Epidemiology of physical activity and sedentary behavior levels among patients entering treatment for substance use disorder in the United States: a descriptive study.

Introduction: Little is known about physical activity behaviors among people with SUD. This study aimed to (a) describe self-reported moderate-to-vigorous physical activity (MVPA) and sedentary (SED) behaviors of adults with SUD initiating treatment (b), determine the potential contributions of drug of choice (DOC) on these behaviors, and (c) determine the potential contributions of level of care and demographic variables on these behaviors. Methods: Secondary data that was collected via surveys including demographic information, psychological health, drug of choice, MVPA (categorized as inactive, insufficiently active, meets guidelines, exceeds guidelines) and SED (<4 h/day, 4-<6 h/day, 6-8 h/day, >8 h/day) were analyzed from 1,293 patients in inpatient/outpatient treatment facilities across the United States. Results: On average, over half (51%) of patients entering treatment reported not meeting guidelines, but sitting time was generally low (median= 360 min/day). MVPA levels differed based on level of care (p<0.001) with 48% of patients in detox facilities reporting inactivity compared to 37% in residential and 29% in outpatient programs. MVPA and SED levels differed by sex with women less likely to report sitting <4 h/day (27.9% vs. 38.2%, p<0.001) and more likely to report sitting for >8 h/day (31.5% vs. 21.8%, p<0.001) compared to men. SED differed by race (p=0.01), with 54% of Black patients reporting <4 h/day compared to 33% of White patients. Discussion: Understanding activity behavior patterns among individuals entering SUD treatment provides opportunities for identifying the extent of lifestyle behavior needs and opportunities to develop personalized treatment strategies.

Feasibility of an Exercise and CBT Intervention for Treatment of Depression: A Pilot Randomized Controlled Trial.

Depression (DEP) is prevalent and current treatments are ineffective for many people. This pilot study's purpose was to assess the feasibility, acceptability, and plausible efficacy of an 8-week intervention employing 30 min of prescribed moderate intensity exercise ("ActiveCBT") compared to 30 min of usual activities ("CalmCBT") immediately prior to weekly online CBT sessions. Ten adults with DSM-5-diagnosed current DEP were randomized to groups and completed: an intake assessment, eight weekly CBT sessions, final assessment, and 3-month follow-up. ActiveCBT participants were prescribed 30-min of moderate exercise immediately prior to each standardized 50-min CBT session. CalmCBT participants continued with normal activities for 30 min before therapy. Questionnaires regarding DEP symptom severity (Patient Health Questionnaire-9 [PHQ-9]), between-session effectiveness (Behavioral Activation for Depression Survey [BADS], Automatic Thoughts Questionnaire [ATQ]), in-session effectiveness (Working Alliance Inventory-Short Revised [WAI]), and state anhedonia (Dimension Analog Rating Scale [DARS], Visual Analog Scale [VAS]; assessed 3 times: before Active/Calm condition, after, and after therapy) were completed each week. Therapy fidelity ratings were independently coded via a standardized codebook. The Structured Clinical Interview for DSM-5 (SCID) and Hamilton Rating Scale for Depression (HAMD) were used to assess DEP at intake, final, and 3-month follow-up. We found strong feasibility and acceptability (100% adherence, 100% retention at final visit, 74.6% therapy fidelity, and high patient satisfaction ratings). Differences between groups favoring ActiveCBT in anhedonia (DARS, Hedges' g = 0.92; VAS, g = 3.16), within- (WAI, g = 0.1.10), and between-session effectiveness (ATQ g = -0.65; BADS g = -1.40), suggest plausible efficacy of ActiveCBT for enhancing CBT. DEP rates were reduced in both groups from baseline to final (60% MDD SCID remission) and at follow up (Active: 40%; Calm: 25%). Larger and potentially quicker symptom improvement was found favoring the Active condition to the final visit (HAMD, between-group changes g = -1.33; PHQ-9, g = -0.62), with small differences remaining at follow-up (HAMD, g = -0.45; PHQ-9, g = -0.19). Exercise priming appears acceptable and plausibly efficacious for enhancing mechanisms of CBT and overall outcomes, though the present small sample precludes efficacy determinations. It appears feasible to conduct a randomized controlled trial comparing ActiveCBT to CalmCBT. Future trials evaluating this potentially promising treatment approach and mediating mechanisms are warranted.

High Sitting Time Is a Behavioral Risk Factor for Blunted Improvement in Depression Across 8 Weeks of the COVID-19 Pandemic in April-May 2020.

The COVID-19 pandemic has elicited increased sedentary behaviors, decreased moderate-to-vigorous physical activity (MVPA), and worsened mental health, yet the longitudinal impact of these changes and their inter-relations remains unknown. Our purpose was to examine associations between changes in self-reported activity behaviors and mental health over an 8-week period following the COVID-19 outbreak. Participants from all 50 states and the District of Colombia were recruited through convenience and snowball sampling at baseline April 3-10, 2020. Prospective data from 2,327 US adults with ≥2 responses (63.8% female; 74.3% response rate) were collected weekly via online survey for eight consecutive weeks (April 3-June 3, 2020). Primary exposures were self-reported time spent sitting, viewing screens and in MVPA, with primary outcomes being depressive symptoms, anxiety symptoms, and positive mental health (PMH). A significant sitting-by-time interaction (p < 0.05) showed slightly higher marginal effects for depressive symptoms for the 90th-percentile of sitting time than the 10th-percentile at baseline (5.8 [95% confidence interval = 5.5-6.2] vs. 5.7 [5.4-6.1]), with the difference magnifying over time (week 8: 3.5 [3.2-3.9] vs. 2.7 [2.4-2.9]). No other interactions over time were significant. Screen time was negatively associated with PMH and positively associated with depressive and anxiety symptoms (p < 0.05). Sitting time was negatively associated with PMH (p < 0.05). Rapid changes in sitting patterns (e.g., due to a pandemic) may have lasting effects on depressive symptoms. Strategies targeting those most affected (i.e., young adults, females) and/or focused on reducing sitting time may be critical for preventing long-term mental health effects resulting from COVID-19 or other large-scale behavior changes in the general population.

Associations Between Change in Outside Time Pre- and Post-COVID-19 Public Health Restrictions and Mental Health: Brief Research Report.

The novel coronavirus disease 2019 (COVID-19) and associated pandemic has resulted in systemic changes to much of life, affecting both physical and mental health. Time spent outside is associated with positive mental health; however, opportunities to be outside were likely affected by the COVID-19 public health restrictions that encouraged people not to leave their homes unless it was required. This study investigated the impact of acute COVID-19 public health restrictions on outside time in April 2020, and quantified the association between outside time and both stress and positive mental health, using secondary analyses of cross-sectional data from the COVID and Well-being Study. Participants (n = 3,291) reported demographics, health behaviors, amount of time they spent outside pre/post COVID-19 public health restrictions (categorized as increased, maintained, or decreased), current stress (Perceived Stress Scale-4), and positive mental health (Short Warwick-Edinburgh Mental Well-being Scale). Outside time was lower following COVID-19 restrictions (p < 0.001; Cohen's d = -0.19). Participants who increased or maintained outside time following COVID-19 restrictions reported lower stress (p < 0.001, 5.93 [5.74-6.12], Hedges' g = -0.18; p < 0.001, mean = 5.85 [5.67-6.02], Hedges' g = -0.21; respectively) and higher positive mental health (p < 0.001, 24.49 [24.20-24.77], Hedges' g = 0.21; p < 0.001, 24.78 [24.52-25.03], Hedges' g = 0.28) compared to those who decreased outside time. These findings indicate that there are likely to be negative stress and mental health implications if strategies are not implemented to encourage and maintain safe time outside during large-scale workplace and societal changes (e.g., during a pandemic).

A qualitative analysis of barriers and facilitators to reducing sedentary time in adults with chronic low back pain.

BACKGROUND: Sedentary time (SED) is associated with many detrimental health outcomes, yet little is known about what factors influence one's ability to reduce SED. Even less is known about these factors in specific patient populations for whom high levels of SED may influence symptoms, such as those with chronic low back pain (cLBP). The purpose of this study was to qualitatively explore participants' perceptions of factors that influenced their ability to reduce SED across an 8-week intervention to reduce SED in adults with cLBP and elevated depressive symptoms. METHODS: Three months after a theory-based intervention to break up and reduce sitting, semi-structured interviews explored factors that influenced reducing SED. Three researchers independently coded each conversation. Codes were charted and mapped with participants reviewing their own transcripts and the merged codes. The research team then defined key themes. Factors that were perceived to either facilitate behavior change or acted as barriers were identified and thematized as positive or negative determinants. RESULTS: Common barriers for reducing SED included environmental constraints, opposing social norms, and productivity; these barriers were frequently encountered in the workplace. Common facilitators for reducing SED included habit development, self-monitoring tools, restructuring the physical environment, and social accountability. Notably, back pain was not a frequently reported barrier or facilitator for reducing SED. CONCLUSION: This sample of patients with cLBP and elevated depressive symptoms had similar determinants for reducing SED as previously reported in non-patient populations and did not appear to need strategies specific to dealing with chronic pain. Since work-related social norms and environmental factors were perceived as significant barriers to sitting less, workplace interventions that provide standing desks, offer standing meetings rooms, and/or institution-wide standing breaks may help reduce SED at work. The use of an activity monitor with sitting reminders and education regarding how to use the reminders as external cues to develop new sitting habits may also aid in adoption and adherence to this behavior change across settings. Developing coping plans and restructuring physical environments were perceived as successful strategies for overcoming social and environmental barriers. Future interventions targeting SED reductions may benefit from incorporating these strategies.

Evaluating Motivational Interviewing and Habit Formation to Enhance the Effect of Activity Trackers on Healthy Adults' Activity Levels: Randomized Intervention.

BACKGROUND: While widely used and endorsed, there is limited evidence supporting the benefits of activity trackers for increasing physical activity; these devices may be more effective when combined with additional strategies that promote sustained behavior change like motivational interviewing (MI) and habit development. OBJECTIVE: This study aims to determine the utility of wearable activity trackers alone or in combination with these behavior change strategies for promoting improvements in active and sedentary behaviors. METHODS: A sample of 91 adults (48/91 female, 53%) was randomized to receive a Fitbit Charge alone or in combination with MI and habit education for 12 weeks. Active and sedentary behaviors were assessed pre and post using research-grade activity monitors (ActiGraph and activPAL), and the development of habits surrounding the use of the trackers was assessed postintervention with the Self-Reported Habit Index. During the intervention, Fitbit wear time and activity levels were monitored with the activity trackers. Linear regression analyses were used to determine the influence of the trial on outcomes of physical activity and sedentary time. The influence of habits was examined using correlation coefficients relating habits of tracker use (wearing the tracker and checking data on the tracker and associated app) to Fitbit wear time and activity levels during the intervention and at follow-up. RESULTS: Regression analyses revealed no significant differences by group in any of the primary outcomes (all P>.05). However, personal characteristics, including lower baseline activity levels (beta=-.49, P=.01) and lack of previous experience with pedometers (beta=-.23, P=.03) were predictive of greater improvements in moderate and vigorous physical activity. Furthermore, for individuals with higher activity levels at the baseline, MI and habit education were more effective for maintaining these activity levels when compared with receiving a Fitbit alone (eg, small increase of ~48 steps/day, d=0.01, vs large decrease of ~1830 steps/day, d=0.95). Finally, habit development was significantly related to steps/day during (r=.30, P=.004) and following the intervention (r=.27, P=.03). CONCLUSIONS: This study suggests that activity trackers may have beneficial effects on physical activity in healthy adults, but benefits vary based on individual factors. Furthermore, this study highlights the importance of habit development surrounding the wear and use of activity trackers and the associated software to promote increases in physical activity. TRIAL REGISTRATION: ClinicalTrials.gov NCT03837366; https://clinicaltrials.gov/ct2/show/NCT03837366.