Eric B. Hekler

Objective Light-Intensity Physical Activity Associations With Rated Health in Older Adults

The extent to which light-intensity physical activity contributes to health in older adults is not well known. The authors examined associations between physical activity across the intensity spectrum (sedentary to vigorous) and health and well-being variables in older adults. Two 7-day assessments of accelerometry from 2005 to 2007 were collected 6 months apart in the observational Senior Neighborhood Quality of Life Study of adults aged >65 years in Baltimore, Maryland, and Seattle, Washington. Self-reported health and psychosocial variables (e.g., lower-extremity function, body weight, rated stress) were also collected. Physical activity based on existing accelerometer thresholds for moderate/vigorous, high-light, low-light, and sedentary categories were examined as correlates of physical health and psychosocial well-being in mixed-effects regression models. Participants (N = 862) were 75.4 (standard deviation, 6.8) years of age, 56% female, 71% white, and 58% overweight/obese. After adjustment for study covariates and time spent in moderate/vigorous physical activity and sedentary behavior, low-light and high-light physical activity were positively related to physical health (all P < 0.0001) and well-being (all P < 0.001). Additionally, replacing 30 minutes/day of sedentary time with equal amounts of low-light or high-light physical activity was associated with better physical health (all P < 0.0001). Objectively measured light-intensity physical activity is associated with physical health and well-being variables in older adults.

Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications

Theoretical conceptualizations of generalized anxiety disorder (GAD) continue to undergo scrutiny and refinement. The current paper critiques five contemporary models of GAD: the Avoidance Model of Worry and GAD [Borkovec, T. D. (1994). The nature, functions, and origins of worry. In: G. Davey & F. Tallis (Eds.), Worrying: perspectives on theory assessment and treatment (pp. 5-33). Sussex, England: Wiley & Sons; Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In: R. Heimberg, C. Turk, & D. Mennin (Eds.), Generalized anxiety disorder: advances in research and practice (pp. 77-108). New York, NY, US: Guilford Press]; the Intolerance of Uncertainty Model [Dugas, M. J., Letarte, H., Rheaume, J., Freeston, M. H., & Ladouceur, R. (1995). Worry and problem solving: evidence of a specific relationship. Cognitive Therapy and Research, 19, 109-120; Freeston, M. H., Rheaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791-802]; the Metacognitive Model [Wells, A. (1995). Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301-320]; the Emotion Dysregulation Model [Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9, 85-90]; and the Acceptance-based Model of GAD [Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: integrating mindfulness/acceptance-based approaches with existing cognitive behavioral models. Clinical Psychology: Science and Practice, 9, 54-68]. Evidence in support of each model is critically reviewed, and each models corresponding evidence-based therapeutic interventions are discussed. Generally speaking, the models share an emphasis on avoidance of internal affective experiences (i.e., thoughts, beliefs, and emotions). The models cluster into three types: cognitive models (i.e., IUM, MCM), emotional/experiential (i.e., EDM, ABM), and an integrated model (AMW). This clustering offers directions for future research and new treatment strategies.

Reallocating Time to Sleep, Sedentary Behaviors, or Active Behaviors: Associations With Cardiovascular Disease Risk Biomarkers, NHANES 2005–2006

Sleep and sedentary and active behaviors are linked to cardiovascular disease risk biomarkers, and across a 24-hour day, increasing time in 1 behavior requires decreasing time in another. We explored associations of reallocating time to sleep, sedentary behavior, or active behaviors with biomarkers. Data (n = 2,185 full sample; n = 923 fasting subanalyses) from the cross-sectional 2005-2006 US National Health and Nutrition Examination Survey were analyzed. The amounts of time spent in sedentary behavior, light-intensity activity, and moderate-to-vigorous physical activity (MVPA) were derived from ActiGraph accelerometry (ActiGraph LLC, Pensacola, Florida), and respondents reported their sleep duration. Isotemporal substitution modeling indicated that, independent of potential confounders and time spent in other activities, beneficial associations (P < 0.05) with cardiovascular disease risk biomarkers were associated with the reallocation of 30 minutes/day of sedentary time with equal time of either sleep (2.2% lower insulin and 2.0% lower homeostasis model assessment of β-cell function), light-intensity activity (1.9% lower triglycerides, 2.4% lower insulin, and 2.2% lower homeostasis model assessment of β-cell function), or MVPA (2.4% smaller waist circumference, 4.4% higher high-density lipoprotein cholesterol, 8.5% lower triglycerides, 1.7% lower glucose, 10.7% lower insulin, and 9.7% higher homeostasis model assessment of insulin sensitivity. These findings provide evidence that MVPA may be the most potent health-enhancing, time-dependent behavior, with additional benefit conferred from light-intensity activities and sleep duration when reallocated from sedentary time.

Mind the theoretical gap: interpreting, using, and developing behavioral theory in HCI research

Researchers in HCI and behavioral science are increasingly exploring the use of technology to support behavior change in domains such as health and sustainability. This work, however, remain largely siloed within the two communities. We begin to address this silo problem by attempting to build a bridge between the two disciplines at the level of behavioral theory. Specifically, we define core theoretical terms to create shared understanding about what theory is, discuss ways in which behavioral theory can be used to inform research on behavior change technologies, identify shortcomings in current behavioral theories, and outline ways in which HCI researchers can not only interpret and utilize behavioral science theories but also contribute to improving them.

Building health behavior models to guide the development of just-in-time adaptive interventions: A pragmatic framework.

Advances in wireless devices and mobile technology offer many opportunities for delivering just-in-time adaptive interventions (JITAIs)-suites of interventions that adapt over time to an individuals changing status and circumstances with the goal to address the individuals need for support, whenever this need arises. A major challenge confronting behavioral scientists aiming to develop a JITAI concerns the selection and integration of existing empirical, theoretical and practical evidence into a scientific model that can inform the construction of a JITAI and help identify scientific gaps. The purpose of this paper is to establish a pragmatic framework that can be used to organize existing evidence into a useful model for JITAI construction. This framework involves clarifying the conceptual purpose of a JITAI, namely, the provision of just-in-time support via adaptation, as well as describing the components of a JITAI and articulating a list of concrete questions to guide the establishment of a useful model for JITAI construction. The proposed framework includes an organizing scheme for translating the relatively static scientific models underlying many health behavior interventions into a more dynamic model that better incorporates the element of time. This framework will help to guide the next generation of empirical work to support the creation of effective JITAIs.

Effects of a College Course About Food and Society on Students' Eating Behaviors

BACKGROUND Health education programs for promoting a healthful diet have shown limited success in clinical trials. PURPOSE This paper aims to examine whether an innovative educational course focused on societal-level issues related to food and food production (Food and Society) would promote healthful eating among college students. METHODS A quasi-experimental non-RCT was conducted to compare changes in eating behaviors among students taking the Food and Society course (n=28) versus students taking health-related human biology courses about obesity, health psychology, and community health assessment (n=72). All participants were undergraduates. A Food Frequency Questionnaire was administered at the beginning and end of the four courses taught from January through March 2009. Students in the Food and Society course read selected portions of popular books and essays (e.g., Michael Pollans Omnivores Dilemma) and watched documentaries (e.g., Aaron Woolfs King Corn) highlighting environmental, ethical, social justice, cultural, political, and agricultural issues related to food and food production, and discussed these major themes during class sessions. In addition, students were required to (1) write an Op-Ed article and (2) create a brief YouTube video focused on themes discussed in the course. RESULTS The students who took the Food and Society course reported significantly improving their healthful eating (F[2, 97]=5.72, p=0.02), with greatest improvements in increased vegetable (F[2, 97]=10.96, p=0.001) and decreased high-fat dairy (F[2, 97]=5.39, p=0.02) intakes relative to the comparison group. CONCLUSIONS The results suggest that it may be possible to change dietary behaviors in college students by focusing on social, ethical, cultural, and environmental issues related to food and food production.

Moderators and mediators of exercise-induced objective sleep improvements in midlife and older adults with sleep complaints.

OBJECTIVE Exercise can improve sleep quality, but for whom and by what means remains unclear. We examined moderators and mediators of objective sleep improvements in a 12-month randomized controlled trial among underactive midlife and older adults reporting mild/moderate sleep complaints. METHODS Participants (N = 66, 67% women, 55-79 years) were randomized to moderate-intensity exercise or health education control. Putative moderators were gender, age, physical function, self-reported global sleep quality, and physical activity levels. Putative mediators were changes in BMI, depressive symptoms, and physical function at 6 months. Objective sleep outcomes measured by in-home polysomnography were percent time in Stage I sleep, percent time in Stage II sleep, and number of awakenings during the first third of sleep at 12 months. RESULTS Baseline physical function and sleep quality moderated changes in Stage I sleep; individuals with higher initial physical function (p = .01) and poorer sleep quality (p = .03) had greater improvements. Baseline physical activity level moderated changes in Stage II sleep (p = .04) and number of awakenings (p = .01); more sedentary individuals had greater improvements. Decreased depressive symptoms (CI:-1.57 to -0.02) mediated change in Stage I sleep. Decreased depressive symptoms (CI:-0.75 to -0.01), decreased BMI (CI:-1.08 to -0.06), and increased physical function (CI: 0.01 to 0.72) mediated change in number of awakenings. CONCLUSIONS Initially less active individuals with higher initial physical function and poorer sleep quality improved the most. Affective, functional, and metabolic mediators specific to sleep architecture parameters were suggested. These results indicate strategies to more efficiently treat poor sleep through exercise in older adults.

Agile science: creating useful products for behavior change in the real world

Evidence-based practice is important for behavioral interventions but there is debate on how best to support real-world behavior change. The purpose of this paper is to define products and a preliminary process for efficiently and adaptively creating and curating a knowledge base for behavior change for real-world implementation. We look to evidence-based practice suggestions and draw parallels to software development. We argue to target three products: (1) the smallest, meaningful, self-contained, and repurposable behavior change modules of an intervention; (2) “computational models” that define the interaction between modules, individuals, and context; and (3) “personalization” algorithms, which are decision rules for intervention adaptation. The “agile science” process includes a generation phase whereby contender operational definitions and constructs of the three products are created and assessed for feasibility and an evaluation phase, whereby effect size estimates/casual inferences are created. The process emphasizes early-and-often sharing. If correct, agile science could enable a more robust knowledge base for behavior change.

Exercise effects on night-to-night fluctuations in self-rated sleep among older adults with sleep complaints

Sleep interventions have rarely explored reductions in night‐to‐night fluctuations [i.e. intra‐individual variability (IIV)] in sleep, despite the negative impacts of such fluctuations on affective states and cognitive and physical symptoms. In a community‐based randomized controlled trial we evaluated whether physical exercise reduced IIV in self‐rated sleep outcomes among middle‐aged and older adults with sleep complaints. Under‐active adults 55 years and older (n = 66, 67% women) with mild to moderate sleep complaints were randomized to 12 months of a moderate‐intensity endurance exercise (n = 36) or a health education control group (n = 30). Daily sleep logs, Pittsburgh Sleep Quality Index (PSQI) and in‐home polysomnographic sleep recordings (PSG) were collected at baseline, 6 months and 12 months. Sleep log‐derived means and IIV were computed for sleep‐onset latency (SOL), time in bed, feeling rested in the morning, number of nighttime awakenings, and wake after final awakening (WAFA). Using intent‐to‐treat methods, at 6 months no differences in IIV were observed by group. At 12 months, SOL‐based IIV was reduced in the exercise group compared with the control (difference = 23.11, 95% CI: 3.04–47.18, P = 0.025, Cohen’s d = 0.57). This change occurred without mean‐level or IIV changes in sleep–wake schedules. For all sleep variables, except SOL and WAFA, IIV changes and mean‐level changes in each variable were negatively correlated (r = −0.312 to −0.691, P < 0.05). Sleep log‐derived IIV changes were modestly correlated with mean‐level PSQI and PSG‐based changes at 12 months. Twelve months of moderate‐intensity exercise reduced night‐to‐night fluctuations in self‐rated time to fall asleep, and this relationship was independent of mean‐level time to fall asleep.

Food Marketing to Children Through Toys: Response of Restaurants to the First U.S. Toy Ordinance

BACKGROUND On August 9, 2010, Santa Clara County CA became the first U.S. jurisdiction to implement an ordinance that prohibits the distribution of toys and other incentives to children in conjunction with meals, foods, or beverages that do not meet minimal nutritional criteria. Restaurants had many different options for complying with this ordinance, such as introducing more healthful menu options, reformulating current menu items, or changing marketing or toy distribution practices. PURPOSE To assess how ordinance-affected restaurants changed their child menus, marketing, and toy distribution practices relative to non-affected restaurants. METHODS Childrens menu items and child-directed marketing and toy distribution practices were examined before and at two time points after ordinance implementation (from July through November 2010) at ordinance-affected fast-food restaurants compared with demographically matched unaffected same-chain restaurants using the Childrens Menu Assessment tool. RESULTS Affected restaurants showed a 2.8- to 3.4-fold improvement in Childrens Menu Assessment scores from pre- to post-ordinance with minimal changes at unaffected restaurants. Response to the ordinance varied by restaurant. Improvements were seen in on-site nutritional guidance; promotion of healthy meals, beverages, and side items; and toy marketing and distribution activities. CONCLUSIONS The ordinance appears to have positively influenced marketing of healthful menu items and toys as well as toy distribution practices at ordinance-affected restaurants, but did not affect the number of healthful food items offered.