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The primary objective of this clinical trial is to test the efficacy of an innovative multimodal eHealth & mHealth intervention (focused on emphasizing identity/habit and/or self-regulation) on increasing moderate to vigorous (MVPA) across 12 months among newly retired adults not meeting Physical Activity guidelines at study baseline, thus at higher risk of age-related chronic diseases.
The secondary objectives are to examine whether these approaches improve physical and mental well-being and health related fitness-outcomes.
Principal Research Question 1: Does an intervention focused on identity/habit + self-regulation skills + education (ID) increase moderate-to-vigorous intensity physical activity (MVPA) compared with an intervention focused on self-regulation skills + education (SR), and an education control condition (ED)? Three-arm parallel design single blinded randomized controlled trial. Participants will be randomized to one of three groups (ID, SR, ED) for 12 months duration.
BACKGROUND: According to the 2021 census, there are 9.7 million people aged 60 or over in Canada, a surge of 8% since the 2016 census. Further, with life expectancy increasing, the prevalence of chronic diseases and conditions such as hypertension, type 2 diabetes, cancer, cognitive decline, frailty, and dementia that are associated with an ageing population are placing increasing pressures on healthcare systems. There is compelling evidence that engaging in regular PA, of at least 150 minutes of moderate to vigorous intensity aerobic PA throughout the week complemented with muscle strengthening activities at least twice a week, can prevent the onset and progress of age-related chronic diseases and positively influence physical and mental health outcomes. Despite these well-documented benefits, 80% of Canadian adults are not meeting the recommended PA guidelines, with levels of PA decreasing steadily with age. Thus, implementing interventions that effectively increase PA to optimize the physical and mental health outcomes is a public health priority. To date, interventions promoting PA have shown mixed results, so there is a need to better understand, and test innovative behavior change techniques. Further, PA interventions have not focused on specific aging subgroups (e.g., 60-70 years, >80 years), making it difficult to design and implement effective interventions and make suitable recommendations for policy and practice. One of those important groups that has not received enough evidence-based research (only two small studies), are those transitioning into retirement (i.e., 60-70 years). Transitioning into retirement is established as a seminal period where significant altercations in lifestyle (e.g., reframing of identity, lack of routine) present an opportunity to promote PA.
TARGET POPULATION: Participants will be:
The researcher will also screen participants on baseline accelerometry results (as a secondary assurance).
Those participants above the Canadian recommended guidelines will be excluded from the trial.
SAMPLE SIZE : 159 participants, 53 participants per group
Participants will then be randomized into one of the three conditions (post accelerometer screening):
1) The ID condition will be comprised of a 6-week, 10 module format, covering all reflective, regulatory, and reflexive processes.
2 The SR condition will have access to modules 1 through 6 (reflective and regulatory processes)
3 The ED condition will have access to modules 1 to 3 (reflective processes).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Identity Intervention Condition | Experimental | The ID condition will be comprised of a 6-week, 10 module format (1-2 modules released per week), covering all reflective, regulatory, and reflexive processes. Modules 8-10 cover behavior change techniques targeting habit and identity that correspond to PA during the transition to retirement.
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| Self Regulation Intervention Condition | Experimental | Self Regulation Intervention Condition will have access to modules 1 through 6 (reflective and regulatory processes). 4 additional modules will be included to ensure equivalence of dose across conditions. & focus on general retirement considerations such as travel, socializing, and financial planning with the same style and formatting as the PA modules. Participants will be provided with an accelerometer to wear for a week. Participants will complete online survey & attend fitness testing @ the lab. All groups receive support/booster check-ins on the same material as their intervention designation at 3-,6-, and 12 weeks and 6-months. After the initial 6-week intervention period, participants will be given follow-up online questionnaires and accelerometers. This will follow a similar protocol for the 3-, 6- and 12-month time period (6-month assessment will include fitness testing). All participants will be asked to participate in a 6 month exit interview. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Self Regulation Digital Health Online Platform | Behavioral | The Digital Health Online Platform has 10 lessons that the participant will gain access to on a weekly basis. The Self Regulation (SR) Intervention Condition will have access to Lessons 1 through 6 (reflective and regulatory processes). Lesson titles are as follows: Lesson 1: Why Physical Activity Matters During Retirement Lesson 2: Physical Activity Enhances Your Mood and Wellbeing Lesson 3: Social Connections, Confidence and Enjoyment: Keys to an Active Life Lesson 4: Setting Goals and Planning Ahead for Active Living Lesson 5: Staying on Track: Monitoring Your Activity on Your Own and With Others Lesson 6: How to Keep Moving When You Don't Feel Like It 4 additional lessons will be included in the SR condition to ensure equivalence of dose across conditions. |
| Measure | Description | Time Frame |
|---|---|---|
| MVPA | Primary Outcome - MVPA will be measured with wGT3X-BT ActiGraph accelerometers, the gold standard for PA measurement in field settings. Participants will wear the devices during waking hours on a belt around the waist (with the device positioned above the right iliac crest) for seven consecutive days. Valid cut-points (counts per minute) for adults will be used to classify MVPA. For a day to be considered valid, there will need to be a minimum of 300 minutes (6 hours) within a 24-hour period of valid wear time.Missing data will be modelled from available data. | From enrollment to the end of data collection (Baseline, 6 Weeks, 3 Months & 6 Months & 12 months ) |
| Measure | Description | Time Frame |
|---|---|---|
| Secondary Outcome Health-Related Fitness Measure 1 - Body Mass Index (BMI) | Secondary Outcome Measure 1 Title: Body Mass Index (BMI) Description: Body mass (kg) and height (cm) will be measured using standard procedures and combined to calculate BMI (kg/m²). Unit of Measure: kg/m² Time Frame: Baseline and 6 months | At Baseline & 6 Months |
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Inclusion Criteria:
Screening with Godin's Leisure Time Exercise Questionnaire, and Baseline accelerometry as secondary confirmation
Exclusion Criteria:
- Participation in 150 minutes or more of MVPA per week, based on questionnaire or accelerometry screening
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sandy Courtnall L Project Coordinator/Manager, Behavioural Medicine Lab | Contact | 250 472 5288 | bml@uvic.ca |
| Name | Affiliation | Role |
|---|---|---|
| Ryan Rhodes, PhD | University of Victoria | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Victoria | Victoria | British Columbia | V8W 2Y2 | Canada |
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Three-arm parallel design single blinded randomized controlled trial.
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| Control Education Group | Experimental | Control Group will have access to education lessons 1 to 3 (reflective processes). 7 additional education lessons are included in the Control Education group to ensure equivalence of dose across conditions.
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| Identity Digital Health Online Platform | Behavioral | The Digital Health Online platform has 10 lessons that the Identity (ID) Intervention Condition participant will gain access to on a weekly basis. Lesson titles are as follows: Lesson 1: Why Physical Activity Matters During Retirement Lesson 2: Physical Activity Enhances Your Mood and Wellbeing Lesson 3: Social Connections, Confidence and Enjoyment: Keys to an Active Life Lesson 4: Setting Goals and Planning Ahead for Active Living Lesson 5: Staying on Track: Monitoring Your Activity on Your Own and With Others Lesson 6: How to Keep Moving When You Don't Feel Like It Lesson 7: How to Build Lasting Habits Lesson 8: Habits That Last: Staying Active Through Change Lesson 9: Who You Are When You Move: Understanding and Building Identities Lesson 10: Staying Connected and True to Your Values |
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| Control Digital Health Online Platform | Behavioral | Control Group will have access to education lessons 1 to 3 (reflective processes). 7 additional education lessons are included in the Control Education group to ensure equivalence of dose across conditions. Participants will be provided with an accelerometer-mailed or delivered-to wear for seven consecutive days. Following accelerometer wear, participants will complete an online questionnaire and attend the laboratory for fitness testing. All groups will receive support/booster check-ins on the same material as their intervention designation at 3-,6-, and 12 weeks and 6-months. - After the initial 6-week intervention period, participants will be given follow-up online questionnaires and accelerometers. - This will follow a similar protocol for the 3-, 6- and 12-month time period (6-month assessment will include fitness testing). - In addition, all participants will be asked to participate in an end-of-trial semi-structured interview (at 6-months). |
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| Secondary Outcome Health-Related Fitness Measure 2 - Waist Circumference |
Secondary Outcome Measure 2 Title: Waist Circumference Description: Waist circumference (cm) will be measured using standardized anthropometric procedures. Unit of Measure: cm Time Frame: Baseline and 6 months |
| Time Frame: Baseline and 6 months |
| Secondary Outcome Health-Related Fitness Measure 3 - Cardiovascular Fitness | Secondary Outcome Measure 3 Title: Cardiovascular Fitness Description: Cardiovascular fitness will be assessed using the YMCA submaximal cycle ergometer test, with estimated cardiorespiratory fitness derived according to standard protocols. Unit of Measure: Estimated VO₂ (mL/kg/min) or workload-based estimate (choose whichever you will report) Time Frame: Baseline and 6 months | Time Frame: Baseline and 6 months |
| Secondary Outcome Health-Related Fitness Measure 4 - Upper-Body Strength | Secondary Outcome Measure 4 Title: Upper-Body Strength - 30 second bicep curl strength test Description: Upper-body strength will be assessed using the 30-second bicep curl test. The test involves performing as many arm curls as possible in 30 seconds, while sitting in a chair holding a dumbbell in the dominant arm. Test purpose: This test measures upper body strength and endurance. Unit of Measure: repetitions Time Frame: Baseline and 6 months | Time Frame: Baseline and 6 months |
| Secondary Outcome Health-Related Fitness Measure 5 - Lower-Body Strength | Secondary Outcome Measure 5 Title: Lower-Body Strength Description: Lower-body strength and power will be assessed using the 30-second chair stand test. Unit of Measure: repetitions Time Frame: Baseline and 6 months | Time Frame: Baseline and 6 months |
| Secondary Outcome Health-Related Fitness Measure 6 - Flexibility | Secondary Outcome Measure 6 Title: Flexibility Description: Flexibility will be assessed using the sit-and-reach test. Unit of Measure: cm Time Frame: Baseline and 6 months | Time Frame: Baseline and 6 months |
| Secondary Outcome Measure: Reflective Processes | Reflective Processes Description: Attitudes and perceived capability and opportunity will be assessed using M-PAC self-report items rated on 7-point bipolar Likert scales, with higher scores indicating stronger reflective processes. Unit of Measure: score on 7-point scale Time Frame: Baseline, 6 weeks, 3 months, 6 months, 12 months | Time Frame: Baseline, 6 weeks, 3 months, 6 months, 12 months |
| Secondary Outcome Measure: Regulatory Processes | Regulatory Processes Description: Regulatory processes will be assessed using the Physical Activity Regulation Scale (PARS). Items are rated on a 7-point Likert scale, with higher scores indicating greater use of self-regulatory strategies. Unit of Measure: score on 7-point scale Time Frame: Baseline, 6 weeks, 3 months, 6 months, 12 months | Time Frame: Baseline, 6 weeks, 3 months, 6 months, 12 months |
| Secondary Outcome Measure: Reflexive Processes - Habit Automaticity (Self-Report Habit Index - Automaticity Subscale) | Habit automaticity will be assessed using the Automaticity Subscale of the Self-Report Habit Index (SRHI), a validated self-report questionnaire measuring the extent to which a behavior is performed automatically. Participants rate each item on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Higher scores indicate stronger habit automaticity. Unit of Measure: Score on the Automaticity Subscale (range: mean item score on 1-5 scale) | Time Frame: Baseline, 6 weeks, 3 months, 6 months, 12 months |
| Secondary Outcome Measure: Reflexive Processes - Identity | Reflexive Processes - Identity Description: Exercise identity will be assessed using the Exercise Identity Scale. Items are rated on a 7-point Likert scale, with higher scores indicating stronger exercise identity. Unit of Measure: score on 7-point scale Time Frame: Baseline, 6 weeks, 3 months, 6 months, 12 months | Time Frame: Baseline, 6 weeks, 3 months, 6 months, 12 months |
| Social Identity & Prior Identity | Social Identity Social identity will be assessed using the Multidimensional Inventory of Physical Activity Identity (25-item version). Items are rated on 7-point Likert scales (1-7), with higher scores indicating stronger social physical activity identity. Prior Identity Prior physical activity identity will be assessed using retrospective self-report items assessing identity "when younger" (e.g., when describing oneself to others in earlier life). Items are rated on 7-point Likert scales (1-7), with higher scores indicating stronger prior physical activity identity. | From enrollment to the end of data collection (Baseline, 6 Weeks, 3 Months & 6 Months & 12 months ) |
| Well-being outcomes | 6. Well-being (Psychological Flourishing) Description: Psychological well-being will be assessed using the Flourishing Scale. The scale includes 8 items assessing self-perceived success in areas such as relationships, self-esteem, purpose, and optimism. Items are rated on a 7-point Likert scale (range: 1-7) and summed to produce a total flourishing score, with higher scores indicating greater psychological flourishing. | From enrollment to the end of data collection (Baseline, 6 Weeks, 3 Months & 6 Months & 12 months) |
| Subjective norm - Descriptive | Subjective Norm - Descriptive Description: Descriptive subjective norm will be assessed using M PAC self report items rated on a 7 point Likert scale, with higher scores indicating stronger perceived norms. Unit of Measure: score on 7 point scale Time Frame: Baseline, 6 weeks, 3 months, 6 months | Time Frame: Baseline, 6 weeks, 3 months, 6 months |
| Subjective norm - Injunctive | 21. Subjective Norm - Injunctive Description: Injunctive Description: Injunctive subjective norm will be assessed using M PAC self report items rated on a 7 point Likert scale, with higher scores indicating stronger perceived social approval. Unit of Measure: score on 7 point scale Time Frame: Baseline, 6 weeks, 3 months, 6 months Time Frame: Time Frame: Baseline, 6 weeks, 3 months, 6 months | Time Frame: Baseline, 6 weeks, 3 months, 6 months |
| Relatedness | Relatedness Description: Relatedness will be assessed using the relatedness subscale of the Basic Psychological Need Satisfaction and Frustration Scale. Items are rated on a 5 point Likert scale, with higher scores indicating greater perceived relatedness. (8 items total, but only using 4 satisfaction items) Unit of Measure: score on 5 point scale Time Frame: Baseline, 6 weeks, 3 months, 6 months | Time Frame: Baseline, 6 weeks, 3 months, 6 months |
| Perceived mental and physical health | Perceived Mental and Physical Health Description: Perceived mental and physical health will be assessed using the 12-Item Short Form Health Survey (SF-12). The survey yields a Physical Component Summary (PCS) score and a Mental Component Summary (MCS) score. Scores are standardized (range: 0-100), with higher scores indicating better perceived physical and mental health. | From enrollment to the end of data collection (Baseline, 6 Weeks, 3 Months & 6 Months & 12 months) |
| Sociodemographic variables | Sociodemographic variables will be collected at baseline including age, sex, gender, marital status, highest level of education, current employment status, income, ethnicity, PA history. We will disaggregate and analyze all primary and secondary outcomes by gender and sex. Other demographic (e.g., age, ethnicity) variables that intersect with gender will also be considered. The approach recommended by experts in gender related measures is the two-step approach (Centre of Excellence for Transgender Health), which involves asking participants about both their current gender identity and their sex assigned at birth. Specific M-PAC constructs (e.g., perceived capability, habit, identity) may vary by sex and gender, thus targeting these considerations may maximize the potential effectiveness of PA interventions | Sociodemographic variables will be collected at baseline |
| Personality Questionnaire | Personality Traits Description: Personality traits will be assessed using a study-developed self-report questionnaire based on the Five-Factor Model of personality (McCrae & Costa), assessing Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. Each domain is assessed using 12 items rated on a 5-point Likert scale (range: 1-5), with higher scores indicating greater expression of the respective personality trait. Time Frame: 3 months only | One time ask @ 3 months only |
| Experience w/Computers | Experience with Computers - Years of Use Experience with computers will be assessed by self-report of the number of years the participant has been using computers (years), with higher values indicating greater experience. Experience with Computers - Weekly Use Experience with computers will be assessed by self-report of the typical number of hours per week the participant uses a computer (hours/week), with higher values indicating greater use. | One time ask @ Baseline only |
| Outcome Measure: Home Environment & Home Environment for Physical Activity | Home Environment for Physical Activity Description: The home environment for physical activity will be assessed using the Home Environment Survey (Gattshall et al.), which evaluates availability and accessibility of physical activity equipment. Items are rated on 4 point Likert-type scale, with higher scores indicating greater support for physical activity in the home. Unit of Measure: score on scale Time Frame: 6 weeks only | One time ask @ 6 weeks only |
| Ecological Momentary Assessment (EMA) | Ecological Momentary Assessment (EMA): EMA smartphone check-ins to capture within-day changes in motivation and feelings toward physical activity behaviors. | Participants will complete brief EMA surveys through the Pathverse mobile app for 7 consecutive days at weeks 5, 10, 15, 30, and 45. |
| System Usability - - Time on Platform | Time on Platform Description: Website usage will be assessed using automatically collected platform analytics, including average time spent on the platform per week and average time spent on module pages per week. Unit of Measure: minutes per week Time Frame: Baseline, 6 weeks, 3 months, 6 months | Time Frame: Baseline, 6 weeks, 3 months, 6 months |
| System Usability - Engagement Breadth | Engagement Breadth Description: Engagement breadth will be assessed using automatically collected platform analytics, defined as the percentage of total available pages accessed. Unit of Measure: percent of pages accessed (%) Time Frame: Baseline, 6 weeks, 3 months, 6 months | Time Frame: Baseline, 6 weeks, 3 months, 6 months |
| System Usability - Engagement Duration | Engagement Duration Description: Engagement duration will be assessed using automatically collected platform analytics, defined as the total number of weeks participants engaged with the online platform. Unit of Measure: weeks Time Frame: Baseline, 6 weeks, 3 months, 6 months | Time Frame: Baseline, 6 weeks, 3 months, 6 months |
| Process Evaluation | Process Evaluation will involve a brief quantitative questionnaire to assess use of the intervention material and overall satisfaction of the study similar to our prior trials. Semi-structured interviews will be used to examine each of the subcomponents described in the first step. | Process Evaluation will be completed immediately post-intervention (12 months) |
| ID | Term |
|---|---|
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D017009 | Professional Autonomy |
| D004522 | Educational Status |
| ID | Term |
|---|---|
| D011364 | Professional Practice |
| D009934 | Organization and Administration |
| D006298 | Health Services Administration |
| D012959 | Socioeconomic Factors |
| D011154 | Population Characteristics |
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