Understanding Heterogeneity in Individual Responses to Digital Lifestyle Intervention Through Self-Monitoring Adherence Trajectories in Adults With Overweight or Obesity: Secondary Analysis of a 6-Month Randomized Controlled Trial.

BACKGROUND: Achieving clinically significant weight loss through lifestyle interventions for obesity management is challenging for most individuals. Improving intervention effectiveness involves early identification of intervention nonresponders and providing them with timely, tailored interventions. Early and frequent self-monitoring (SM) adherence predicts later weight loss success, making it a potential indicator for identifying nonresponders in the initial phase. OBJECTIVE: This study aims to identify clinically meaningful participant subgroups based on longitudinal adherence to SM of diet, activity, and weight over 6 months as well as psychological predictors of participant subgroups from a self-determination theory (SDT) perspective. METHODS: This was a secondary data analysis of a 6-month digital lifestyle intervention for adults with overweight or obesity. The participants were instructed to perform daily SM on 3 targets: diet, activity, and weight. Data from 50 participants (mean age: 53.0, SD 12.6 y) were analyzed. Group-based multitrajectory modeling was performed to identify subgroups with distinct trajectories of SM adherence across the 3 SM targets. Differences between subgroups were examined for changes in clinical outcomes (ie, body weight, hemoglobin A1c) and SDT constructs (ie, eating-related autonomous motivation and perceived competence for diet) over 6 months using linear mixed models. RESULTS: Two distinct SM trajectory subgroups emerged: the Lower SM group (21/50, 42%), characterized by all-around low and rapidly declining SM, and the Higher SM group (29/50, 58%), characterized by moderate and declining diet and weight SM with high activity SM. Since week 2, participants in the Lower SM group exhibited significantly lower levels of diet (P=.003), activity (P=.002), and weight SM (P=.02) compared with the Higher SM group. In terms of clinical outcomes, the Higher SM group achieved a significant reduction in body weight (estimate: -6.06, SD 0.87 kg; P<.001) and hemoglobin A1c (estimate: -0.38, SD 0.11%; P=.02), whereas the Lower SM group exhibited no improvements. For SDT constructs, both groups maintained high levels of autonomous motivation for over 6 months. However, the Lower SM group experienced a significant decline in perceived competence (P=.005) compared with the Higher SM group, which maintained a high level of perceived competence throughout the intervention (P=.09). CONCLUSIONS: The presence of the Lower SM group highlights the value of using longitudinal SM adherence trajectories as an intervention response indicator. Future adaptive trials should identify nonresponders within the initial 2 weeks based on their SM adherence and integrate intervention strategies to enhance perceived competence in diet to benefit nonresponders. TRIAL REGISTRATION: ClinicalTrials.gov NCT05071287; https://clinicaltrials.gov/study/NCT05071287. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1016/j.cct.2022.106845.

Impact of ¡Míranos! on parent-reported home-based healthy energy balance-related behaviors in low-income Latino preschool children: a clustered randomized controlled trial.

BACKGROUND: Widespread establishment of home-based healthy energy balance-related behaviors (EBRBs), like diet, physical activity, sedentary behavior, screen time, and sleep, among low-income preschool-aged children could curb the childhood obesity epidemic. We examined the effect of an 8-month multicomponent intervention on changes in EBRBs among preschool children enrolled in 12 Head Start centers. METHODS: The Head Start (HS) centers were randomly assigned to one of three treatment arms: center-based intervention group (CBI), center-based plus home-based intervention group (CBI + HBI), or control. Before and following the intervention, parents of 3-year-olds enrolled in participating HS centers completed questionnaires about their child's at-home EBRBs. Adult-facilitated physical activity (PA) was measured by an index based on questions assessing the child's level of PA participation at home, with or facilitated by an adult. Fruit, vegetable, and added sugar intake were measured via a short food frequency questionnaire, and sleep time and screen time were measured using 7-day logs. A linear mixed effects model examined the intervention's effect on post-intervention changes in PA, intake of fruit, vegetable, and added sugar, sleep time, and screen time from baseline to post-intervention. RESULTS: A total of 325 parents participated in the study (CBI n = 101; CBI + HBI n = 101; and control n = 123). Compared to control children, CBI and CBI + HBI parents reported decreases in children's intake of added sugar from sugar-sweetened beverages. Both CBI and CBI + HBI parents also reported smaller increases in children's average weekday screen time relative to controls. In addition, CBI + HBI parents reported CBI + HBI parents reported increases in children's adult-facilitated PA, fruit and vegetable intake, and daily sleep time during weekdays (excluding weekends) and the total week from baseline to post-intervention, while children in the CBI increased sleep time over the total week compared to the children in the control group. CONCLUSIONS: Parent engagement strengthened the improvement in parent-reported EBRBs at home in young children participating in an evidence-based obesity prevention program in a childcare setting. Future studies should investigate equity-related contextual factors that influence the impact of obesity prevention in health-disparity populations. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03590834. Registered July 18, 2018, https://clinicaltrials.gov/ct2/show/NCT03590834.

¡Míranos! a Comprehensive Preschool Obesity Prevention Program in Low-Income Latino Children: One-year Results of a Clustered Randomized Controlled Trial.

OBJECTIVE: Test a culturally tailored obesity prevention intervention in low-income, minority preschool-age children. DESIGN: A three-group clustered randomized controlled trial. SETTING: Twelve Head Start Centers were randomly assigned to a center-based intervention, a combined center- and home-based intervention, or control using a 1:1:1 ratio. The center-based intervention modified center physical activity and nutrition policies, staff practices, and child behaviors, while the home-based intervention supported parents for obesity prevention at home. STUDY OUTCOMES: The primary endpoint was change in children's body mass index (BMI; kg/m2) at posttest immediately following completion of the 8-month intervention. Secondary endpoints included standardized scores for BMI (BMIz) and body weight (WAZ), and BMI percentiles (BMI pctl). PARTICIPANTS: Three-year-old children enrolled in Head Start in San Antonio, Texas, with written parent consent (N=325), 87% Latino; 57% female with mean age (SD) of 3.58 years (0.29). RESULTS: Change in BMI at posttest was 1.28 (0.97), 1.28 (0.87), and 1.41 (0.71) in the center+home-based intervention, center-based intervention, and control, respectively. There was no significant difference in BMI change between center+home-based intervention and control or center-based intervention and control at posttest. BMIz (adjusted difference -0.12 [95% CI, -0.24 to 0.01], p = .06) and WAZ (adjusted difference, -0.09 [-0.17 to -0.002], p = .04) were reduced for children in center+home-based intervention compared to control group. CONCLUSIONS: There was no reduction in BMI at posttest in children who received the intervention. Findings shed light on methodological challenges in childhood obesity research and offer future directions to explore health equity-oriented obesity prevention.

Associations of physical activity with sarcopenia and sarcopenic obesity in middle-aged and older adults: the Louisiana osteoporosis study.

BACKGROUND: This study examined the associations between physical activity, obesity, and sarcopenia in middle-aged and older adults. METHODS: We analyzed the data of 8, 919 study participants aged between 45 to 97 (mean age = 57.2 ± 8.8) from a Southern state in the United States. Self-reported physical activity was classified to regular exercise ≥ 3 times/week, < 3 times/week, and no regular exercise. Associations between physical activity, obesity and sarcopenia were explored with generalized linear models and ordinal logistic regressions stratified by age (middle-aged and older adults) and gender adjusting for covariates. RESULTS: In middle-aged and older adults, all examined obesity related traits (e.g., body mass index, waist circumference) were inversely associated with physical activity levels (p < 0.01) in both genders. Exercising ≥ 3 times/week was negatively associated with lean mass indicators (e.g., appendicular lean mass) in middle-aged and older females (p < 0.01), while the negative associations become positive after adjusting for weight. Positive associations between physical activity and grip strength were only found in middle-aged males (p < 0.05). Ordinal logistic regression revealed that those exercising ≥ 3 times/week were less likely to have obesity, sarcopenia, and sarcopenia obesity in all groups (p < 0.01), except for sarcopenia in older males and females (p > 0.05). Positive associations of exercising < 3 times/week with sarcopenia and sarcopenia obesity were only found in middled adults. CONCLUSION: The associations of exercise frequency with obesity and sarcopenia vary considerably across gender and age groups. Exercise programs need to be individualized to optimize health benefits. Future research exploring physical activity strategies to balance weight reduction and lean mass maintaining is warranted in middle-aged and especially older adults.

Egg protein supplementation improved upper body muscle strength and protein intake in community-dwelling older adult females who attended congregate meal sites or adult learning centers: A pilot randomized controlled trial.

Background: Older adults that utilize community-based nutrition services are at higher nutritional risk than the general aging population, yet studies on the efficacy of protein interventions in this population are lacking. Aim: A double-blinded randomized controlled pilot study trial evaluated the impact of egg white protein supplementation on muscle mass, strength, and physical function in predominantly low-income Latina community-dwelling adult females aged 60 or older with reduced muscle strength or function. Methods: Participants (mean age = 73.6 ± 8.3 years) were randomly assigned to receive a daily dried egg white (20 g protein) or isocaloric maltodextrin supplement for 6 months (n = 16 intervention; n = 13 control). The primary outcome measure was appendicular skeletal muscle mass. Secondary outcomes were measures of muscle strength and function and dietary protein intake. Comparisons of baseline demographics were conducted using t-tests and χ2 or Fisher's exact tests. Differences between groups were assessed using general linear models, adjusted for baseline values, and differences within groups were assessed using paired t-tests or Kruskal-Wallis. Results: No significant between-group differences were found for all measures, but protein intake, handgrip strength, and the number of arm curls significantly improved in the intervention group. Under-recruitment of study participants and a high dropout rate impacted the ability of this study to detect significant differences between groups. Conclusion: Daily egg white protein supplementation increases protein intake and supports upper body physical function in older adults, but additional studies are needed to investigate its role in the prevention of age-related muscle mass decline in older adults. Trial #NCT03530774 (https://clinicaltrials.gov/ct2/show/NCT03530774).

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials.

OBJECTIVES: To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness. DESIGN: Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity. PARTICIPANTS: Data for 6621 children and adolescents aged 4-18 years from 20 trials were included. MAIN OUTCOME MEASURES: Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity. RESULTS: Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness. CONCLUSIONS: Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

Impacts on patient-centered outcomes of a chronic pain self-management program in a rural community: A feasibility study.

This study explored if a self-management training program was feasible for a predominantly older rural Latino adults with chronic pain who had limited access to non-pharmacologically based pain treatment. Physical therapy doctoral students delivered the six-week low-literacy low-cost patient-centered program. The intervention was feasible to the participants (n=38) who showed improvement in a majority of the eight outcome measures at 6-week posttest and three measures at 18-week followup. The changes in pain severity, pain interference and pain-related physical functions reached minimally clinically important difference at follow-up. A randomized controlled trial with long-term follow-up is needed to test the program effectiveness in partnership with community health centers to increase access to pain management in rural communities.

Higher levels of physical activity buffered the negative effect of pain severity on physical frailty in older Latinx adults.

This cross-sectional study examined whether and to what extent physical activity (PA) mediated the effect of chronic pain on physical frailty in a sample of predominantly older Latinx adults. Study participants were 118 community-dwelling older adults in southwest United States. Physical frailty was measured by a summary score of physical function tests. Pain severity and pain interference were measured by the Brief Pain Inventory. PA levels were defined as meeting the PA recommendation by 7-day accelerometry. Pain outcomes and PA were associated with physical frailty, respectively. Hierarchical regression analysis revealed that PA mediated the relationship between pain severity and physical frailty. However, no mediation effect of PA was found in the relationship between pain interference and physical frailty scores. Higher levels of PA buffered the negative effect of pain severity on physical frailty. Future studies should pay attention to PA promotion to prevent the negative consequences of frailty in older minority adults.

Chronic Pain Self-Management Program for Low-Income Patients: Themes from a Qualitative Inquiry.

OBJECTIVE: To examine factors influencing initial engagement, ongoing participation, learned behaviors, and subjective functional outcomes after a trial of the Living Better Beyond Pain (LBBP) chronic pain self-management program. DESIGN: Qualitative study using the Grounded Theory approach. SETTING: Two 60-minute focus groups and phone interviews in May 2017. SUBJECTS: Focus groups with 18 participants who completed LBBP and six-month measures; telephone interviews with 17 participants who stopped attending. METHODS: Study coordinators randomly selected program completers for focus groups and conducted phone interviews with noncompleters. Inductive thematic analysis was used to identify patterns in semantic content with a recursive process applied to focus group transcripts and interview transcriptions to codify into themes. Themes were categorized according to the Theory of Planned Behavior. RESULTS: Focus group and telephone interview participants were primarily Hispanic and unemployed. Attitudes fostering participation in LBBP included dissatisfaction with the status quo, need to reduce pain medication, and lack of training and knowledge about chronic pain. Positive social norms from meeting others with chronic pain and support from the LBBP team encouraged attendance and adoption of behaviors. Transportation, pain, and competing activities were barriers, whereas adapting activities for the disabled was a facilitator. Maintaining behaviors and activities at home was challenging but ultimately rewarding due to improvement in daily function with less pain medication. CONCLUSIONS: This qualitative study complements quantitative results showing clinically significant improvements in function after the LBBP program by adding practical insights into ways to increase participation and outcomes. Participants strongly endorsed the need for chronic pain self-management training.

Study protocol for a cluster randomized controlled trial to test "¡Míranos! Look at Us, We Are Healthy!" - an early childhood obesity prevention program.

BACKGROUND: One in three Head Start children is either overweight or obese. We will test the efficacy of an early childhood obesity prevention program, "¡Míranos! Look at Us, We Are Healthy!" (¡Míranos!), which promotes healthy growth and targets multiple energy balance-related behaviors in predominantly Latino children in Head Start. The ¡Míranos! intervention includes center-based (policy changes, staff development, gross motor program, and nutrition education) and home-based (parent engagement/education and home visits) interventions to address key enablers and barriers in obesity prevention in childcare. In partnership with Head Start, we have demonstrated the feasibility and acceptability of the proposed interventions to influence energy balance-related behaviors favorably in Head Start children. METHODS: Using a three-arm cluster randomized controlled design, 12 Head Start centers will be randomly assigned in equal number to one of three conditions: 1) a combined center- and home-based intervention, 2) center-based intervention only, or 3) comparison. The interventions will be delivered by trained Head Start staff during the academic year. A total of 444 3-year-old children (52% females; n = 37 per center at baseline) in two cohorts will be enrolled in the study and followed prospectively 1 year post-intervention. Data collection will be conducted at baseline, immediately post-intervention, and at the one-year follow-up and will include height, weight, physical activity (PA) and sedentary behaviors, sleep duration and screen time, gross motor development, dietary intake and food and activity preferences. Information on family background, parental weight, PA- and nutrition-related practices and behaviors, PA and nutrition policy and environment at center and home, intervention program costs, and treatment fidelity will also be collected. DISCUSSION: With endorsement and collaboration of two local Head Start administrators, ¡Míranos!, as a culturally tailored obesity prevention program, is poised to provide evidence of efficacy and cost-effectiveness of a policy and environmental approach to prevent early onset of obesity in low-income Latino preschool children. ¡Míranos! can be disseminated to various organized childcare settings, as it is built on the Head Start program and its infrastructure, which set a gold standard for early childhood education, as well as current PA and nutrition recommendations for preschool children. TRIAL REGISTRATION: ClinicalTrials.Gov ( NCT03590834 ) July 18, 2018.

Process evaluation of a community-based diabetes prevention program in China: the Pathway to Health (PATH).

High prevalence of diabetes and prediabetes has emerged as a concern in China. The Pathway to Health Program was designed to prevent type 2 diabetes onset in prediabetic women in a north China urban community. This process evaluation of a randomized controlled trial analysed participant surveys at the 6- and 12-month assessment times, participant weekly logs, class attendance records and post-study participant focus group results. The reported levels of participant engagement in physical activity (PA)-related behaviors were higher than diet-related behaviors at the 6-month assessment. The engagement in both PA- and diet-related behaviors declined during the 6-month follow-up period. Step counts from the participants' pedometers indicated an increase in PA in the first 6 months of the intervention. Study participants expressed high levels of satisfaction with the intervention and increased their scores on diabetes-related knowledge. Conflicts with work and family responsibilities were the main barriers for missing health lessons, likely contributing to minimal weight loss. There was good fidelity in program implementation. Intensive lifestyle modification programs are difficult to sustain once the program is complete. A more structured 6-month follow-up phase may have provided needed support to enable participants to maintain their lifestyle changes.

Randomized Trial of Chronic Pain Self-Management Program in the Community or Clinic for Low-Income Primary Care Patients.

BACKGROUND: Patients with chronic pain often lack the skills and resources necessary to manage this disease. OBJECTIVE: To develop a chronic pain self-management program reflecting community stakeholders' priorities and to compare functional outcomes from training in two settings. DESIGN: A parallel-group randomized trial. PARTICIPANTS: Eligible subjects were 35-70 years of age, with chronic non-cancer pain treated with opioids for >2 months at two primary care and one HIV clinic serving low-income Hispanics. INTERVENTIONS: In one study arm, the 6-month program was delivered in monthly one-on-one clinic meetings by a community health worker (CHW) trained as a chronic pain health educator, and in the second arm, content experts gave eight group lectures in a nearby library. MAIN MEASURES: Five times Sit-to-Stand test (5XSTS) assessed at baseline and 3 and 6 months. Other reported physical and cognitive measures include the 6-Min Walk (6 MW), Borg Perceived Effort Test (Borg Effort), 50-ft Speed Walk (50FtSW), SF-12 Physical Component Summary (SF-12 PCS), Patient-Specific Functional Scale (PSFS), and Symbol-Digit Modalities Test (SDMT). Intention-to-treat (ITT) analyses in mixed-effects models adjust for demographics, body mass index, maximum pain, study arm, and measurement time. Multiple imputation was used for sensitivity analyses. KEY RESULTS: Among 111 subjects, 53 were in the clinic arm and 58 in the community arm. In ITT analyses at 6 months, subjects in both arms performed the 5XSTS test faster (-4.9 s, P = 0.001) and improved scores on Borg Effort (-1, P = 0.02), PSFS (1.6, P < 0.001), and SDMT (5.9, P < 0.001). Only the clinic arm increased the 6 MW (172.4 ft, P = 0.02) and SF-12 PCS (6.2 points, P < 0.001). 50ftSW did not change (P = 0.15). Results were similar with multiple imputation. Five falls were possible adverse events. CONCLUSIONS: In low-income subjects with chronic pain, physical and cognitive function improved significantly after self-management training from expert lectures in the community and in-clinic meetings with a trained health educator.

Excessive homework, inadequate sleep, physical inactivity and screen viewing time are major contributors to high paediatric obesity.

AIM: This study examined the relationships between energy balance-related behaviours (EBRBs) outside school hours and obesity in Chinese primary school students. We also explored the influence of gender on those relationships. METHODS: The study sample was a cross-sectional cohort of 5032 Chinese children who were enrolled in grades 1-6 in primary schools in five Chinese cities and whose mean ages ranged from seven years and three months to 11.9 years. The children's parents completed a survey on their child's height, weight and EBRBs outside school hours. RESULTS: The response rate was 97%, and the reported rates of overweight and obesity were 13.6% and 13.8%, respectively. The obesity rates were higher in boys and lower grade children. Most EBRBs varied between boys and girls and with increased grade levels. The amount of time spent on academic-related activities, screen viewing, outdoor activities and sleep was mostly associated with obesity on weekdays and varied by gender. CONCLUSION: Rate of obesity was alarmingly high in the primary school Chinese children in this cohort, especially in younger children. Excessive time spent on academic-related activities outside school hours, inadequate sleep, physical inactivity and higher levels of screen viewing were major contributors to obesity in these Chinese children.

¡Miranos! (Look at Us! We Are Healthy!): Home-Based and Parent Peer-Led Childhood Obesity Prevention.

Parent interventions for childhood obesity prevention have traditionally experienced low participation rates or used passive methods such as newsletters. In contrast, the ¡Miranos! intervention home-based activities included parent-led face-to-face meetings delivered after school, take-home bags with educational materials, and scavenger hunt games to deliver health information to Head Start families regarding nutrition, physical activity, and healthy growth promotion for their preschooler. This study employed a quasi-experimental design with three intervention centers (two that received only center-based activities and one that received center- and home-based activities) and one comparison center. Data were collected on participating Head Start children and their parents/guardians and included parent attendance, parent health message recall through intercept interviews, parent knowledge through pre- and posttests, and family supportive behaviors and child health behaviors through a parent questionnaire. Parents/guardians that received both center- and home-based activities significantly increased knowledge scores (t = 2.50, degrees of freedom = 123, p < .05) and family supportive behaviors from baseline to follow-up (t = 2.12, degrees of freedom = 122, p < .05). This study demonstrates the effects home-based interventions can have when coupled with center-based activities and implemented in the center at the end of the school day.

Longer rest intervals do not attenuate the superior effects of accumulated exercise on arterial stiffness.

PURPOSE: To examine and compare the acute effects of moderate-intensity continuous and accumulated exercise in three bouts with different intervals on arterial stiffness. METHOD: Nineteen healthy young males (mean age = 24.7 years) were randomized to no-exercise control (CON), continuous exercise (CE, 30-min cycling), accumulated exercise with 10-min intervals (AE10, 3 × 10-min cycling, 10-min interval), and accumulated exercise with 60-min intervals (AE60, 3 × 10-min cycling, 60-min interval) trial in balanced self-control crossover design. The intensity in all the exercise trials was set at 50% heart rate reserve. Cardio-ankle vascular index (CAVI), an index of arterial stiffness, was measured at baseline (BL), immediately after (0 min) and 60 min after the completion of the exercise. RESULTS: CAVI remained stable (6.8 ± 0.1, 6.8 ± 0.2, 6.9 ± 0.1 at BL, 0 and 60 min, respectively) in CON trial. Immediately after exercise, CAVI in CE, AE10 and AE60 trials all decreased significantly to similar degree compared to CON trial (P < 0.05 for CE, AE10 and AE60 vs. CON). Though CAVI in CE trial returned to baseline level after 60 min of recovery, CAVI in both AE10 and AE60 trials remained significantly low compared to CON trial (P < 0.01 for AE10 and AE60 vs. CON). CONCLUSION: When the total duration and relative intensity were matched, the effects of accumulated exercise in three bouts were superior to continuous exercise. Elongation of intervals between bouts did not attenuate the superior effects of accumulated exercise on arterial stiffness. TRIAL REGISTRATION: ChiCTR-OTRCC-14005229.

Weight Outcomes of Latino Adults and Children Participating in the Y Living Program, a Family-Focused Lifestyle Intervention, San Antonio, 2012-2013.

INTRODUCTION: US Latinos have disproportionately higher rates of obesity and physical inactivity than the general US population, putting them at greater risk for chronic disease. This evaluation aimed to examine the impact of the Y Living Program (Y Living), a 12-week family-focused healthy lifestyle program, on the weight status of adult and child (aged ≥7 years) participants. METHODS: In this pretest-posttest evaluation, participants attended twice-weekly group education sessions and engaged in physical activity at least 3 times per week. Primary outcome measures were body mass index ([BMI], zBMI and BMI percentile for children), weight, waist circumference, and percentage body fat. Wilcoxon signed-rank tests and mixed effects models were used to evaluate pretest-posttest differences (ie, absolute change and relative change) for adults and children separately. RESULTS: BMI, weight, waist circumference, and percentage body fat improved significantly (both absolutely and relatively) among adults who completed the program (n = 180; all P ≤ .001). Conversely, child participants that completed the program (n = 72) showed no improvements. Intervention effects varied across subgroups. Among adults, women and participants who were obese at baseline had larger improvements than did children who were obese at baseline or who were in families that had an annual household income of $15,000 or more. CONCLUSION: Significant improvements in weight were observed among adult participants but not children. This family-focused intervention has potential to prevent excess weight gain among high-risk Latino families.

A policy-driven multifaceted approach for early childhood physical fitness promotion: impacts on body composition and physical fitness in young Chinese children.

BACKGROUND: The prevalence of obesity increased while certain measures of physical fitness deteriorated in preschool children in China over the past decade. This study tested the effectiveness of a multifaceted intervention that integrated childcare center, families, and community to promote healthy growth and physical fitness in preschool Chinese children. METHODS: This 12-month study was conducted using a quasi-experimental pretest/posttest design with comparison group. The participants were 357 children (mean age = 4.5 year) enrolled in three grade levels in two childcare centers in Beijing, China. The intervention included: 1) childcare center intervention (physical activity policy changes, teacher training, physical education curriculum and food services training), 2) family intervention (parent education, internet website for support, and family events), and 3) community intervention (playground renovation and community health promotion events). The study outcome measures included body composition (percent body fat, fat mass, and muscle mass), Body Mass Index (BMI) and BMI z-score and physical fitness scores in 20-meter agility run (20M-AR), broad jump for distance (BJ), timed 10-jumps, tennis ball throwing (TBT), sit and reach (SR), balance beam walk (BBW), 20-meter crawl (20M-C)), 30-meter sprint (30M-S)) from a norm referenced test. Measures of process evaluation included monitoring of children's physical activity (activity time and intensity) and food preparation records, and fidelity of intervention protocol implementation. RESULTS: Children in the intervention center significantly lowered their body fat percent (-1.2%, p < 0.0001), fat mass (-0.55 kg, p <0.0001), and body weight (0.36 kg, p <0.02) and increased muscle mass (0.48 kg, p <0.0001), compared to children in the control center. They also improved all measures of physical fitness except timed 10-jumps (20M-AR: -0.74 seconds, p < 0.0001; BJ: 8.09 cm, p < 0.0001; TBT: 0.52 meters, p < 0.006; SR: 0.88 cm, p < 0.03; BBW: -2.02 seconds, p <0.0001; 30M-S: -0.45 seconds, p < 0.02; 20M-C: -3.36 seconds, p < 0.0001). Process evaluation data showed that the intervention protocol was implemented with high fidelity. CONCLUSIONS: The study demonstrated that a policy-driven multi-faceted intervention can improve preschool children's body composition and physical fitness. Program efficacy should be tested in a randomized trial. TRIAL REGISTRATION: ChiCTR-ONRC-14004143.

Assessing media access and use among Latina adolescents to inform development of a physical activity promotion intervention incorporating text messaging.

Increasing physical activity (PA) during preadolescence and adolescence is critical to reversing the obesity epidemic. A recent report described the promising role of eHealth--the use of new media for purposes of health promotion--in reducing and preventing childhood obesity. This study assessed access/use of various media (cell phones, computers, gaming systems, Internet) among adolescent Latino girls and examined the relationship between PA and media access/use. A convenience sample of 110 Latino girls ages 11 to 14 was recruited from Girl Scouts of Southwest Texas and other groups. The media survey was self-administered (April-July 2010) on personal digital assistants. Of the girls, 55% reported owning a cell phone and spending 40 (SD = 4.2) hours per week talking, texting, listening to music, and browsing the Internet. Cell phone access increased significantly with age (p = .029). Compared to those with no cell phone, girls with a cell phone have greater odds of reporting more than 5 days of PA in the past week (odds ratio = 5.5, 95% confidence interval [CI] = 2.1, 14) and engaging in daily physical education classes (odds ratio = 2.6, 95% CI = 1.1, 5.9). Since girls with cell phones report greater PA, cell phones may be an effective strategy for communicating with girls about engaging in PA.

Decoding Heterogeneity in Data-Driven Self-Monitoring Adherence Trajectories in Digital Lifestyle Interventions for Weight Loss: A Qualitative Study.

Background: Data-driven trajectory modeling is a promising approach for identifying meaningful participant subgroups with various self-monitoring (SM) responses in digital lifestyle interventions. However, there is limited research investigating factors that underlie different subgroups. This qualitative study aimed to investigate factors contributing to participant subgroups with distinct SM trajectory in a digital lifestyle intervention over 6 months. Methods: Data were collected from a subset of participants (n = 20) in a 6-month digital lifestyle intervention. Participants were classified into Lower SM Group (n = 10) or a Higher SM (n = 10) subgroup based on their SM adherence trajectories over 6 months. Qualitative data were obtained from semi-structured interviews conducted at 3 months. Data were thematically analyzed using a constant comparative approach. Results: Participants were middle-aged (52.9 ± 10.2 years), mostly female (65%), and of Hispanic ethnicity (55%). Four major themes with emerged from the thematic analysis: Acceptance towards SM Technologies, Perceived SM Benefits, Perceived SM Barriers, and Responses When Facing SM Barriers. Participants across both subgroups perceived SM as positive feedback, aiding in diet and physical activity behavior changes. Both groups cited individual and technical barriers to SM, including forgetfulness, the burdensome SM process, and inaccuracy. The Higher SM Group displayed positive problem-solving skills that helped them overcome the SM barriers. In contrast, some in the Lower SM Group felt discouraged from SM. Both subgroups found diet SM particularly challenging, especially due to technical issues such as the inaccurate food database, the time-consuming food entry process in the Fitbit app. Conclusions: This study complements findings from our previous quantitative research, which used data-drive trajectory modeling approach to identify distinct participant subgroups in a digital lifestyle based on individuals' 6-month SM adherence trajectories. Our results highlight the potential of enhancing action planning problem solving skills to improve SM adherence in the Lower SM Group. Our findings also emphasize the necessity of addressing the technical issues associated with current diet SM approaches. Overall, findings from our study may inform the development of practical SM improvement strategies in future digital lifestyle interventions. Trial registration: The study was pre-registered at ClinicalTrials.gov (NCT05071287) on April 30, 2022.

A systematic umbrella review and meta-meta-analysis of eHealth and mHealth interventions for improving lifestyle behaviours.

The aim of this meta-meta-analysis was to systematically review randomised controlled trial (RCT) evidence examining the effectiveness of e- and m-Health interventions designed to improve physical activity, sedentary behaviour, healthy eating and sleep. Nine electronic databases were searched for eligible studies published from inception to 1 June 2023. Systematic reviews with meta-analyses of RCTs that evaluate e- and m-Health interventions designed to improve physical activity, sedentary behaviour, sleep and healthy eating in any adult population were included. Forty-seven meta-analyses were included, comprising of 507 RCTs and 206,873 participants. Interventions involved mobile apps, web-based and SMS interventions, with 14 focused on physical activity, 3 for diet, 4 for sleep and 26 evaluating multiple behaviours. Meta-meta-analyses showed that e- and m-Health interventions resulted in improvements in steps/day (mean difference, MD = 1329 [95% CI = 593.9, 2065.7] steps/day), moderate-to-vigorous physical activity (MD = 55.1 [95% CI = 13.8, 96.4] min/week), total physical activity (MD = 44.8 [95% CI = 21.6, 67.9] min/week), sedentary behaviour (MD = -426.3 [95% CI = -850.2, -2.3] min/week), fruit and vegetable consumption (MD = 0.57 [95% CI = 0.11, 1.02] servings/day), energy intake (MD = -102.9 kcals/day), saturated fat consumption (MD = -5.5 grams/day), and bodyweight (MD = -1.89 [95% CI = -2.42, -1.36] kg). Analyses based on standardised mean differences (SMD) showed improvements in sleep quality (SMD = 0.56, 95% CI = 0.40, 0.72) and insomnia severity (SMD = -0.90, 95% CI = -1.14, -0.65). Most subgroup analyses were not significant, suggesting that a variety of e- and m-Health interventions are effective across diverse age and health populations. These interventions offer scalable and accessible approaches to help individuals adopt and sustain healthier behaviours, with implications for broader public health and healthcare challenges.