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

Laura D Ellingson, Jeni E Lansing, Kathryn J DeShaw, Karissa L Peyer, Yang Bai, Maria Perez, L Alison Phillips, Gregory J Welk, Laura D Ellingson, Jeni E Lansing, Kathryn J DeShaw, Karissa L Peyer, Yang Bai, Maria Perez, L Alison Phillips, Gregory J Welk

Abstract

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://ichgcp.net/clinical-trials-registry/NCT03837366.

Keywords: activity tracker; habit; mHealth; mobile phone; motivational interviewing; physical activity; wearable electronic devices.

Conflict of interest statement

Conflicts of Interest: None declared.

©Laura D Ellingson, Jeni E Lansing, Kathryn J DeShaw, Karissa L Peyer, Yang Bai, Maria Perez, L Alison Phillips, Gregory J Welk. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 14.02.2019.

Figures

Figure 1
Figure 1
Timeline of study procedures.
Figure 2
Figure 2
Wear data and steps collected from the Fitbit via Fitabase during the 12-week intervention. FB+: Fitbit plus motivational interviewing and habit education; FB: Fitbit alone.
Figure 3
Figure 3
Within- and between-group comparisons of changes in active and sedentary behaviors measured via ActiGraph and activPAL pre-post based on original grouping (FB+, FB) and baseline activity level. Positive values for change scores indicate an increase from pre- to postintervention. FB+: Fitbit with motivational interviewing; FB: Fitbit alone.
Figure 4
Figure 4
Fitbit wear time in relation to habit automaticity over the intervention period by the group (FB+, FB). High versus low habit was defined using a median split of the data. FB+: Fitbit with motivational interviewing; FB: Fitbit alone.

References

    1. Bogaty S. 2015. [2015-11-30]. The demographic divide: Fitness trackers and smartwatches attracting very different segments of the market, according to the NPD group Internet .
    1. Llamas R. IDC Media Center. [2018-11-22]. Worldwide Wearables Market to Nearly Double by 2021, According to IDC Internet .
    1. Witkowski W. marketwatch. [2018-01-16]. Smartwatch growth surges ahead of Apple, Fitbit offerings - MarketWatch Internet .
    1. Bort-Roig J, Gilson ND, Puig-Ribera A, Contreras RS, Trost SG. Measuring and influencing physical activity with smartphone technology: a systematic review. Sports Med. 2014 May;44(5):671–86. doi: 10.1007/s40279-014-0142-5.
    1. Sullivan AN, Lachman ME. Behavior Change with Fitness Technology in Sedentary Adults: A Review of the Evidence for Increasing Physical Activity. Front Public Health. 2016;4:289. doi: 10.3389/fpubh.2016.00289. doi: 10.3389/fpubh.2016.00289.
    1. Vandelanotte C, Müller AM, Short CE, Hingle M, Nathan N, Williams SL, Lopez ML, Parekh S, Maher CA. Past, Present, and Future of eHealth and mHealth Research to Improve Physical Activity and Dietary Behaviors. J Nutr Educ Behav. 2016 Mar;48(3):219–228.e1. doi: 10.1016/j.jneb.2015.12.006.S1499-4046(15)00806-4
    1. Patel MS, Asch DA, Volpp KG. Wearable devices as facilitators, not drivers, of health behavior change. JAMA. 2015 Feb 3;313(5):459–60. doi: 10.1001/jama.2014.14781.2089651
    1. Thompson WG, Kuhle CL, Koepp GA, McCrady-Spitzer SK, Levine JA. “Go4Life” exercise counseling, accelerometer feedback, and activity levels in older people. Arch Gerontol Geriatr. 2014;58(3):314–9. doi: 10.1016/j.archger.2014.01.004.S0167-4943(14)00005-3
    1. Choi J, Lee JH, Vittinghoff E, Fukuoka Y. mHealth Physical Activity Intervention: A Randomized Pilot Study in Physically Inactive Pregnant Women. Matern Child Health J. 2016 May;20(5):1091–101. doi: 10.1007/s10995-015-1895-7.10.1007/s10995-015-1895-7
    1. Finkelstein EA, Haaland BA, Bilger M, Sahasranaman A, Sloan RA, Nang EEK, Evenson KR. Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial. Lancet Diabetes Endocrinol. 2016 Dec;4(12):983–995. doi: 10.1016/S2213-8587(16)30284-4.S2213-8587(16)30284-4
    1. Wang JB, Cadmus-Bertram LA, Natarajan L, White MM, Madanat H, Nichols JF, Ayala GX, Pierce JP. Wearable Sensor/Device (Fitbit One) and SMS Text-Messaging Prompts to Increase Physical Activity in Overweight and Obese Adults: A Randomized Controlled Trial. Telemed J E Health. 2015 Oct;21(10):782–92. doi: 10.1089/tmj.2014.0176.
    1. Lobelo F, Kelli HM, Tejedor SC, Pratt M, McConnell MV, Martin SS, Welk GJ. The Wild Wild West: A Framework to Integrate mHealth Software Applications and Wearables to Support Physical Activity Assessment, Counseling and Interventions for Cardiovascular Disease Risk Reduction. Prog Cardiovasc Dis. 2016;58(6):584–94. doi: 10.1016/j.pcad.2016.02.007.S0033-0620(16)30015-9
    1. Miller WR, Rollnick S. Meeting in the middle: motivational interviewing and self-determination theory. Int J Behav Nutr Phys Act. 2012;9:25. doi: 10.1186/1479-5868-9-25. 1479-5868-9-25
    1. Brodie DA, Inoue A. Motivational interviewing to promote physical activity for people with chronic heart failure. J Adv Nurs. 2005 Jun;50(5):518–27. doi: 10.1111/j.1365-2648.2005.03422.x.JAN3422
    1. Hardcastle SJ, Taylor AH, Bailey MP, Harley RA, Hagger MS. Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up. Int J Behav Nutr Phys Act. 2013 Mar 28;10:40. doi: 10.1186/1479-5868-10-40. 1479-5868-10-40
    1. Hettema J, Steele J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol. 2005;1:91–111. doi: 10.1146/annurev.clinpsy.1.102803.143833.
    1. Verplanken B, Aarts H, van Knippenberg A, Moonen A. Habit versus planned behaviour: a field experiment. Br J Soc Psychol. 1998 Mar;37 ( Pt 1):111–28.
    1. Gardner B, Lally P, Wardle J. Making health habitual: the psychology of 'habit-formation' and general practice. Br J Gen Pract. 2012 Dec;62(605):664–6. doi: 10.3399/bjgp12X659466.
    1. Kaushal N, Rhodes RE, Meldrum JT, Spence JC. The role of habit in different phases of exercise. Br J Health Psychol. 2017 Dec;22(3):429–448. doi: 10.1111/bjhp.12237.
    1. Kaushal N, Rhodes RE, Spence JC, Meldrum JT. Increasing Physical Activity Through Principles of Habit Formation in New Gym Members: a Randomized Controlled Trial. Ann Behav Med. 2017 Aug;51(4):578–586. doi: 10.1007/s12160-017-9881-5.10.1007/s12160-017-9881-5
    1. Phillips LA, Gardner B. Habitual exercise instigation (vs. execution) predicts healthy adults' exercise frequency. Health Psychol. 2016 Jan;35(1):69–77. doi: 10.1037/hea0000249.2015-30036-001
    1. Gollwitzer PM. Goal Achievement: The Role of Intentions. European Review of Social Psychology. 1993 Jan;4(1):141–185. doi: 10.1080/14792779343000059.
    1. Orbell S, Sheeran P. Motivational and Volitional Processes in Action Initiation: A Field Study of the Role of Implementation Intentions1. J Appl Social Pyschol. 2000 Apr;30(4):780–797. doi: 10.1111/j.1559-1816.2000.tb02823.x.
    1. Scholz U, Keller R, Perren S. Predicting behavioral intentions and physical exercise: a test of the health action process approach at the intrapersonal level. Health Psychol. 2009 Nov;28(6):702–8. doi: 10.1037/a0016088.2009-20990-007
    1. Schwarzer R, Lippke S, Luszczynska A. Mechanisms of health behavior change in persons with chronic illness or disability: the Health Action Process Approach (HAPA) Rehabil Psychol. 2011 Aug;56(3):161–70. doi: 10.1037/a0024509.2011-14571-001
    1. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C, Fernandez M. How we design feasibility studies. Am J Prev Med. 2009 May;36(5):452–7. doi: 10.1016/j.amepre.2009.02.002. S0749-3797(09)00096-8
    1. Adams R. Revised Physical Activity Readiness Questionnaire. Can Fam Physician. 1999 Apr;45:992, 995, 1004–5.
    1. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug;35(8):1381–95. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Ellingson LD, Schwabacher IJ, Kim Y, Welk GJ, Cook DB. Validity of an Integrative Method for Processing Physical Activity Data. Med Sci Sports Exerc. 2016 Dec;48(8):1629–38. doi: 10.1249/MSS.0000000000000915.
    1. Verplanken B, Orbell S. Reflections on past behavior: A self-report index of habit strength. J Appl Soc Psychol. 2003;33(6):1330.
    1. Gardner B, de Bruijn G, Lally P. A systematic review and meta-analysis of applications of the Self-Report Habit Index to nutrition and physical activity behaviours. Ann Behav Med. 2011 Oct;42(2):174–87. doi: 10.1007/s12160-011-9282-0.
    1. Gardner B, Abraham C, Lally P, de Bruijn G. Towards parsimony in habit measurement: testing the convergent and predictive validity of an automaticity subscale of the Self-Report Habit Index. Int J Behav Nutr Phys Act. 2012 Aug 30;9:102. doi: 10.1186/1479-5868-9-102. 1479-5868-9-102
    1. Tudor-Locke C, Craig CL, Brown WJ, Clemes SA, De CK, Giles-Corti B, Hatano Y, Inoue S, Matsudo SM, Mutrie N, Oppert J, Rowe DA, Schmidt MD, Schofield GM, Spence JC, Teixeira PJ, Tully MA, Blair SN. How many steps/day are enough? For adults. Int J Behav Nutr Phys Act. 2011;8:79. doi: 10.1186/1479-5868-8-79. 1479-5868-8-79
    1. Gardner B, Lally P. Does intrinsic motivation strengthen physical activity habit? Modeling relationships between self-determination, past behaviour, and habit strength. J Behav Med. 2013 Oct;36(5):488–97. doi: 10.1007/s10865-012-9442-0.
    1. Cadmus-Bertram LA, Marcus BH, Patterson RE, Parker BA, Morey BL. Randomized Trial of a Fitbit-Based Physical Activity Intervention for Women. Am J Prev Med. 2015 Sep;49(3):414–8. doi: 10.1016/j.amepre.2015.01.020.S0749-3797(15)00044-6
    1. Rowe-Roberts D, Cercos R, Mueller F'. Preliminary results from a study of the impact of digital activity trackers on health risk status. Stud Health Technol Inform. 2014;204:143–8.
    1. Jakicic JM, Davis KK, Rogers RJ, King WC, Marcus MD, Helsel D, Rickman AD, Wahed AS, Belle SH. Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial. JAMA. 2016 Sep 20;316(11):1161–1171. doi: 10.1001/jama.2016.12858.2553448
    1. Kim Y, Lumpkin A, Lochbaum M, Stegemeier S, Kitten K. Promoting physical activity using a wearable activity tracker in college students: A cluster randomized controlled trial. J Sports Sci. 2018 Aug;36(16):1889–1896. doi: 10.1080/02640414.2018.1423886.
    1. Le A, Mitchell H, Zheng DJ, Rotatori J, Fahey JT, Ness KK, Kadan-Lottick NS. A home-based physical activity intervention using activity trackers in survivors of childhood cancer: A pilot study. Pediatr Blood Cancer. 2017 Dec;64(2):387–394. doi: 10.1002/pbc.26235.
    1. Maslakovic M. Gadgets Wearables. Wearable sales are booming, but are we wearing them? Internet
    1. Rothman AJ, Gollwitzer PM, Grant AM, Neal DT, Sheeran P, Wood W. Hale and Hearty Policies: How Psychological Science Can Create and Maintain Healthy Habits. Perspect Psychol Sci. 2015 Nov;10(6):701–5. doi: 10.1177/1745691615598515.10/6/701
    1. Martin A, Fitzsimons C, Jepson R, Saunders DH, van der Ploeg Hidde P, Teixeira PJ, Gray CM, Mutrie N, EuroFIT consortium Interventions with potential to reduce sedentary time in adults: systematic review and meta-analysis. Br J Sports Med. 2015 Aug;49(16):1056–63. doi: 10.1136/bjsports-2014-094524.bjsports-2014-094524

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