Is long-term maintenance worth the wait? Using real time data capture to examine delayed discounting as a putative target of physical activity adherence in weight loss maintenance interventions

长期维护值得等待吗？

• 批准号: 9789376
• 负责人: Amy A Gorin
• 金额: $ 20.13万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789376
• 关键词: Accelerometer; Adherence; Automobile Driving; Behavior; Behavioral; Biological Assay; Body Weight; Body Weight decreased; Clinic; Clinical Research; Cognitive; Data; Decision Making; Development; Ecological momentary assessment; Environment; Environmental Risk Factor; Exercise; Friends; Future; Goals; Health; Health behavior change; Imagery; Individual; Informal Social Control; Intention; Intervention; Lead; Life Style; Link; Maintenance; Measures; Mediating; Mediation; Medicine; Methods; Modeling; Monitor; Outcome; Participant; Pathway interactions; Patient Self-Report; Persons; Physical activity; Procedures; Process; Psyche structure; Randomized; Recommendation; Research; Research Support; Rewards; Role; Schedule; Science; Testing; Thinking; Time; Weather; Weight; Weight maintenance regimen; Work; adaptive intervention; base; behavior change; behavioral adherence; behavioral outcome; cost; design; discount; discounting; executive function; experimental study; healthy lifestyle; individual variation; innovation; insight; inter-individual variation; longitudinal design; novel; obesity management; pleasure; sedentary activity; success; theories; therapy design; treatment response; weight loss intervention; weight maintenance

Weight loss maintenance (WLM) is the major challenge in weight management. While most individuals who lose weight intend to keep their weight off, decay in adherence to behavioral recommendations is common, leading to weight regain. Behavioral WLM interventions can help sustain healthy lifestyles but response to treatment is variable. Moreover, the mechanisms of action by which interventions exert their effects are not clearly elucidated, which has thwarted the development of more efficacious treatment approaches. To advance the science of behavior change, research is needed to identify putative targets that are engaged by WLM interventions and that drive behavior change. Temporal Self-Regulation Theory (TST) posits that whether intentions lead to behavior depends, in large part, on self-regulatory capacity (i.e., executive function). Particularly relevant to WLM is the cognitive construct of delayed discounting (DD), or the tendency to discount a larger future reward (weight management) in favor of smaller immediate rewards (e.g., a pleasurable sedentary activity). Experimental and clinical research suggests that DD is instrumental in behavioral decision- making and predictive of health behavior change but has yet to be explored in the context of WLM. Further, TST posits a moderating role for the environment such that when the costs of engaging in a behavior (e.g., exercising in bad weather) are more proximal than its benefits (health improvements), self-regulatory constructs such as DD will be a stronger determinant of behavior. The aim of the proposed study is to test whether, as predicted by TST, delayed discounting mediates adherence to physical activity (PA) recommendations in WLM interventions and whether environmental factors moderate this relationship. PA is the behavior of focus as it is a robust predictor of WLM success and can be measured objectively in the natural environment. This work is novel because it will use an experimental medicine approach to establish whether DD is engaged by a behavioral WLM intervention that explicitly targets DD through the use of episodic future thinking, a visualization procedure that shows promise in amplifying the value of long-term rewards, thus reducing DD. Temporal associations between engagement of DD and physical activity will be examined with real time data capture methods (Ecological Momentary Assessment and accelerometry) providing a nuanced understanding of how/when the putative target (DD) is in engaged in WLM treatment and whether this engagement predicts sustained PA behavior change. This intensive within-person longitudinal design will also allow for an exploration of how environmental factors moderate the delayed discounting-physical activity link, setting the stage for a future just-in-time adaptive intervention for weight loss maintenance.

减肥维持（WLM）是体重管理中的主要挑战。而大多数人 减肥打算减轻体重，遵守行为建议的衰减很常见， 导致体重恢复。行为WLM干预措施可以帮助维持健康的生活方式，但对 治疗是可变的。此外，干预措施发挥作用的作用机制不是 清楚地阐明了，这阻碍了更有效的治疗方法的发展。前进 行为改变科学需要研究以确定WLM参与的推定目标 干预措施和驱动行为改变。时间自我调节理论（TST）认为是否是否 意图导致行为的意图在很大程度上取决于自我调节能力（即执行功能）。 与WLM特别相关的是延迟折扣（DD）的认知结构，或折现的趋势 较大的未来奖励（体重管理）支持较小的立即奖励（例如，令人愉悦的 久坐活动）。实验和临床研究表明，DD在行为决策中起了重要作用 - 制造和预测健康行为的变化，但在WLM的背景下尚未探索。更远， TST对环境提出了调节作用，以至于当从事行为的成本（例如， 在恶劣天气下锻炼）比其福利（健康改善）更近端 诸如DD之类的结构将是行为的更强大的决定因素。拟议的研究的目的是测试 如TST所预测的是否延迟了折现介导对体育活动（PA） WLM干预措施中的建议以及环境因素是否适应这种关系。 PA是 焦点的行为是WLM成功的强大预测指标，可以在自然中客观地衡量 环境。这项工作是新颖的，因为它将使用实验医学方法来确定是否是否 DD由行为WLM干预介绍，该干预措施通过使用情节未来明确针对DD 思考，一种可视化过程，显示出扩大长期奖励价值的希望 减少DD。 DD参与与体育活动之间的时间关联将与 实时数据捕获方法（生态瞬时评估和加速度计）提供细微差别 了解推定目标（DD）如何/何时从事WLM治疗以及是否这样 参与预测持续的PA行为改变。这种密集的人内纵向设计也将 允许探索环境因素如何适应延迟的折现运动活动链接， 为未来的及时自适应干预措施设置阶段，以维持减肥。