Correction: Improving Nutrition and Activity Behaviors Using Digital Technology and Tailored Feedback: Protocol for the Tailored Diet and Activity (ToDAy) Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/12782.].

Improving Nutrition and Activity Behaviors Using Digital Technology and Tailored Feedback: Protocol for the Tailored Diet and Activity (ToDAy) Randomized Controlled Trial.

BACKGROUND: Excess weight is a major risk factor for chronic diseases. In Australia, over 60% of adults are overweight or obese. The overconsumption of energy-dense nutrient-poor (EDNP) foods and low physical activity (PA) levels are key factors contributing to population obesity. New cost-effective approaches to improve population diet and PA behaviors are needed. OBJECTIVE: This 1-year randomized controlled trial (6-month intervention and 6-month follow-up) aims to investigate whether a tailored intervention using mobile technology can improve diet and PA behaviors leading to weight loss in adults (aged 18-65 years) who are overweight or obese and recruited through a social marketing campaign (LiveLighter). METHODS: All eligible participants will provide data on demographics and lifestyle behaviors online at baseline, 6 months, and 12 months. Using two-stage randomization, participants will be allocated into one of three conditions (n=200 per group): tailored feedback delivered via email at seven time points, informed by objective dietary (mobile food record app) and activity (wearable activity monitor) assessment; active control receiving no tailored feedback, but undergoing the same objective assessments as tailored feedback; and online control receiving no tailored feedback or objective assessments. Primary outcome measures at 6 and 12 months are changes in body mass, EDNP food and beverage consumption, and daily moderate-to-vigorous PA (measured via accelerometry). Secondary outcomes include change in fruit and vegetable consumption, daily sedentary behaviors, and cost effectiveness. RESULTS: Enrolment commenced in August 2017. Primary outcomes at 12 months will be available for analysis from September 2019. CONCLUSIONS: Tailored email feedback provided to individuals may deliver a cost-effective strategy to overcome existing barriers to improving diet and PA. If found to be successful and cost effective, upscaling this intervention for inclusion in larger-scale interventions is highly feasible. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617000554369; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=371325&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12782.

Image-Based Dietary Assessment and Tailored Feedback Using Mobile Technology: Mediating Behavior Change in Young Adults.

Assessing the implementation of nutrition interventions is important to identify characteristics and dietary patterns of individuals who benefit most. The aim was to report on young adults' experiences of receiving dietary feedback text messaging intervention. Diet was captured using an image-based 4-day mobile food recordTM application (mFRTM) and assessed to formulate two tailored feedback text messages on fruit and vegetables and energy-dense nutrient-poor (EDNP) foods and beverages. At 6-months 143 participants completed a second mFRTM and a questionnaire evaluating the dietary feedback. Participants who agreed the text messages made them think about how much vegetables they ate were more likely to increase their intake by at least half a serve than those who disagreed [odds ratio (OR) = 4.28, 95% Confidence Interval (CI): 1.76 to 10.39]. Those who agreed the text messages made them think about how much EDNP foods they ate, were twice as likely to decrease their intake by over half a serve (OR = 2.39, 95%CI: 1.12 to 5.25) than those who disagreed. Undertaking detailed dietary assessment ensured the tailored feedback was constructive and relevant. Personal contemplation about vegetable and EDNP food intake appears to be a mediator of dietary change in young adults.

Home-Based Exercise Improves Fitness and Exercise Attitude and Intention in Women with GDM.

PURPOSE: The purpose of the study was to determine the effect of a home-based cycling program for women with a recent diagnosis of gestational diabetes mellitus (GDM) on aerobic fitness, weight gain, self-reported mobility, attitude, and intentions toward maternal exercise, and obstetric and neonatal outcomes. METHODS: Forty women (mean ± SD, 28.8 ± 0.9-wk gestation) were randomized to either a supervised, home-based exercise program, combining continuous steady-state and interval cycling at various intensities, in combination with unsupervised moderate intensity aerobic activity and conventional diabetic management (EX; n = 20) or to conventional management alone (CON; n = 20). The program began following diagnosis until week 34 of pregnancy (mean ± SD duration of training, 6 ± 1 wk). RESULTS: Mean compliance to the training program was 96%. Maternal aerobic fitness, and attitude and intentions toward exercise were improved in response to the home-based exercise intervention compared with CON (P < 0.05). No differences were observed between the groups with respect to maternal weight gain or obstetric and neonatal outcomes (P > 0.05). CONCLUSION: A home-based exercise program of 6 ± 1 wk in duration commenced after diagnosis of GDM can improve aerobic fitness and attitude and intentions toward exercise, with no adverse effect on maternal and neonatal pregnancy outcomes.

Home-based exercise training improves capillary glucose profile in women with gestational diabetes.

PURPOSE: Regular maternal exercise may play an important role in the management of gestational diabetes mellitus (GDM), yet specific exercise guidelines to achieve glycemic control have not been established. Furthermore, many women remain sedentary during pregnancy because of perceived barriers to exercise participation. This study examined the effectiveness of a home-based cycling program commenced upon diagnosis of GDM on daily fasting and postprandial blood glucose levels, glycosylated hemoglobin (HbA1c), and the response of glucose and insulin to a 75-g oral glucose load. METHODS: Forty sedentary women (28.8 ± 0.9 wk of gestation) were randomized to either home-based exercise training in combination with conventional management (EX, n = 20) or to conventional management alone (CON, n = 20) until week 34 of pregnancy. RESULTS: Mean compliance to the supervised exercise training was 96%, and no adverse effects were reported. Capillary glucose concentration was acutely reduced in response to each cycling session (6.3 ± 0.8 mM to 4.9 ± 0.7 mM, P < 0.001). Overall, the EX group had lower mean daily postprandial glucose concentrations throughout the intervention compared with that in the CON group (P < 0.05) despite consuming a greater proportion of dietary carbohydrate (P < 0.05). No differences were observed between groups with respect to HbA1c or the glucose and insulin response to oral glucose ingestion postintervention (P > 0.05). CONCLUSIONS: A home-based cycling program may help to maintain daily postprandial normoglycemia in women with diet-controlled GDM.

Moderate-intensity exercise affects perceived hunger and fullness but not appetite-related hormones in late pregnancy.

The effect of exercise on appetite and appetite-related hormones during pregnancy is not known. This study found that 30 min of moderate-intensity stationary cycling transiently attenuated hunger and increased fullness in late gestational women (n = 12). Exercise did not affect perceived appetite or appetite-related hormones in response to subsequent caloric consumption. These observations suggest that appetite responses do not intrinsically compensate for the additional energy expenditure induced by exercise, at least in the short term.

Pregnant women exercise at a higher intensity during 30 min of self-paced cycling compared with walking during late gestation: implications for 2 h postprandial glucose levels.

OBJECTIVE: To compare the effect of an acute 30-min bout of self-paced stationary cycling (SC) with treadmill walking (TW) or a resting control (CON) on maternal blood glucose, insulin and metabolic responses during pregnancy. METHODS: Twelve healthy women at 29.9±2.4 (mean±SD) weeks gestation consumed a 75 g carbohydrate drink as part of an oral glucose tolerance test (OGTT) following 30 min of SC, TW or CON. Blood was sampled before and after exercise, and for 2 h in response to the OGTT for the determination of glucose and insulin. Exercise intensity was monitored and enjoyment of TW and SC was assessed post-exercise. RESULTS: Women selectively worked harder in SC compared with TW, with a higher maternal heart rate, rating of perceived exertion, mean oxygen consumption, respiratory exchange ratio, and total energy expenditure during exercise (p<0.05). SC was also associated with significantly lower postprandial blood glucose levels at 120 min following the OGTT (6.9±0.9 mmol∙l(-1)) compared with both CON (8.1±0.7 mmol∙l(-1), p=0.001) and TW (7.8±0.9 mmol∙l(-1), p=0.004) and lower insulin at 120 min post-glucose ingestion compared with TW (p=0.021). Enjoyment was similar between exercise protocols (p=0.437). CONCLUSIONS: In late pregnancy, an acute 30 min bout of self-paced SC may be preferable to a matched duration of TW given the additional energy expenditure that can be achieved, which in turn appears beneficial for blunting the glycemic response to glucose ingestion.

Postexercise water immersion increases short-term food intake in trained men.

PURPOSE: The performance of exercise while immersed in cold water has been shown to influence energy intake in the subsequent meal. In addition, cold water immersion (CWI) itself has been shown to reduce the concentration of the hormone leptin, high concentrations of which signal satiety. Taken together, these findings raise the question of whether the common practice of postexercise CWI by athletes acutely affects energy intake. Hence, this study investigated the acute effect of CWI after exercise on subsequent energy intake and macronutrient preferences as well as the circulating levels of a range of appetite-related hormones. METHODS: Ten physically active men participated in three randomized, counterbalanced trials consisting of 40 min of treadmill running (70% VO(2peak)), followed by 20 min of CWI (15°C), neutral water immersion (NWI; 33°C), or a resting control with no immersion (CON). Participants were then given a 30-min access to a buffet-type breakfast of precisely known quantity and nutrient composition from which they could consume ad libitum. RESULTS: Participants consumed significantly more energy after both CWI (mean ± SD = 4893 ± 1554 kJ, P = 0.006) and NWI (5167 ± 1975 kJ, P = 0.010) compared with CON (4089 ± 1585 kJ). However, there was no significant difference in total energy intake between the CWI and the NWI trials (P = 0.595). These changes were associated with a significant interaction effect of time and trial on both leptin (P = 0.045) and active ghrelin (P = 0.046). CONCLUSION: Postexercise water immersion is associated with higher energy intake in the subsequent meal compared with CON. This is an important consideration for trained men using water immersion as a method of recovery from exercise.