A technology-based randomized controlled trial of self-affirmation and gain-framed health messaging to reduce sedentary behavior in older adults

ObjectiveSedentary behavior significantly increases the risk for chronic diseases and cognitive decline in aging, underscoring the need for effective interventions. Older adults exhibit a positivity effect, whereby processing of positive information is prioritized over negative information. In addition, self-affirmation was shown to reduce sedentary behavior in younger adults, but its effects in older adults remain unknown. This study tested a novel, technology-based intervention combining daily self-affirmation and gain-framed health messages to reduce sedentary behavior in older adults. MethodsIn a 6-week randomized controlled trial (NCT0431536), 48 cognitively unimpaired, sedentary older adults were randomized into two groups: The intervention group (mean age=70.0{+/-}5.4years) completed daily self-affirmation based on their highest-ranked value, followed by gain-framed health messages. The active control group (mean age=68.4{+/-}5.0years) performed self-affirmation on their lowest-ranked value, followed by loss-framed messages. This was a single-blinded clinical trial that incorporated a hybrid efficacy and implementation design. Thus, information about intervention feasibility was examined. In addition, baseline motivational traits, including reward sensitivity, were assessed as moderators of behavior change. The neural basis of self-affirmation and gain-framed health messaging was examined at baseline using a task-based, event-related fMRI paradigm across groups, after randomization at the outset of the intervention. ResultsThe intervention showed high adherence (0.92{+/-}0.08) and positive ease-of-use ratings. While the intervention did not significantly reduce sedentary behavior compared to the active control condition, increased reward sensitivity predicted reduced sedentary behavior across all participants. FMRI results showed increased ventral striatal activation in the intervention group, compared to the active control group during reading of gain-framed compared to neutral messages. ConclusionsThis study supports the feasibility of technology-based sedentary beahvior reduction interventions for older adults. While self-affirmation combined with gain-framed messaging did not significantly reduce sedentary behavior, gain-framed messages engaged the reward network, and reward sensitivity predicted future reduction in sedentary behavior.