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Abstract Background Older adult women often do not engage in sufficient physical activity (PA) and can encounter biological changes that exacerbate the negative effects of inadequate activity. Wearable activity monitors can facilitate PA initiation, but evidence of sustained behavior change is lacking. Supplementing wearable technologies with intervention content that evokes enjoyment, interest, meaning, and personal values associated with PA may support long term adherence. In this paper, we present the protocol of an NIA-funded study designed to evaluate the efficacy of CHALLENGE for increasing step count and motivation for PA in insufficiently active older women (Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-based Exercise). CHALLENGE uses social media to supplement wearable activity monitors with the autonomy-supportive frame of a game. We hypothesize that CHALLENGE will engender playful experiences that will improve motivation for exercise and lead to sustained increases in step count. Methods We will recruit 300 healthy, community dwelling older adult women on a rolling basis and randomize them to receive either the CHALLENGE intervention (experimental arm) or an activity monitor-only intervention (comparison arm). Participants in both groups will receive a wearable activity monitor and personalized weekly feedback emails. In the experimental group, participants will also be added to a private Facebook group, where study staff will post weekly challenges that are designed to elicit playful experiences while walking. Assessments at baseline and 6, 12, and 18 months will measure PA and motivation-related constructs. We will fit linear mixed-effects models to evaluate differences in step count and motivational constructs, and longitudinal mediation models to evaluate if interventional effects are mediated by changes in motivation. We will also conduct thematic content analysis of text and photos posted to Facebook and transcripts from individual interviews. Discussion By taking part in a year-long intervention centered on imbuing walking behaviors with playful and celebratory experiences, participating older adult women may internalize changes to their identity and relationship with PA that facilitate sustained behavior change. Study results will have implications for how we can harness powerful and increasingly ubiquitous technologies for health promotion to the vast and growing population of older adults in the U.S. and abroad. Trial registration ClinicalTrials.gov Identifier NCT04095923. Registered September 17th, 2019.

The purpose of this paper is to describe a protocol for a systematic review (SR) and meta-analysis examining the associations between an episode of COVID-19 and trajectory as well as the risk of frailty. The protocol for this SR has been registered in the PROSPERO database (CRD42023468297) and conforms to the guidelines proposed by the Preferred Reporting Items for Systematic Reviews (PRISMA). The search strategy will involve retrieving literature from six different databases and will be guided by keywords encompassing population (community-dwelling or institution-dwelling adults), exposure (episode of COVID-19), and outcome (frailty). The citations retrieved from the search process will be screened for their eligibility. The risk of bias for the articles identified to be eligible for the review will be examined using the Quality In Prognosis Studies (QUIPS) tool. The Metafor package in R will be used for quantitative data synthesis of the literature. Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess the quality and certainty of the body of evidence. This systematic review will provide crucial information to determine whether an episode of COVID-19 is associated with an increased risk of frailty. The results of this review will have significant clinical implications in mitigating the risk of frailty after COVID-19.

BackgroundOlder adult women are at risk for negative health outcomes that engaging in sustained physical activity can help prevent. However, promoting long-term maintenance of physical activity in this population has proven to be a challenge. Increasing autonomous motivations (ie, intrinsic, integrated, and identified regulations) for physical activity may facilitate enduring behavior change. Digitally delivered games for health that take a celebratory technology approach, that is, using technology to create new ways to experience valued behaviors and express valued beliefs, may be a useful way to target autonomous motivations for physical activity. Formative research with the target population is needed to design compelling intervention content. ObjectiveThe objective of this study is to investigate older adult women’s reactions to and thoughts about a photography-based, social media walking game targeting autonomous motivations for physical activity. MethodsDuring an individual semistructured interview, a moderator solicited feedback from 20 older adult women (age range 65-74 years) as part of formative research to develop a social media game featuring weekly walking challenges. The challenges were designed to target autonomous motivations for physical activity. Interviews were audio-recorded and transcribed verbatim. Two reviewers conducted thematic content analysis on interview transcripts. ResultsWe identified 3 overarching themes in qualitative data analysis. These reflected the playful experiences, value, and acceptability associated with the intervention challenges. Generally, participants understood what the challenges were asking them to do, proffered appropriate example responses, and indicated that the challenges would be enjoyable. Participants reported that the intervention content afforded many and varied playful experiences (eg, competition, discovery, exploration, expression, fellowship, humor, nurture, sensation). Further, participants indicated that the intervention increased their motivation for physical activity, occasioned meaningful shifts in perspective, increased their knowledge of various topics of interest, provided an opportunity to create valued connection with others, and provided health-related benefits. Participants suggested the intervention emphasize local history, nature, and cultural events. ConclusionsThe photography-based, social media walking game with relatively simple game mechanics was well received and judged to be apt to bring about a wide variety of emotive experiences. A clear, geographically specific identity emerged as a key driver of interest for intervention content. Taking a celebratory technology approach holds promise for targeting autonomous motivations for physical activity in older adult women.

BackgroundGames for health are a promising approach to health promotion. Their success depends on achieving both experiential (game) and instrumental (health) objectives. There is little to guide game for health (G4H) designers in integrating the science of behavior change with the art of game design. ObjectiveThe aim of this study is to extend the Behaviour Change Wheel program planning model to develop Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-Based Exercise (CHALLENGE), a G4H centered on increasing physical activity in insufficiently active older women. MethodsWe present and apply the G4H Mechanics, Experiences, and Change (MECHA) process, which supplements the Behaviour Change Wheel program planning model. The additional steps are centered on identifying target G4H player experiences and corresponding game mechanics to help game designers integrate design elements and G4H objectives into behavioral interventions. ResultsWe identified a target behavior of increasing moderate-intensity walking among insufficiently active older women and key psychosocial determinants of this behavior from self-determination theory (eg, autonomy). We used MECHA to map these constructs to intervention functions (eg, persuasion) and G4H target player experiences (eg, captivation). Next, we identified behavior change techniques (eg, framing or reframing) and specific game mechanics (eg, transforming) to help realize intervention functions and elicit targeted player experiences. ConclusionsMECHA can help researchers map specific linkages between distal intervention objectives and more proximal game design mechanics in games for health. This can facilitate G4H program planning, evaluation, and clearer scientific communication.

The default mode network (DMN) refers to regional brain activity that is greater during rest periods than during attention-demanding tasks and many studies have reported DMN alterations in patient populations. It has also been shown that the DMN is suppressed by scanner background noise (SBN), which is the noise produced by functional magnetic resonance imaging (fMRI). However, it is unclear whether different approaches to rest in the noisy MR environment can alter the DMN and constitute a confound in studies investigating the DMN in particular patient populations (e.g., individuals with schizophrenia, Alzheimer’s disease). We examined twenty-seven healthy adult volunteers who completed an fMRI experiment with 3 different instructions for rest: (1) relax and be still, (2) attend to SBN, or (3) ignore SBN. Region of interest (ROI) analyses were performed to determine the influence of rest period instructions on core regions of the DMN and DMN regions previously reported to be altered in patients with or at risk for Alzheimer’s disease or schizophrenia. The dorsal medial prefrontal cortex (dmPFC) exhibited greater activity when specific resting instructions were given (i.e. attend to or ignore SBN) compared to when non-specific resting instructions were given. Condition-related differences in connectivity were also observed between regions of the dmPFC and inferior parietal/posterior superior temporal cortex. We conclude that rest period instructions and SBN levels should be carefully considered for fMRI studies on the DMN, especially studies on clinical populations and groups that may have different approaches to rest, such as first-time research participants and children.

The purpose of this paper is to describe a protocol for a systematic review (SR) and meta-analysis examining the associations between an episode of COVID-19 and trajectory as well as the risk of frailty. The protocol for this SR has been registered in the PROSPERO database (CRD42023468297) and conforms to the guidelines proposed by the Preferred Reporting Items for Systematic Reviews (PRISMA). The search strategy will involve retrieving literature from six different databases and will be guided by keywords encompassing population (community-dwelling or institution-dwelling adults), exposure (episode of COVID-19), and outcome (frailty). The citations retrieved from the search process will be screened for their eligibility. The risk of bias for the articles identified to be eligible for the review will be examined using the Quality In Prognosis Studies (QUIPS) tool. The Metafor package in R will be used for quantitative data synthesis of the literature. Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess the quality and certainty of the body of evidence. This systematic review will provide crucial information to determine whether an episode of COVID-19 is associated with an increased risk of frailty. The results of this review will have significant clinical implications in mitigating the risk of frailty after COVID-19. [ABSTRACT FROM AUTHOR]