An mHealth-Facilitated Personalized Intervention for Physical Activity and Sleep in Community-Dwelling Older Adults

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Junxin Li
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Sarah L. Szanton
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Miranda V. McPhillips
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Nada Lukkahatai
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Grace W. Pien
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KerCheng Chen
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Melissa D. Hladek
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Nancy Hodgson
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Nalaka S. Gooneratne
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This randomized controlled pilot trial tested the preliminary effect of a 24-week mHealth-facilitated, personalized intervention on physical activity (PA) and sleep in 21 community-dwelling older adults. The intervention included a personalized exercise prescription, training, goal setting, and financial incentives. mHealth strategies, including self-monitoring, motivational messages, activity reminders, and phone coaching, were used to facilitate PA participation. PA and sleep were measured using actigraphy and questionnaires at baseline and 8-, 16-, and 24-week visits. Participants in the intervention group had lower objective PA levels at 24 weeks than at 8 and 16 weeks, although levels of PA remained higher than at baseline. Compared with the control group, the intervention increased PA at 8, 16, and 24 weeks; improved subjective sleep quality at 16 and 24 weeks; and increased actigraphy-measured sleep duration and sleep efficiency at 24 weeks. mHealth PA interventions may benefit PA and sleep in older adults. Strategies for maintaining long-term PA behavioral changes are needed.

Li, Szanton, Lukkahatai, and Hladek are with the Johns Hopkins University School of Nursing, Baltimore, MD, USA. Szanton is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. McPhillips and Hodgson are with the University of Pennsylvania School of Nursing, Philadelphia, PA, USA. Pien is with the Johns Hopkins University School of Medicine, Baltimore, MD, USA. Chen and Gooneratne is with the Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Li (junxin.li@jhu.edu) is corresponding author.

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  • Alessi, C., & Vitiello, M.V. (2015). Insomnia (primary) in older people: Non-drug treatments. BMJ Clinical Evidence, 2015, 2302. PubMed ID: 25968443

    • Search Google Scholar
    • Export Citation
  • Banno, M., Harada, Y., Taniguchi, M., Tobita, R., Tsujimoto, H., Tsujimoto, Y., . . . Noda, A. (2018). Exercise can improve sleep quality: A systematic review and meta-analysis. PeerJ, 6, e5172. PubMed ID: 30018855 doi:10.7717/peerj.5172

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bastien, C.H., Vallières, A., & Morin, C.M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297307. PubMed ID: 11438246 doi:10.1016/S1389-9457(00)00065-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bickmore, T.W., Silliman, R.A., Nelson, K., Cheng, D.M., Winter, M., Henault, L., & Paasche-Orlow, M.K. (2013). A randomized controlled trial of an automated exercise coach for older adults. Journal of the American Geriatrics Society, 61(10), 16761683. PubMed ID: 24001030 doi:10.1111/jgs.12449

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brewster, G.S., Riegel, B., & Gehrman, P.R. (2018). Insomnia in the older adult. Sleep Medicine Clinics, 13(1), 1319. PubMed ID: 29412980 doi:10.1016/j.jsmc.2017.09.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bunn, F., Dickinson, A., Barnett-Page, E., Mcinnes, E., & Horton, K. (2008). A systematic review of older people’s perceptions of facilitators and barriers to participation in falls-prevention interventions. Ageing & Society, 28(4), 449472. doi:10.1017/S0144686X07006861

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Buysse, D.J., Reynolds, C.F., 3rd, Monk, T.H., Berman, S.R., & Kupfer, D.J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193213. PubMed ID: 2748771 doi:10.1016/0165-1781(89)90047-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chen, M.C., Liu, H.E., Huang, H.Y., & Chiou, A.F. (2012). The effect of a simple traditional exercise programme (Baduanjin exercise) on sleep quality of older adults: A randomized controlled trial. The International Journal of Nursing Studies, 49(3), 265273. PubMed ID: 21963235 doi:10.1016/j.ijnurstu.2011.09.009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Costello, E., Kafchinski, M., Vrazel, J., & Sullivan, P. (2011). Motivators, barriers, and beliefs regarding physical activity in an older adult population. Journal of Geriatric Physical Therapy, 34(3), 138147. PubMed ID: 21937904 doi:10.1519/JPT.0b013e31820e0e71

    • Crossref
    • Search Google Scholar
    • Export Citation
  • de Rezende, L.F.M., Rey-López, J.P., Matsudo, V.K.R., & do Carmo Luiz, O. (2014). Sedentary behavior and health outcomes among older adults: A systematic review. BMC Public Health, 14(1), 333. doi:10.1186/1471-2458-14-333

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Eckerstorfer, L.V., Tanzer, N.K., Vogrincic-Haselbacher, C., Kedia, G., Brohmer, H., Dinslaken, I., & Corcoran, K. (2018). Key elements of mHealth interventions to successfully increase physical activity: Meta-regression. JMIR mHealth and uHealth, 6(11), e10076. PubMed ID: 30425028 doi:10.2196/10076

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Elavsky, S., Knapova, L., Klocek, A., & Smahel, D. (2019). Mobile health interventions for physical activity, sedentary behavior, and sleep in adults aged 50 years and older: A systematic literature review. Journal of Aging and Physical Activity, 27(4), 565593. PubMed ID: 30507266 doi:10.1123/japa.2017-0410

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Haynes, J., Talbert, M., Fox, S., & Close, E. (2018). Cognitive behavioral therapy in the treatment of insomnia. Southern Medical Journal, 111(2), 7580. doi:10.14423/SMJ.0000000000000769

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kelley, G.A., & Kelley, K.S. (2017). Exercise and sleep: A systematic review of previous meta-analyses. The Journal of Evidence-Based Medicine, 10(1), 2636. PubMed ID: 28276627 doi:10.1111/jebm.12236

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kochersberger, G., McConnell, E., Kuchibhatla, M.N., & Pieper, C. (1996). The reliability, validity, and stability of a measure of physical activity in the elderly. Archives of Physical Medicine and Rehabilitation, 77(8), 793795. PubMed ID: 8702373 doi:10.1016/S0003-9993(96)90258-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kovacevic, A., Mavros, Y., Heisz, J.J., & Fiatarone Singh, M.A. (2018). The effect of resistance exercise on sleep: A systematic review of randomized controlled trials. Sleep Medicine Reviews, 39, 5268. PubMed ID: 28919335 doi:10.1016/j.smrv.2017.07.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kredlow, M.A., Capozzoli, M.C., Hearon, B.A., Calkins, A.W., & Otto, M.W. (2015). The effects of physical activity on sleep: A meta-analytic review. The Journal of Behavioral Medicine, 38(3), 427449. PubMed ID: 25596964 doi:10.1007/s10865-015-9617-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kwan, R.Y., Lee, D., Lee, P.H., Tse, M., Cheung, D.S., Thiamwong, L., & Choi, K.-S. (2020). Effects of an mHealth brisk walking intervention on increasing physical activity in older people with cognitive frailty: Pilot randomized controlled trial. JMIR mHealth and uHealth, 8(7), e16596. doi:10.2196/16596

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Li, J., Grandner, M.A., Chang, Y.P., Jungquist, C., & Porock, D. (2017). Person-centered dementia care and sleep in assisted living residents with dementia: A pilot study. Behavioral Sleep Medicine, 15(2), 97113. doi:10.1080/15402002.2015.1104686

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Li, J., Hodgson, N., Lyons, M.M., Chen, K.-C., Yu, F., & Gooneratne, N.S. (2020). A personalized behavioral intervention implementing mHealth technologies for older adults: A pilot feasibility study. Geriatric Nursing, 41(3), 313319. PubMed ID: 31810730 doi:10.1016/j.gerinurse.2019.11.011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Li, Z., Li, J., Yu, F., Li, K., & Szanton, S. (2020). The effect of resistance training on sleep in Chinese older adults: A randomized controlled trial. Geriatric Nursing, 42(1), 289294. PubMed ID: 32977992 doi:10.1016/j.gerinurse.2020.09.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Loland, N. (2002). Reliability of the physical activity scale for the elderly (PASE). European Journal of Sport Science, 2(5), 112. doi:10.1080/17461390200072504

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Muellmann, S., Forberger, S., Möllers, T., Bröring, E., Zeeb, H., & Pischke, C.R. (2018). Effectiveness of eHealth interventions for the promotion of physical activity in older adults: A systematic review. Preventive Medicine, 108, 93110. PubMed ID: 29289643 doi:10.1016/j.ypmed.2017.12.026

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nasreddine, Z.S., Phillips, N.A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., . . . Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695699. PubMed ID: 15817019 doi:10.1111/j.1532-5415.2005.53221.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nicolson, P.J., Bennell, K.L., Dobson, F.L., Van Ginckel, A., Holden, M.A., & Hinman, R.S. (2017). Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis: A systematic review and meta-analysis. British Journal of Sports Medicine, 51(10), 791799. PubMed ID: 28087567 doi:10.1136/bjsports-2016-096458

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Onen, S.-H., & Onen, F. (2018). Chronic medical conditions and sleep in the older adult. Sleep Medicine Clinics, 13(1), 7179. PubMed ID: 29412985 doi:10.1016/j.jsmc.2017.09.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pa, J., Goodson, W., Bloch, A., King, A.C., Yaffe, K., & Barnes, D.E. (2014). Effect of exercise and cognitive activity on self-reported sleep quality in community-dwelling older adults with cognitive complaints: A randomized controlled trial. Journal of the American Geriatrics Society, 62(12), 23192326. PubMed ID: 25516028 doi:10.1111/jgs.13158

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rodriguez, J.C., Dzierzewski, J.M., & Alessi, C.A. (2015). Sleep problems in the elderly. The Medical clinics of North America, 99(2), 431439. PubMed ID: 25700593 doi:10.1016/j.mcna.2014.11.013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Schoeppe, S., Alley, S., Van Lippevelde, W., Bray, N.A., Williams, S.L., Duncan, M.J., & Vandelanotte, C. (2016). Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: A systematic review. The International Journal of Behavioral Nutrition and Physical Activity, 13(1), 127. doi:10.1186/s12966-016-0454-y

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Seol, J., Abe, T., Fujii, Y., Joho, K., & Okura, T. (2020). Effects of sedentary behavior and physical activity on sleep quality in older people: A cross-sectional study. Nursing & Health Sciences, 22(1), 6471. PubMed ID: 31523925 doi:10.1111/nhs.12647

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shi, L., Chen, S.-J., Ma, M.-Y., Bao, Y.-P., Han, Y., Wang, Y.-M., . . . Lu, L. (2018). Sleep disturbances increase the risk of dementia: A systematic review and meta-analysis. Sleep Medicine Reviews, 40, 416. PubMed ID: 28890168 doi:10.1016/j.smrv.2017.06.010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Silva, B. M., Rodrigues, J.J., de la Torre Díez, I., López-Coronado, M., & Saleem, K. (2015). Mobile-health: A review of current state in 2015. Journal of Biomedical Informatics, 56, 265272. doi:10.1016/j.jbi.2015.06.003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sonnega, A., Leggett, A., Pepin, R., & Assari, S. (2020). Physical activity and insomnia symptoms over 10 years in a US national sample of late-middle-age and older adults: Age matters. Journal of Aging and Physical Activity, 24(8), 613622.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stranges, S., Tigbe, W., Gómez-Olivé, F.X., Thorogood, M., & Kandala, N.-B. (2012). Sleep problems: An emerging global epidemic Findings from the INDEPTH WHO-SAGE study among more than 40,000 older adults from 8 countries across Africa and Asia. Sleep, 35(8), 11731181. PubMed ID: 22851813 doi:10.5665/sleep.2012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tanaka, M., Ikeuchi, M., Matsuki, H., Yaguchi, K., Kutsuzawa, T., Tanaka, K., & Kaneita, Y. (2018). Effects of Brief Cognitive Behavioral Therapy for insomnia on sleep and usage of hypnotics among community-dwelling older adults: Randomized controlled trial. Nihon Koshu Eisei Zasshi, 65(8), 386398. PubMed ID: 30224584 doi:10.11236/jph.65.8_386

    • Search Google Scholar
    • Export Citation
  • Tsunoda, K., Kitano, N., Kai, Y., Uchida, K., Kuchiki, T., Okura, T., & Nagamatsu, T. (2015). Prospective study of physical activity and sleep in middle-aged and older adults. The American Journal of Preventive Medicine, 48(6), 662673. PubMed ID: 25891000 doi:10.1016/j.amepre.2014.12.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tudor-Locke, C., Craig, C.L., Aoyagi, Y., Bell, R.C., Croteau, K.A., De Bourdeaudhuij, I., . . . Blair, S.N. (2011). How many steps/day are enough For older adults and special populations. The International Journal of Behavioral Nutrition and Physical Activity 8(1), 80. doi:10.1186/1479-5868-8-80

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • Valenzuela, T., Okubo, Y., Woodbury, A., Lord, S.R., & Delbaere, K. (2018). Adherence to technology-based exercise programs in older adults: A systematic review. Journal of Geriatric Physical Therapy, 41(1), 4961. PubMed ID: 27362526 doi:10.1519/JPT.0000000000000095

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vanderlinden, J., Boen, F., & van Uffelen, J.G.Z. (2020). Effects of physical activity programs on sleep outcomes in older adults: A systematic review. The International Journal of Behavioral Nutrition and Physical Activity, 17(1), 1111. doi:10.1186/s12966-020-0913-3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Washburn, R.A., Smith, K.W., Jette, A.M., & Janney, C.A. (1993). The Physical Activity Scale for the Elderly (PASE): Development and evaluation. The Journal of Clinical Epidemiology, 46(2), 153162. PubMed ID: 8437031 doi:10.1016/0895-4356(93)90053-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Yang, P.Y., Ho, K.H., Chen, H.C., & Chien, M.Y. (2012). Exercise training improves sleep quality in middle-aged and older adults with sleep problems: A systematic review. Journal of Physiotherapy, 58(3), 157163. PubMed ID: 22884182 doi:10.1016/S1836-9553(12)70106-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Yerrakalva, D., Yerrakalva, D., Hajna, S., & Griffin, S. (2019). Effects of mobile health app interventions on sedentary time, physical activity, and fitness in older adults: Systematic review and meta-analysis. Journal of Medical Internet Research, 21(11), e14343. doi:10.2196/14343

    • Crossref
    • Search Google Scholar
    • Export Citation
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