Promoting Walking Among Older Adults Through Affective Communication and Step-Monitoring

Official title

Self-Continuity Messages and Step-Monitoring to Promote Walking Among Older Adults: Protocol of a 4-Arm Randomised Controlled Trial

Overview

Physical inactivity increases substantially after age 60 and represents a major public health challenge in older adults, as it is linked to increased risk of functional and cognitive decline and aging problems. Walking is one of the most accessible and recommended forms of light-to-moderate physical activity for this population. However, promoting sustained engagement in walking remains difficult, as traditional informational approaches often fail to activate personally meaningful motivations. This study tests whether persuasive affective messages can promote walking by leveraging self-continuity, meaning the use of autobiographical memory to maintain the sense of being the same person across time and contexts, connecting the past, present, and future self. Self-continuity is associated with psychological resources such as self-esteem, self-efficacy, and a sense of meaning in life. The affective mechanism that sustains self-continuity is nostalgia: both promote emotional and behavioral regulation and support goal achievement. Building on this framework, the present trial examines whether activating feelings of self-continuity and positive nostalgic memories can strengthen older adults' motivation to engage in walking behavior. In addition, the study investigates whether combining self-continuity messaging with a self-regulation strategy (daily step monitoring) enhances intervention effectiveness. Self-monitoring is a well-established behavioral technique that supports goal pursuit by increasing awareness and feedback. Using a 4-arm randomised controlled factorial design, the study compares the effects of self-continuity messages, step-monitoring reminders, their combination, and an active control condition on walking behaviour and its psychological determinants. A national sample of 1,000 Italian adults aged 65-74, recruited through a certified panel provider (Ipsos) and balanced for age, gender, and geographic region, will be randomly assigned to one of the four conditions. All participants will receive one message per day through a mobile application over a 14-day period. Participants in the step-monitoring conditions will also be asked to track and report their daily step count using a pedometer application. Behavioral, psychological, and process measures will be collected at baseline, post-intervention, and follow-up. The study therefore aims to provide experimental evidence on the role of self-continuity as a motivational driver of health behaviour change, and to clarify whether combining affective and self-regulatory strategies enhances intervention effectiveness in older adults.

Interventions

• Behavioral Self-continuity prompts
  The Day 1 introductory message presents a daily walking goal consistent with WHO recommendations and informs participants that subsequent messages describe the benefits of walking. Participants will be encouraged to pursue the physical activity goal according to their individual capabilities. Messages delivered from Day 2 to Day 13 aim to activate different positive nostalgic experiences related to walking and movement, including past memories, emotions, bodily sensations, personal values, and s
• Behavioral Step-monitoring reminders
  The Day 1 introductory message presents a daily walking goal consistent with WHO recommendations and informs participants that subsequent messages prompt them to monitor their daily step count. Participants will be encouraged to pursue the physical activity goal according to their individual capabilities. Messages delivered from Day 2 to Day 13 provide reminders to monitor step counts throughout the day using the pedometer app and to record the total number of daily steps in PsyMe at the end of
• Behavioral Water intake messages
  The Day 1 introductory message presents a daily water-intake goal consistent with standard recommendations and informs participants that subsequent messages describe the benefits of adequate hydration. Participants will be encouraged to pursue the goal according to their individual capabilities. Messages delivered from Day 2 to Day 13 provide brief information about different beneficial effects of adequate water intake and link hydration to each outcome using counterfactual formulations (e.g., "

Primary outcome measures

• Change from Baseline in Self-Reported Walking Frequency and Duration at 2-Week Post-Intervention and 4-Week Follow-up [Time frame: Baseline and 2 weeks and 4 weeks]
• Change from Baseline in Self-Reported Walking Intensity at 2-Week Post-Intervention and 4-Week Follow-up [Time frame: Baseline and 2 weeks and 4 weeks]
• Change from Baseline in Daily Step Count at 2-Week Post-Intervention as Measured Via Pedometer App [Time frame: Baseline and 2 weeks]

Secondary outcome measures (12)

• Change from Baseline in Self-Reported Sedentary Behaviour Duration at 2-Week Post-Intervention and 4-Week Follow-up [Time frame: Baseline and 2 weeks and 4 weeks]
• Change from Baseline in Self-Reported Light Physical Activity Frequency and Duration at 2-Week Post-Intervention and 4-Week Follow-up [Time frame: Baseline and 2 weeks and 4 weeks]
• Change from Baseline in Self-Reported Moderate Physical Activity Frequency and Duration at 2-Week Post-Intervention and 4-Week Follow-up [Time frame: Baseline and 2 weeks and 4 weeks]
• Change from Baseline in Self-Reported Vigorous Physical Activity Frequency and Duration at 2-Week Post-Intervention and 4-Week Follow-up [Time frame: Baseline and 2 weeks and 4 weeks]
• Change from Baseline in Pedometer Usage and Usage Frequency (Past Week) at 2-Week Post-Intervention and 4-Week Follow-up [Time frame: Baseline and 2 weeks and 4 weeks]
• Change from Baseline in Attitude toward Walking at 2-Week Post-Intervention and 4-Week Follow-up [Time frame: Baseline and 2 weeks and 4 weeks]
• Change from Baseline in Intention to Walk at 2-Week Post-Intervention and 4-Week Follow-up [Time frame: Baseline and 2 weeks and 4 weeks]
• Change from Baseline in Self-Efficacy to Walk at 2-Week Post-Intervention and 4-Week Follow-up [Time frame: Baseline and 2 weeks and 4 weeks]
• Change from Baseline in Anticipated Positive Emotions Toward Walking at 2-Week Post-Intervention and 4-Week Follow-up [Time frame: Baseline and 2 weeks and 4 weeks]
• Change from Baseline in Anticipated Negative Emotions Toward Walking at 2-Week Post-Intervention and 4-Week Follow-up [Time frame: Baseline and 2 weeks and 4 weeks]
• Change from Baseline in Self-Reported Daily Water Intake at 2-Week Post-Intervention [Time frame: Baseline and 2 weeks]
• Change from Baseline in Attitude toward Water Intake at 2-Week Post-Intervention [Time frame: Baseline and 2 weeks]

Eligibility criteria

Inclusion criteria

• Age between 65 and 74 years
• Willingness and ability to install and use the mobile applications required for study participation
• Sufficient proficiency in the Italian language to understand study materials and complete the questionnaires.

Exclusion criteria

\- Physical disabilities or medical conditions that preclude engagement in light to moderate physical activity, specifically:

• medical advice or prescription prohibiting engagement in light to moderate physical activity, assessed via a close-ended screening question;
• positive screening on a study specific close-ended question assessing ability to perform physical activity;
• positive screening on the adapted revised Physical Activity Readiness Questionnaire (rPAR-Q), indicating that participant may be unsafe.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Factorial

Masking

Single blind

Primary purpose

Prevention

Study locations

Italy · 1 center

• Catholic University of the Sacred Heart (Milan) — Milan

Publications

• Bluck, S., Alea, N., Habermas, T., & Rubin, D.C. (2005). A tale of three functions: The self-reported uses of autobiographical memory. Social Cognition, 23(1). pp. 91-117.
• Sedikides, C., & Wildschut, T. (2018). Finding Meaning in Nostalgia. Review of General Psychology, 22(1), 48-61.
• Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug;35(8):1381-95. doi: 10.1249/01.MSS.0000078924.61453.FB. PMID 12900694
• Soraci P, Bevan N, Griffiths MD, Pisanti R, Servidio R, Ferrari A, Di Bernardo C, Pakpour AH. The Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS): an Italian validation using confirmatory factor analysis and Rasch analysis. BMC Psychol. 2024 Nov 21;12(1):680. doi: 10.1186/s40359-024-02177-8. PMID 39574182
• Wurm S, Diehl M, Kornadt AE, Westerhof GJ, Wahl HW. How do views on aging affect health outcomes in adulthood and late life? Explanations for an established connection. Dev Rev. 2017 Dec;46:27-43. doi: 10.1016/j.dr.2017.08.002. Epub 2017 Sep 14. PMID 33927468
• Namikawa T. [Individual difference in making temporal comparisons: development of Temporal Comparison Orientation Scale]. Shinrigaku Kenkyu. 2011 Feb;81(6):593-601. doi: 10.4992/jjpsy.81.593. Japanese. PMID 21400863
• Sedikides C., Wildschut T., Routledge C., and Arndt J. (2015) Nostalgia counteracts self-discontinuity and restores self-continuity, Eur. J. Soc. Psychol., 45, 52-61, doi: 10.1002/ejsp.2073.
• Wildschut T, Sedikides C, Arndt J, Routledge C. Nostalgia: content, triggers, functions. J Pers Soc Psychol. 2006 Nov;91(5):975-993. doi: 10.1037/0022-3514.91.5.975. PMID 17059314

Identifiers

NCT: NCT07570303 · 6069838_48_26

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗