virtual Health Assistant.

Artificial intelligence virtual health assistants are a promising emerging technology. This study is a process evaluation of a 12-week pilot physical activity and diet program delivered by virtual assistant "Paola". This single-arm repeated measures study (n = 28, aged 45-75 years) was evaluated on technical performance (accuracy of conversational exchanges), engagement (number of weekly check-ins completed), adherence (percentage of step goal and recommended food servings), and user feedback. Paola correctly asked scripted questions and responded to participants during the check-ins 97% and 96% of the time, respectively, but correctly responded to spontaneous exchanges only 21% of the time. Participants completed 63% of weekly check-ins and conducted a total of 3648 exchanges. Mean dietary adherence was 91% and was lowest for discretionary foods, grains, red meat, and vegetables. Participants met their step goal 59% of the time. Participants enjoyed the program and found Paola useful during check-ins but not for spontaneous exchanges. More in-depth knowledge, personalized advice and spontaneity were identified as important improvements. Virtual health assistants should ensure an adequate knowledge base and ability to recognize intents and entities, include personality and spontaneity, and provide ongoing technical troubleshooting of the virtual assistant to ensure the assistant remains effective.

Can Instagram be used to deliver an evidence-based exercise program for young women? A process evaluation.

BACKGROUND: Instagram provides an opportunity to deliver low cost, accessible and appealing physical activity content. This study evaluated the feasibility of delivering an exercise program for young women using Instagram. METHODS: A single-group pre- and post-intervention trial examined the feasibility and preliminary efficacy of a 12-week Instagram-delivered program with young inactive women (n = 16; M = 23 years), which prescribed running and body weight exercises to complete three times per week. Daily Instagram posts delivered the exercises, video demonstrations and motivational content. Feasibility was evaluated by examining exposure (Instagram posts viewed per week), engagement (likes, comments and tags on Instagram posts; number of exercise sessions completed per week; retention, defined as completion of the online survey at weeks 6 and 12), and acceptability [whether the program increased participants' motivation to exercise (1 = strongly disagree-5 = strongly agree); satisfaction with the program (1 = not satisfied-5 = very satisfied)]. Preliminary efficacy was evaluated by comparing baseline and 12-week self-reported physical activity (IPAQ short-form) and fitness (cardiorespiratory and muscle strength; 1 = very poor-5 = very good, International Fitness Scale) using the Exact sign test. RESULTS: On average, participants reported seeing six posts in their Instagram feed per week. Posts received an average of five likes (IQR = 3-6). A total of four comments and one tag were observed across all posts. On average, participants reported completing two exercise sessions per week. Retention was 88% at 6 weeks but dropped to 56% at 12 weeks. Participants reported increased motivation to exercise (Mdn = 4, IQR = 3-4) and were satisfied with the program (Mdn = 4, IQR = 3-4). Only self-reported cardiorespiratory fitness showed a meaningful, though nonsignificant, improvement (MdnΔ = 1, IQR = 0-1, p = .06). CONCLUSIONS: Although Instagram has the potential to deliver a low cost, convenient exercise program for young women, additional research is needed to identify methods of improving engagement (interaction with the Instagram content, exercise sessions completed, and retention in the program). Future research could examine the use of behaviour change theory and provide information that enables participants to tailor the exercises to their interests and needs. Additionally, the use of objective assessments of physical activity and fitness among a larger participants sample is needed.

Low-Cost Consumer-Based Trackers to Measure Physical Activity and Sleep Duration Among Adults in Free-Living Conditions: Validation Study.

BACKGROUND: Wearable trackers for monitoring physical activity (PA) and total sleep time (TST) are increasingly popular. These devices are used not only by consumers to monitor their behavior but also by researchers to track the behavior of large samples and by health professionals to implement interventions aimed at health promotion and to remotely monitor patients. However, high costs and accuracy concerns may be barriers to widespread adoption. OBJECTIVE: This study aimed to investigate the concurrent validity of 6 low-cost activity trackers for measuring steps, moderate-to-vigorous physical activity (MVPA), and TST: Geonaut On Coach, iWown i5 Plus, MyKronoz ZeFit4, Nokia GO, VeryFit 2.0, and Xiaomi MiBand 2. METHODS: A free-living protocol was used in which 20 adults engaged in their usual daily activities and sleep. For 3 days and 3 nights, they simultaneously wore a low-cost tracker and a high-cost tracker (Fitbit Charge HR) on the nondominant wrist. Participants wore an ActiGraph GT3X+ accelerometer on the hip at daytime and a BodyMedia SenseWear device on the nondominant upper arm at nighttime. Validity was assessed by comparing each tracker with the ActiGraph GT3X+ and BodyMedia SenseWear using mean absolute percentage error scores, correlations, and Bland-Altman plots in IBM SPSS 24.0. RESULTS: Large variations were shown between trackers. Low-cost trackers showed moderate-to-strong correlations (Spearman r=0.53-0.91) and low-to-good agreement (intraclass correlation coefficient [ICC]=0.51-0.90) for measuring steps. Weak-to-moderate correlations (Spearman r=0.24-0.56) and low agreement (ICC=0.18-0.56) were shown for measuring MVPA. For measuring TST, the low-cost trackers showed weak-to-strong correlations (Spearman r=0.04-0.73) and low agreement (ICC=0.05-0.52). The Bland-Altman plot revealed a variation between overcounting and undercounting for measuring steps, MVPA, and TST, depending on the used low-cost tracker. None of the trackers, including Fitbit (a high-cost tracker), showed high validity to measure MVPA. CONCLUSIONS: This study was the first to examine the concurrent validity of low-cost trackers. Validity was strongest for the measurement of steps; there was evidence of validity for measurement of sleep in some trackers, and validity for measurement of MVPA time was weak throughout all devices. Validity ranged between devices, with Xiaomi having the highest validity for measurement of steps and VeryFit performing relatively strong across both sleep and steps domains. Low-cost trackers hold promise for monitoring and measurement of movement and sleep behaviors, both for consumers and researchers.

A Social Networking and Gamified App to Increase Physical Activity: Cluster RCT.

INTRODUCTION: Appealing approaches to increasing physical activity levels are needed. This study evaluated whether a social and gamified smartphone app (Active Team) could be one such approach. STUDY DESIGN: A 3-group cluster RCT compared the efficacy of Active Team with a basic self-monitoring app and waitlist control group. SETTING/PARTICIPANTS: Australian adults (N=444, mean age of 41 years, 74% female) were recruited in teams (n=121) and randomly assigned (1:1:1) to the Active Team (n=141, 39 teams), self-monitoring app (n=160, 42 teams), or waitlist group (n=143, 40 teams). Data were collected in 2016-2017, and analysis was conducted in 2018-2019. INTERVENTION: Active Team is a 100-day app-based, gamified, online social networking physical activity intervention. MAIN OUTCOME MEASURES: The primary outcome was change in objective physical activity from baseline to 3-month follow-up. Secondary outcomes included objective physical activity at 9 months and self-reported physical activity, quality of life, depression, anxiety and stress, well-being, and engagement. RESULTS: Mixed models indicated no significant differences in objective physical activity between groups at 3 (F=0.17, p=0.84; Cohen's d=0.03, 95% CI= -0.21, 0.26) or 9 months (F=0.23, p=0.92; d=0.06, 95% CI= -0.17, 0.29) and no significant differences for secondary outcomes of quality of life, depression, anxiety and stress, or well-being. Self-reported moderate-to-vigorous physical activity was significantly higher in the Active Team group at the 9-month follow-up (F=3.05, p=0.02; d=0.50, 95% CI=0.26, 0.73). Engagement was high; the Active Team group logged steps on an average of 72 (SD=35) days and used the social and gamified features an average of 89 (SD=118) times. CONCLUSIONS: A gamified, online social networking physical activity intervention did not change objective moderate-to-vigorous physical activity, though it did increase self-reported moderate-to-vigorous physical activity and achieve high levels of engagement. Future work is needed to understand if gamification, online social networks, and app-based approaches can be leveraged to achieve positive behavior change. TRIAL REGISTRATION: This study is registered at Australian and New Zealand Clinical Trial Registry (protocol: ANZCTR12617000113358).

The Association Between Time-Use Behaviors and Physical and Mental Well-Being in Adults: A Compositional Isotemporal Substitution Analysis.

BACKGROUND: Substantial evidence links activity domains with health and well-being; however, research has typically examined time-use behaviors independently, rather than considering daily activity as a 24-hour time-use composition. This study used compositional data analysis to estimate the difference in physical and mental well-being associated with reallocating time between behaviors. METHODS: Participants (n = 430; 74% female; 41 [12] y) wore an accelerometer for 7 days and reported their body mass index; health-related quality of life (QoL); and symptoms of depression, anxiety, and stress. Regression models determined whether time-use composition, comprising sleep, sedentary behavior, light physical activity (LPA), and moderate to vigorous physical activity (MVPA), was associated with well-being. Compositional isotemporal substitution models estimated the difference in well-being associated with reallocating time between behaviors. RESULTS: Time-use composition was associated with body mass index and physical health-related QoL. Reallocating time to MVPA from sleep, sedentary behavior, and LPA showed favorable associations with body mass index and physical health-related QoL, whereas reallocations from MVPA to other behaviors showed unfavorable associations. Reallocations from LPA to sedentary behavior were associated with better physical health-related QoL and vice versa. CONCLUSION: Results reinforce the importance of MVPA for physical health but do not suggest that replacing sedentary behavior with LPA is beneficial for health and well-being.

Validity and bias on the online active Australia survey: activity level and participant factors associated with self-report bias.

BACKGROUND: This study examined the criterion validity of the online Active Australia Survey, using accelerometry as the criterion, and whether self-report bias was related to level of activity, age, sex, education, body mass index and health-related quality of life. METHODS: The online Active Australia Survey was validated against the GENEActiv accelerometer as a direct measure of activity. Participants (n = 344) wore an accelerometer for 7 days, completed the Active Australia Survey, and reported their health and demographic characteristics. A Spearman's rank coefficient examined the association between minutes of moderate-to-vigorous physical activity recorded on the Active Australia Survey and GENEActiv accelerometer. A Bland-Altman plot illustrated self-report bias (the difference between methods). Linear mixed effects modelling was used to examine whether participant factors predicted self-report bias. RESULTS: The association between moderate-to-vigorous physical activity reported on the online Active Australia Survey and accelerometer was significant (rs = .27, p < .001). Participants reported 4 fewer minutes per day on the Active Australia Survey than was recorded by accelerometry (95% limits of agreement -104 - 96 min) but the difference was not significant (t(343) = -1.40, p = .16). Self-report bias was negatively associated with minutes of accelerometer-recorded moderate-to-vigorous physical activity and positively associated with mental health-related quality of life. CONCLUSIONS: The online Active Australia Survey showed limited criterion validity against accelerometry. Self-report bias was related to activity level and mental health-related quality of life. Caution is recommended when interpreting studies using the online Active Australia Survey.

Characteristics of Adopters of an Online Social Networking Physical Activity Mobile Phone App: Cluster Analysis.

BACKGROUND: To date, many online health behavior programs developed by researchers have not been translated at scale. To inform translational efforts, health researchers must work with marketing experts to design cost-effective marketing campaigns. It is important to understand the characteristics of end users of a given health promotion program and identify key market segments. OBJECTIVE: This study aimed to describe the characteristics of the adopters of Active Team, a gamified online social networking physical activity app, and identify potential market segments to inform future research translation efforts. METHODS: Participants (N=545) were Australian adults aged 18 to 65 years who responded to general advertisements to join a randomized controlled trial (RCT) evaluating the Active Team app. At baseline they provided demographic (age, sex, education, marital status, body mass index, location of residence, and country of birth), behavioral (sleep, assessed by the Pittsburgh Quality Sleep Index) and physical activity (assessed by the Active Australia Survey), psychographic information (health and well-being, assessed by the PERMA [Positive Emotion, Engagement, Relationships, Meaning, Achievement] Profile; depression, anxiety and stress, assessed by the Depression, Anxiety, and Stress Scale [DASS-21]; and quality of life, assessed by the 12-Item Short Form Health Survey [SF-12]). Descriptive analyses and a k-medoids cluster analysis were performed using the software R 3.3.0 (The R Foundation) to identify key characteristics of the sample. RESULTS: Cluster analyses revealed four clusters: (1) younger inactive women with poor well-being (218/545), characterized by a higher score on the DASS-21, low mental component summary score on the SF-12, and relatively young age; (2) older, active women (153/545), characterized by a lower score on DASS-21, a higher overall score on the SF-12, and relatively older age; (3) young, active but stressed men (58/545) with a higher score on DASS-21 and higher activity levels; and (4) older, low active and obese men (30/545), characterized by a high body mass index and lower activity levels. CONCLUSIONS: Understanding the characteristics of population segments attracted to a health promotion program will guide the development of cost-effective research translation campaigns. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12617000113358; https://www.anzctr.org .au/Trial/Registration/TrialReview.aspx?id=371463. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-017-4882-7.

Perceived ease of activity (but not strategy use) mediates the relationship between self-efficacy and activity engagement in midlife and older adults.

Objectives: Activity participation is associated with a range of positive outcomes in older adults but tends to decline with age. Understanding protective factors is important to facilitate activity in later life. Social cognitive theory suggests that having high self-efficacy may promote activity because individuals with higher self-efficacy perceived their activities to be easier and use adaptive strategies to overcome barriers to activity. Despite considerable research linking self-efficacy and activity, limited research has examined the proposed mechanisms behind this association. This study therefore examined whether perceived ease of activity and use of adaptive strategies account for the association between self-efficacy and activity. Method: Participants were 412 adults aged 50-93 years who completed a cross-sectional survey. Structural equation modelling was used to examine whether the effects of self-efficacy on activity were mediated by perceived ease of activity and use of adaptive strategies. Results: Perceived ease of activity mediated the positive associations between self-efficacy and social (0.04 [0.02, 0.07]) and physical activity (0.16 [0.08, 0.25]), but not mental activity (0.01 [0.000, 0.03]). For physical activity, this effect was stronger for adults aged 70+ years than those aged 50-69 years (older a2*b2 - younger a2*b2 0.13 [0.04, 0.24]). Use of adaptive strategies was not a significant mediator in any model. Conclusion: This study suggests that self-efficacy may influence older adults' perception of activities and, in turn, the activities they choose to participate in. This has potential implications for the development of interventions aimed at promoting activity engagement in later life.

Perceived Control and Social Activity in Midlife and Older Age: A Reciprocal Association? Findings From the German Ageing Survey.

Objectives: Perceived control may promote social activity in older adults because individuals with greater perceived control have greater confidence in their ability to achieve outcomes and are more likely to choose difficult activities, show persistence, and employ strategies to overcome challenges. Cross-sectional research has linked perceived control with social activity in life span and older adult samples but provides little insight into the direction of influence. We examined reciprocal associations between perceived control and social activity in order to establish temporal sequencing, which is one prerequisite for determining potential causation. Method: Participants were 14,126 midlife and older adults from the German Ageing Survey. Using cross-lagged autoregressive modeling with age as the time metric (40-87 years), we examined reciprocal 3-year lagged associations between perceived control and social activity, while controlling for concurrent associations. Results: Perceived control significantly predicted social activity 3 years later. Reciprocally, social activity significantly predicted perceived control 3 years later. The influence of perceived control on social activity was greater than the influence of social activity on perceived control. Discussion: The finding that perceived control significantly predicts future social activity has potential implications for developing interventions aimed at promoting social activity in midlife and older adults.