Mechanisms of change in diet and activity in the Make Better Choices 1 trial.

Abstract

Objective The Make Better Choices 1 trial demonstrated that participants with unhealthy diet and activity behaviors who were randomized to increase fruits/vegetables and decrease sedentary leisure achieved greater diet and activity improvement than those randomized to change other pairs of eating and activity behaviors. Participants randomized to decrease saturated fat and increase physical activity achieved the least diet-activity improvement. This study examined which psychological mechanisms mediated the effects of the study treatments on healthy behavior change. Methods Participants (n=204) were randomized to one of four treatments: increase fruits/vegetables and physical activity; decrease saturated fat and sedentary leisure; decrease saturated fat and increase physical activity; increase fruits/vegetables and decrease sedentary leisure. Treatments provided three weeks of remote coaching supported by mobile decision support technology and financial incentives. Mediational analyses were performed to examine whether changes in positive and negative affect, and self-efficacy, stages of readiness to change, liking, craving and attentional bias for fruit/vegetable intake, saturated fat intake, physical activity and sedentary leisure, explained the impact of the treatments on diet-activity improvement. Results Greater diet-activity improvement in those randomized to increase fruits/vegetables and decrease sedentary leisure was mediated by increased self-efficacy (indirect effect estimate=0.04; 95% bias corrected CI: 0.003, 0.11). All treatments improved craving, stage of change and positive affect. Conclusion Accomplishing healthy lifestyle changes for 3 weeks improves positive affect, increases cravings for healthy foods and activities and enhances readiness to make healthy behavior changes. Maximal diet and activity improvement occurs when interventions enhance self-efficacy to make multiple healthy behavior changes.

Multicomponent mHealth Intervention for Large, Sustained Change in Multiple Diet and Activity Risk Behaviors: The Make Better Choices 2 Randomized Controlled Trial

“…Fruit and vegetable intake and sedentary leisure showed the largest improvements in this study, as they had in our prior MBC1 study. Notably, in the MBC1 study, improvements in these two behaviors were also unique in being accompanied by increased self-efficacy, suggesting that changing them is both feasible and empowering [ 60 ]. Although intervention benefits persisted through nine months, longer duration follow-up remains needed.…”

Mobile health in adults with congenital heart disease: current use and future needs

“…Both patients and clinicians need to be committed to mHealth interventions in order to achieve long-term impact. In a recent mHealth trial on diet and exercise behaviour in healthy volunteers with an increased risk of atherosclerosis, the dropout rate was as high as 20 % [ 19 ]. Therefore, it is important to seek the right balance between time-consuming data collection and dropout.…”

Increasing Protein Intake to Help Older Adults Increase Muscle Strength and Function: A Pilot, Single-Arm Investigation Using Coaching and a Per-Meal Protein Prescription

“…The increase in protein intake among participants was also consistent with the findings of other studies using coaching. These other studies, however, successfully used coaching to help participants improve food choices to reduce risks of conditions such as diabetes, heart disease, and obesity (15)(16)(17)(18). In systematic literature reviews, coaching has been shown to significantly impact behavior change including dietary modifications (15,17).…”

“…Studies examining the effects of protein on muscle have typically provided participants with supplements (whey, casein-or soy-based powders or amino acids) versus allowing participants to self-select protein-rich foods (10)(11)(12)(13)(14). Coaching has been used successfully to help adults change dietary behaviors, primarily improving food choices to reduce disease risks associated with type 2 diabetes, heart disease, and obesity (15)(16)(17)(18). Missing from the literature, and which will be fulfilled from this study, is the use of coaching for the purpose of helping adults to improve their protein intake and the use of protein-rich foods (not supplements) to improve muscle strength and physical function.…”