Trial Outcomes & Findings for Healthy Hearts Healthy Minds (NCT NCT03373110)

NCT ID: NCT03373110

Last Updated: 2022-02-02

Results Overview

Participants randomized to the CBT+fitbit and MBCT+fitbit groups completed 8 weeks of online intervention sessions with biweekly questionnaires whereas participants in the fitbit only group completed 8 weeks of biweekly questionnaires alone. After the first 8 weeks of the study, participants received no new online intervention material (regardless of their initial group assignment), but were instructed to continue wearing their fitbit for the remaining 8 weeks of the study and the MBCT+fitbit and CBT+fitbit groups continued to have access to the intervention material presented in the first 8 weeks of the study. At week 16, participants completed a follow-up assessment. The Fitbit records start and stop times of the day (e.g., indicating when participants were in bed) and therefore, steps were only counted during these times. Participants without any step count data for a given day were treated as missing values for that day.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

506 participants

Primary outcome timeframe

Baseline, 8 weeks, and 16 weeks

Results posted on

2022-02-02

Participant Flow

491 participants were consented, 361 participants met eligibility criteria and were randomized to study intervention arms. 21 participants withdrew their consent and, thus, data from these 21 participants are not used or presented. Of the 340 randomized participants, 314 participants had usable Fitbit data. Therefore, 314 participants were included in all analyses (i.e., primary and secondary outcomes). We have added adverse event data on all randomized participants (i.e., 361 participants).

Participant milestones

Participant milestones
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Overall Study
STARTED
133
137
70
Overall Study
Provided Fitbit Data
123
130
63
Overall Study
COMPLETED
55
58
26
Overall Study
NOT COMPLETED
78
79
44

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

3 participants were missing bipolar disorder diagnosis

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=133 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=137 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=70 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Total
n=340 Participants
Total of all reporting groups
Age, Continuous
42.5 years
STANDARD_DEVIATION 11.6 • n=133 Participants
43.9 years
STANDARD_DEVIATION 11.2 • n=137 Participants
43.4 years
STANDARD_DEVIATION 10.8 • n=70 Participants
43.3 years
STANDARD_DEVIATION 11.3 • n=340 Participants
Sex: Female, Male
Female
108 Participants
n=133 Participants
110 Participants
n=137 Participants
61 Participants
n=70 Participants
279 Participants
n=340 Participants
Sex: Female, Male
Male
25 Participants
n=133 Participants
27 Participants
n=137 Participants
9 Participants
n=70 Participants
61 Participants
n=340 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
9 Participants
n=133 Participants
12 Participants
n=137 Participants
5 Participants
n=70 Participants
26 Participants
n=340 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
122 Participants
n=133 Participants
124 Participants
n=137 Participants
64 Participants
n=70 Participants
310 Participants
n=340 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
2 Participants
n=133 Participants
1 Participants
n=137 Participants
1 Participants
n=70 Participants
4 Participants
n=340 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=133 Participants
0 Participants
n=137 Participants
0 Participants
n=70 Participants
0 Participants
n=340 Participants
Race (NIH/OMB)
Asian
0 Participants
n=133 Participants
0 Participants
n=137 Participants
0 Participants
n=70 Participants
0 Participants
n=340 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=133 Participants
0 Participants
n=137 Participants
0 Participants
n=70 Participants
0 Participants
n=340 Participants
Race (NIH/OMB)
Black or African American
6 Participants
n=133 Participants
10 Participants
n=137 Participants
7 Participants
n=70 Participants
23 Participants
n=340 Participants
Race (NIH/OMB)
White
111 Participants
n=133 Participants
112 Participants
n=137 Participants
58 Participants
n=70 Participants
281 Participants
n=340 Participants
Race (NIH/OMB)
More than one race
11 Participants
n=133 Participants
10 Participants
n=137 Participants
3 Participants
n=70 Participants
24 Participants
n=340 Participants
Race (NIH/OMB)
Unknown or Not Reported
5 Participants
n=133 Participants
5 Participants
n=137 Participants
2 Participants
n=70 Participants
12 Participants
n=340 Participants
Bipolar Disorder
18 Participants
n=132 Participants • 3 participants were missing bipolar disorder diagnosis
21 Participants
n=136 Participants • 3 participants were missing bipolar disorder diagnosis
12 Participants
n=69 Participants • 3 participants were missing bipolar disorder diagnosis
51 Participants
n=337 Participants • 3 participants were missing bipolar disorder diagnosis
Education
Some high school
1 Participants
n=133 Participants
1 Participants
n=137 Participants
0 Participants
n=70 Participants
2 Participants
n=340 Participants
Education
High school graduate/GED
8 Participants
n=133 Participants
9 Participants
n=137 Participants
8 Participants
n=70 Participants
25 Participants
n=340 Participants
Education
Some college/2-year degree
43 Participants
n=133 Participants
50 Participants
n=137 Participants
21 Participants
n=70 Participants
114 Participants
n=340 Participants
Education
4-year college graduate
31 Participants
n=133 Participants
37 Participants
n=137 Participants
14 Participants
n=70 Participants
82 Participants
n=340 Participants
Education
More than 4-year college
49 Participants
n=133 Participants
39 Participants
n=137 Participants
27 Participants
n=70 Participants
115 Participants
n=340 Participants
Education
Missing/unknown
1 Participants
n=133 Participants
1 Participants
n=137 Participants
0 Participants
n=70 Participants
2 Participants
n=340 Participants
Sexual Orientation
Straight
103 Participants
n=133 Participants
118 Participants
n=137 Participants
54 Participants
n=70 Participants
275 Participants
n=340 Participants
Sexual Orientation
Lesbian
4 Participants
n=133 Participants
1 Participants
n=137 Participants
5 Participants
n=70 Participants
10 Participants
n=340 Participants
Sexual Orientation
Gay
5 Participants
n=133 Participants
2 Participants
n=137 Participants
2 Participants
n=70 Participants
9 Participants
n=340 Participants
Sexual Orientation
Bisexual
5 Participants
n=133 Participants
11 Participants
n=137 Participants
6 Participants
n=70 Participants
22 Participants
n=340 Participants
Sexual Orientation
Asexual
5 Participants
n=133 Participants
2 Participants
n=137 Participants
0 Participants
n=70 Participants
7 Participants
n=340 Participants
Sexual Orientation
Other
7 Participants
n=133 Participants
1 Participants
n=137 Participants
2 Participants
n=70 Participants
10 Participants
n=340 Participants
Sexual Orientation
Missing/Unknown
4 Participants
n=133 Participants
2 Participants
n=137 Participants
1 Participants
n=70 Participants
7 Participants
n=340 Participants

PRIMARY outcome

Timeframe: Baseline, 8 weeks, and 16 weeks

Participants randomized to the CBT+fitbit and MBCT+fitbit groups completed 8 weeks of online intervention sessions with biweekly questionnaires whereas participants in the fitbit only group completed 8 weeks of biweekly questionnaires alone. After the first 8 weeks of the study, participants received no new online intervention material (regardless of their initial group assignment), but were instructed to continue wearing their fitbit for the remaining 8 weeks of the study and the MBCT+fitbit and CBT+fitbit groups continued to have access to the intervention material presented in the first 8 weeks of the study. At week 16, participants completed a follow-up assessment. The Fitbit records start and stop times of the day (e.g., indicating when participants were in bed) and therefore, steps were only counted during these times. Participants without any step count data for a given day were treated as missing values for that day.

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=123 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=130 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=63 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps From Baseline
8 weeks
2.8 Change (per day) in Average Daily Steps
Interval -1.7 to 7.0
2.9 Change (per day) in Average Daily Steps
Interval -1.3 to 7.0
-8.2 Change (per day) in Average Daily Steps
Interval -14.5 to -1.9
Change (Per Day) in Average Daily Steps From Baseline
16 weeks
-1.2 Change (per day) in Average Daily Steps
Interval -2.9 to 0.5
-1.8 Change (per day) in Average Daily Steps
Interval -3.5 to -0.1
-2.6 Change (per day) in Average Daily Steps
Interval -5.1 to -0.1

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change per day in average daily steps stratified by the Patient Health Questionnaire (PHQ-9). The PHQ-9 is a 9 item self-report measure assessing presence of depression. Individuals are asked to rank how often they have experienced each item over the past two weeks on a scale from 0 (not at all) - 3 (nearly every day). Possible total scores range from 0-27, with higher scores indicate higher levels of depression. The PHQ-9 is a continuous measure and thus, was left continuous in our model and was not categorized. Because the PHQ-9 is a continuous measure, we assumed a continuous linear change in the effect per unit change. For purposes of presenting the results, we selected scores of 5, 10, and 15 as values to report the model-based slopes.

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=123 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=130 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=63 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by the Patient Health Questionnaire (PHQ-9)
8 weeks: PHQ-9 Score of 5
6.3 Change (per day) in Avg Daily Steps
Interval 0.6 to 12.1
5.7 Change (per day) in Avg Daily Steps
Interval -0.2 to 11.6
-9.1 Change (per day) in Avg Daily Steps
Interval -17.4 to -0.7
Change (Per Day) in Average Daily Steps Stratified by the Patient Health Questionnaire (PHQ-9)
8 weeks: PHQ-9 Score of 10
3.0 Change (per day) in Avg Daily Steps
Interval -1.3 to 7.2
3.2 Change (per day) in Avg Daily Steps
Interval -0.9 to 7.4
-8.3 Change (per day) in Avg Daily Steps
Interval -14.6 to -2.0
Change (Per Day) in Average Daily Steps Stratified by the Patient Health Questionnaire (PHQ-9)
8 weeks: PHQ-9 Score of 15
-.4 Change (per day) in Avg Daily Steps
Interval -5.9 to 5.0
.7 Change (per day) in Avg Daily Steps
Interval -4.5 to 5.9
-7.5 Change (per day) in Avg Daily Steps
Interval -15.2 to 0.2
Change (Per Day) in Average Daily Steps Stratified by the Patient Health Questionnaire (PHQ-9)
16 weeks: PHQ-9 Score of 5
-1.1 Change (per day) in Avg Daily Steps
Interval -3.4 to 1.2
0.9 Change (per day) in Avg Daily Steps
Interval -1.5 to 3.2
-2.2 Change (per day) in Avg Daily Steps
Interval -5.5 to 1.1
Change (Per Day) in Average Daily Steps Stratified by the Patient Health Questionnaire (PHQ-9)
16 weeks: PHQ-9 Score of 10
-1.2 Change (per day) in Avg Daily Steps
Interval -2.9 to 0.5
-1.6 Change (per day) in Avg Daily Steps
Interval -3.3 to 0.1
-2.6 Change (per day) in Avg Daily Steps
Interval -5.0 to -0.1
Change (Per Day) in Average Daily Steps Stratified by the Patient Health Questionnaire (PHQ-9)
16 weeks: PHQ-9 Score of 15
-1.3 Change (per day) in Avg Daily Steps
Interval -3.5 to 0.9
-4.1 Change (per day) in Avg Daily Steps
Interval -6.4 to -1.9
-2.9 Change (per day) in Avg Daily Steps
Interval -6.0 to 0.1

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change per day in average daily steps stratified by the Altman Self-Rating Mania Scale (ASRM), specifically using summed scores of 0,1, and 3. 5-item self rating scale, designed to asses the presence and/or severity of manic symptoms. Each item can be scored from 0-4. Possible total scores range from 0-25, and a score of 6 or higher indicates a high probability of a manic or hypomanic condition. The ASRM is a continuous measure and thus, was left continuous in our model and was not categorized. Because the ASRM is a continuous measure, we assumed a continuous linear change in the effect per unit change. For purposes of presenting the results, we selected scores of 0, 1, and 3 as values to report the model-based slopes.

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=123 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=130 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=63 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by the Altman Self-Rating Mania Scale (ASRM)
8 week: ASRM score 0
2.6 Change (per day) in Avg Daily Steps
Interval -2.8 to 8.0
3.1 Change (per day) in Avg Daily Steps
Interval -2.3 to 8.6
-11.6 Change (per day) in Avg Daily Steps
Interval -19.1 to -4.1
Change (Per Day) in Average Daily Steps Stratified by the Altman Self-Rating Mania Scale (ASRM)
8 week: ASRM score 1
2.7 Change (per day) in Avg Daily Steps
Interval -1.8 to 7.2
3.0 Change (per day) in Avg Daily Steps
Interval -1.5 to 7.6
-9.9 Change (per day) in Avg Daily Steps
Interval -16.6 to -3.3
Change (Per Day) in Average Daily Steps Stratified by the Altman Self-Rating Mania Scale (ASRM)
8 week: ASRM score 3
2.9 Change (per day) in Avg Daily Steps
Interval -1.9 to 7.7
2.8 Change (per day) in Avg Daily Steps
Interval -1.6 to 7.2
-6.6 Change (per day) in Avg Daily Steps
Interval -13.2 to 0.0
Change (Per Day) in Average Daily Steps Stratified by the Altman Self-Rating Mania Scale (ASRM)
16 week: ASRM score 0
0.3 Change (per day) in Avg Daily Steps
Interval -1.9 to 2.5
-.6 Change (per day) in Avg Daily Steps
Interval -2.9 to 1.6
-5.1 Change (per day) in Avg Daily Steps
Interval -8.0 to -2.2
Change (Per Day) in Average Daily Steps Stratified by the Altman Self-Rating Mania Scale (ASRM)
16 week: ASRM score 1
-.5 Change (per day) in Avg Daily Steps
Interval -2.4 to 1.3
-1.2 Change (per day) in Avg Daily Steps
Interval -3.1 to 0.7
-3.9 Change (per day) in Avg Daily Steps
Interval -6.5 to -1.3
Change (Per Day) in Average Daily Steps Stratified by the Altman Self-Rating Mania Scale (ASRM)
16 week: ASRM score 3
-2.2 Change (per day) in Avg Daily Steps
Interval -4.1 to -0.2
-2.3 Change (per day) in Avg Daily Steps
Interval -4.1 to -0.5
-1.4 Change (per day) in Avg Daily Steps
Interval -4.0 to 1.2

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change per day in average daily steps stratified by the Well Being Index (WHO-5). 5 item self report measure (rated on a 6 point Likert scale) to assess quality of life. Possible total scores range from 0-100 with 0 representing worst possible quality of life and 100 representing best possible quality of life. The WHO-5 is a continuous measure and thus, was left continuous in our model and was not categorized. Because the WHO-5 is a continuous measure, we assumed a continuous linear change in the effect per unit change. For purposes of presenting the results, we selected scores of 15, 30, and 45 as values to report the model-based slopes.

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=133 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=137 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=70 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by the Well Being Index (WHO-5)
16 weeks: WHO-5 score 15
-2.0 Change (per day) in Avg Daily Steps
Interval -4.4 to 0.4
-3.5 Change (per day) in Avg Daily Steps
Interval -5.8 to -1.2
-3.9 Change (per day) in Avg Daily Steps
Interval -6.8 to -1.0
Change (Per Day) in Average Daily Steps Stratified by the Well Being Index (WHO-5)
16 weeks: WHO-5 score 30
-1.4 Change (per day) in Avg Daily Steps
Interval -3.1 to 0.4
-2.0 Change (per day) in Avg Daily Steps
Interval -3.8 to -0.3
-2.5 Change (per day) in Avg Daily Steps
Interval -5.0 to -0.1
Change (Per Day) in Average Daily Steps Stratified by the Well Being Index (WHO-5)
16 weeks: WHO-5 score 45
-.7 Change (per day) in Avg Daily Steps
Interval -2.8 to 1.5
-.6 Change (per day) in Avg Daily Steps
Interval -2.6 to 1.5
-1.2 Change (per day) in Avg Daily Steps
Interval -4.2 to 1.8
Change (Per Day) in Average Daily Steps Stratified by the Well Being Index (WHO-5)
8 weeks: WHO-5 score 15
-1.4 Change (per day) in Avg Daily Steps
Interval -7.2 to 4.4
-1.3 Change (per day) in Avg Daily Steps
Interval -6.9 to 4.3
-10.2 Change (per day) in Avg Daily Steps
Interval -17.5 to -2.9
Change (Per Day) in Average Daily Steps Stratified by the Well Being Index (WHO-5)
8 weeks: WHO-5 score 30
2.2 Change (per day) in Avg Daily Steps
Interval -2.1 to 6.6
2.5 Change (per day) in Avg Daily Steps
Interval -1.7 to 6.6
-8.0 Change (per day) in Avg Daily Steps
Interval -14.3 to -1.7
Change (Per Day) in Average Daily Steps Stratified by the Well Being Index (WHO-5)
8 weeks: WHO-5 score 45
5.8 Change (per day) in Avg Daily Steps
Interval 0.5 to 11.1
6.3 Change (per day) in Avg Daily Steps
Interval 1.1 to 11.4
-5.9 Change (per day) in Avg Daily Steps
Interval -13.6 to 1.9

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change per day in average daily steps stratified by the Perceived Stress Scale (PSS), specifically using scores of 15, 20, and 25. 10 item scale (rated 0-4) that aims to measure the degree to which situations in one's life are appraised as stressful. Possible total scores range from 0-40 with higher scores are associated with higher levels of perceived stress. The PSS is a continuous measure and thus, was left continuous in our model and was not categorized. Because the PSS is a continuous measure, we assumed a continuous linear change in the effect per unit change. For purposes of presenting the results, we selected scores of 15, 20, and 25 as values to report the model-based slopes.

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=123 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=130 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=63 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by the Perceived Stress Scale (PSS)
8 weeks: PSS score 15
8.2 Change (per day) in Avg Daily Steps
Interval 2.2 to 14.3
6.3 Change (per day) in Avg Daily Steps
Interval 0.2 to 12.4
-4.8 Change (per day) in Avg Daily Steps
Interval -13.2 to 3.6
Change (Per Day) in Average Daily Steps Stratified by the Perceived Stress Scale (PSS)
8 weeks: PSS score 20
3.9 Change (per day) in Avg Daily Steps
Interval -0.5 to 8.3
4.0 Change (per day) in Avg Daily Steps
Interval -0.4 to 8.4
-7.2 Change (per day) in Avg Daily Steps
Interval -13.7 to -0.7
Change (Per Day) in Average Daily Steps Stratified by the Perceived Stress Scale (PSS)
8 weeks: PSS score 25
-.5 Change (per day) in Avg Daily Steps
Interval -5.5 to 4.5
1.6 Change (per day) in Avg Daily Steps
Interval -2.8 to 6.1
-9.5 Change (per day) in Avg Daily Steps
Interval -16.2 to -2.9
Change (Per Day) in Average Daily Steps Stratified by the Perceived Stress Scale (PSS)
16 weeks: PSS score 15
-.8 Change (per day) in Avg Daily Steps
Interval -3.2 to 1.7
-0.6 Change (per day) in Avg Daily Steps
Interval -3.1 to 1.9
-2.3 Change (per day) in Avg Daily Steps
Interval -5.6 to 1.1
Change (Per Day) in Average Daily Steps Stratified by the Perceived Stress Scale (PSS)
16 weeks: PSS score 20
-1.1 Change (per day) in Avg Daily Steps
Interval -2.9 to 0.5
-1.5 Change (per day) in Avg Daily Steps
Interval -3.2 to 0.3
-2.5 Change (per day) in Avg Daily Steps
Interval -5.1 to 0.1
Change (Per Day) in Average Daily Steps Stratified by the Perceived Stress Scale (PSS)
16 weeks: PSS score 25
-1.5 Change (per day) in Avg Daily Steps
Interval -3.5 to 0.6
-2.3 Change (per day) in Avg Daily Steps
Interval -4.2 to -0.4
-2.7 Change (per day) in Avg Daily Steps
Interval -5.4 to -0.1

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change per day in average daily steps stratified by age. Participants self-reported age on the demographics form. Age is a continuous measure and thus, was left continuous in our model and was not categorized. Because age is a continuous measure, we assumed a continuous linear change in the effect per unit change. For purposes of presenting the results, we selected ages of 35, 45, and 55 as values to report the model-based slopes.

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=123 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=130 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=63 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by Age
8 weeks: age 35
-2.8 Change (per day) in Avg Daily Steps
Interval -8.0 to 2.5
-2.2 Change (per day) in Avg Daily Steps
Interval -7.6 to 3.2
-2.5 Change (per day) in Avg Daily Steps
Interval -10.3 to 5.4
Change (Per Day) in Average Daily Steps Stratified by Age
8 weeks: age 45
.6 Change (per day) in Avg Daily Steps
Interval -3.9 to 5.0
3.3 Change (per day) in Avg Daily Steps
Interval -0.9 to 7.4
-9.4 Change (per day) in Avg Daily Steps
Interval -15.8 to -3.1
Change (Per Day) in Average Daily Steps Stratified by Age
8 weeks: age 55
10.7 Change (per day) in Avg Daily Steps
Interval 4.6 to 16.8
8.7 Change (per day) in Avg Daily Steps
Interval 3.0 to 14.4
-16.4 Change (per day) in Avg Daily Steps
Interval -25.6 to -7.1
Change (Per Day) in Average Daily Steps Stratified by Age
16 weeks: age 35
-2.8 Change (per day) in Avg Daily Steps
Interval -4.9 to -0.8
-2.6 Change (per day) in Avg Daily Steps
Interval -4.9 to -0.4
-2.0 Change (per day) in Avg Daily Steps
Interval -5.1 to 1.2
Change (Per Day) in Average Daily Steps Stratified by Age
16 weeks: age 45
-1.8 Change (per day) in Avg Daily Steps
Interval -3.5 to 0.0
-1.8 Change (per day) in Avg Daily Steps
Interval -3.5 to -0.1
-2.7 Change (per day) in Avg Daily Steps
Interval -5.2 to -0.2
Change (Per Day) in Average Daily Steps Stratified by Age
16 weeks: age 55
1.5 Change (per day) in Avg Daily Steps
Interval -1.1 to 4.1
-.9 Change (per day) in Avg Daily Steps
Interval -3.2 to 1.4
-3.4 Change (per day) in Avg Daily Steps
Interval -7.0 to 0.1

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change per day in average daily steps stratified by sex. Participants self-reported male or female on the demographics form.

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=123 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=130 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=63 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by Sex
8 weeks: Male
-1.9 Change (per day) in Avg Daily Steps
Interval -11.8 to 8.0
-10.7 Change (per day) in Avg Daily Steps
Interval -20.6 to -0.8
-3.2 Change (per day) in Avg Daily Steps
Interval -21.5 to 15.1
Change (Per Day) in Average Daily Steps Stratified by Sex
8 weeks: Female
3.8 Change (per day) in Avg Daily Steps
Interval -0.9 to 8.6
5.8 Change (per day) in Avg Daily Steps
Interval 1.2 to 10.3
-8.8 Change (per day) in Avg Daily Steps
Interval -15.5 to -2.1
Change (Per Day) in Average Daily Steps Stratified by Sex
16 weeks: Male
0.4 Change (per day) in Avg Daily Steps
Interval -3.8 to 4.6
-4.4 Change (per day) in Avg Daily Steps
Interval -8.7 to -0.1
-12.0 Change (per day) in Avg Daily Steps
Interval -20.4 to -3.7
Change (Per Day) in Average Daily Steps Stratified by Sex
16 weeks: Female
-1.5 Change (per day) in Avg Daily Steps
Interval -3.4 to 0.4
-1.3 Change (per day) in Avg Daily Steps
Interval -3.1 to 0.6
-1.7 Change (per day) in Avg Daily Steps
Interval -4.3 to 0.9

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change per day in average daily steps stratified by anxiety. Comorbid anxiety was self-reported in the psychiatric history questionnaire.

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=133 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=137 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=70 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by Anxiety
8 weeks: Anxiety
-1.5 Change (per day) in Avg Daily Steps
Interval -7.2 to 4.2
4.5 Change (per day) in Avg Daily Steps
Interval -1.0 to 9.9
-5.7 Change (per day) in Avg Daily Steps
Interval -13.3 to 1.9
Change (Per Day) in Average Daily Steps Stratified by Anxiety
8 weeks: No anxiety
9.6 Change (per day) in Avg Daily Steps
Interval 3.0 to 16.2
.7 Change (per day) in Avg Daily Steps
Interval -5.7 to 7.0
-13.8 Change (per day) in Avg Daily Steps
Interval -25.0 to -2.5
Change (Per Day) in Average Daily Steps Stratified by Anxiety
16 weeks: Anxiety
-1.8 Change (per day) in Avg Daily Steps
Interval -4.1 to 0.4
-3.6 Change (per day) in Avg Daily Steps
Interval -5.9 to -1.4
-.2 Change (per day) in Avg Daily Steps
Interval -3.2 to 2.8
Change (Per Day) in Average Daily Steps Stratified by Anxiety
16 weeks: No anxiety
.7 Change (per day) in Avg Daily Steps
Interval -2.0 to 3.4
.7 Change (per day) in Avg Daily Steps
Interval -1.9 to 3.2
-7.7 Change (per day) in Avg Daily Steps
Interval -12.0 to -3.4

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change per day in average daily steps stratified by smoking status. Smoker or non-smoker was self-reported on the psychiatric history questionnaire.

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=133 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=137 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=70 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by Smoking
8 weeks: Smoker
-18.2 Change (per day) in Avg Daily Steps
Interval -39.6 to 3.2
-17.3 Change (per day) in Avg Daily Steps
Interval -34.4 to -0.2
-20.2 Change (per day) in Avg Daily Steps
Interval -37.5 to -2.8
Change (Per Day) in Average Daily Steps Stratified by Smoking
8 weeks: Non-smoker
3.6 Change (per day) in Avg Daily Steps
Interval -0.8 to 8.0
4.1 Change (per day) in Avg Daily Steps
Interval -0.1 to 8.4
-6.4 Change (per day) in Avg Daily Steps
Interval -13.2 to 0.4
Change (Per Day) in Average Daily Steps Stratified by Smoking
16 weeks: Smoker
-7.2 Change (per day) in Avg Daily Steps
Interval -16.0 to 1.7
-12.5 Change (per day) in Avg Daily Steps
Interval -19.9 to -5.1
-2.6 Change (per day) in Avg Daily Steps
Interval -9.1 to 4.0
Change (Per Day) in Average Daily Steps Stratified by Smoking
16 weeks: Non-smoker
-1.0 Change (per day) in Avg Daily Steps
Interval -2.7 to 0.8
-1.2 Change (per day) in Avg Daily Steps
Interval -2.9 to 0.6
-2.6 Change (per day) in Avg Daily Steps
Interval -5.3 to 0.1

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change per day in average daily steps stratified by Self-efficacy for exercise (SEE), specifically using scores of 30, 45, and 55. Possible total scores range from 0-90. This 9-item measure, administered at study randomization, asks participants to indicate their self-confidence that they could exercise three times per week for twenty minutes under a variety of conditions. Sample items include being able to exercise if "You were bored by the program or activity" and "The weather was bothering you." Higher total scores on this measure reflect increased self-efficacy for exercise. The SEE is a continuous measure and thus, was left continuous in our model and was not categorized. Because the SEE is a continuous measure, we assumed a continuous linear change in the effect per unit change. For purposes of presenting the results, we selected scores of 30, 45, and 55 as values to report the model-based slopes.

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=133 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=137 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=70 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by Self-efficacy for Exercise (SEE)
8 week: SEE score 30
1.2 Change (per day) in Avg Daily Steps
Interval -4.0 to 6.3
4.5 Change (per day) in Avg Daily Steps
Interval -0.1 to 9.9
-6.0 Change (per day) in Avg Daily Steps
Interval -13.3 to 1.2
Change (Per Day) in Average Daily Steps Stratified by Self-efficacy for Exercise (SEE)
8 week: SEE score 45
3.3 Change (per day) in Avg Daily Steps
Interval -1.1 to 7.7
2.8 Change (per day) in Avg Daily Steps
Interval -1.3 to 7.0
-9.0 Change (per day) in Avg Daily Steps
Interval -15.4 to -2.5
Change (Per Day) in Average Daily Steps Stratified by Self-efficacy for Exercise (SEE)
8 week: SEE score 55
4.7 Change (per day) in Avg Daily Steps
Interval -0.8 to 10.2
1.8 Change (per day) in Avg Daily Steps
Interval -3.1 to 6.6
-11.0 Change (per day) in Avg Daily Steps
Interval -18.7 to -3.2
Change (Per Day) in Average Daily Steps Stratified by Self-efficacy for Exercise (SEE)
16 weeks: SEE score 30
-1.0 Change (per day) in Avg Daily Steps
Interval -3.1 to 1.1
-.8 Change (per day) in Avg Daily Steps
Interval -3.0 to 1.4
-.3 Change (per day) in Avg Daily Steps
Interval -3.1 to 2.6
Change (Per Day) in Average Daily Steps Stratified by Self-efficacy for Exercise (SEE)
16 weeks: SEE score 45
-1.3 Change (per day) in Avg Daily Steps
Interval -3.0 to 0.5
-1.9 Change (per day) in Avg Daily Steps
Interval -3.6 to -0.2
-3.4 Change (per day) in Avg Daily Steps
Interval -5.9 to -0.9
Change (Per Day) in Average Daily Steps Stratified by Self-efficacy for Exercise (SEE)
16 weeks: SEE score 55
-1.4 Change (per day) in Avg Daily Steps
Interval -3.6 to 0.8
-2.5 Change (per day) in Avg Daily Steps
Interval -4.5 to -0.5
-5.4 Change (per day) in Avg Daily Steps
Interval -8.4 to -2.4

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change (per day) in Average Daily Steps Stratified by the Duke Activity Status Index (DASI), specifically using summed scores of 40, 50, and 60. Possible total scores range from 0-58.2. This 12-item questionnaire, administered at the screening session, assesses an individual's current functional capabilities when engaging in various activities that involve physical exertion. Items include "Can you walk a block or two on level ground?" and "Can you climb a flight of stairs or walk up a hill?" Individual item responses are weighted based upon their metabolic cost, and subsequently summed to yield a total score. A higher score indicates better functional capability. The DASI is a continuous measure and thus, was left continuous in our model and was not categorized. Because the DASI is a continuous measure, we assumed a continuous linear change in the effect per unit change. For purposes of presenting the results, we selected scores of 40, 50, and 60 as values to report the model-based

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=133 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=137 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=70 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by the Duke Activity Status Index (DASI)
8 week: DASI score 40
3.3 Change (per day) in Avg Daily Steps
Interval -1.7 to 8.3
4.5 Change (per day) in Avg Daily Steps
Interval -0.7 to 9.6
-7.6 Change (per day) in Avg Daily Steps
Interval -14.7 to -0.5
Change (Per Day) in Average Daily Steps Stratified by the Duke Activity Status Index (DASI)
8 week: DASI score 50
2.6 Change (per day) in Avg Daily Steps
Interval -1.8 to 7.0
2.4 Change (per day) in Avg Daily Steps
Interval -1.8 to 6.6
-8.4 Change (per day) in Avg Daily Steps
Interval -15.0 to -1.8
Change (Per Day) in Average Daily Steps Stratified by the Duke Activity Status Index (DASI)
8 week: DASI score 60
2.0 Change (per day) in Avg Daily Steps
Interval -4.2 to 8.2
.3 Change (per day) in Avg Daily Steps
Interval -5.9 to 6.5
-9.2 Change (per day) in Avg Daily Steps
Interval -18.6 to 0.2
Change (Per Day) in Average Daily Steps Stratified by the Duke Activity Status Index (DASI)
16 week: DASI score 40
-2.0 Change (per day) in Avg Daily Steps
Interval -4.0 to 0.1
-1.9 Change (per day) in Avg Daily Steps
Interval -4.0 to 0.2
-3.5 Change (per day) in Avg Daily Steps
Interval -6.2 to -0.7
Change (Per Day) in Average Daily Steps Stratified by the Duke Activity Status Index (DASI)
16 week: DASI score 50
-1.0 Change (per day) in Avg Daily Steps
Interval -2.7 to -0.8
-1.8 Change (per day) in Avg Daily Steps
Interval -3.5 to 0.0
-2.0 Change (per day) in Avg Daily Steps
Interval -4.6 to 0.5
Change (Per Day) in Average Daily Steps Stratified by the Duke Activity Status Index (DASI)
16 week: DASI score 60
0.0 Change (per day) in Avg Daily Steps
Interval -2.4 to 2.5
-1.6 Change (per day) in Avg Daily Steps
Interval -4.2 to 1.0
-.6 Change (per day) in Avg Daily Steps
Interval -4.2 to 3.1

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change (per day) in Average Daily Steps Stratified by the International Physical Activity Questionnaire (IPAQ) - Short Form, specifically at scores of 150, 350, and 850. This 7-item measure, administered at the screening and study randomization sessions, evaluates engagement in vigorous, moderate, and light (e.g., walking) activity in the prior 7 days. Higher scores on the IPAQ indicate higher activity levels. The IPAQ is a continuous measure and thus, was left continuous in our model and was not categorized. Because the IPAQ is a continuous measure, we assumed a continuous linear change in the effect per unit change. For purposes of presenting the results, we selected scores of 150, 350, and 850 as values to report the model-based slopes. We reported those values based on approximate 25th, 50th, 75th percentiles among baseline IPAQ scores among H3M participants.

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=133 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=137 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=70 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by the International Physical Activity Questionnaire (IPAQ) - Short Form
8 week: IPAQ score 150
1.1 Change (per day) in Avg Daily Steps
Interval -3.8 to 6.0
3.0 Change (per day) in Avg Daily Steps
Interval -1.9 to 7.9
-8.7 Change (per day) in Avg Daily Steps
Interval -16.7 to -1.7
Change (Per Day) in Average Daily Steps Stratified by the International Physical Activity Questionnaire (IPAQ) - Short Form
8 week: IPAQ score 350
2.0 Change (per day) in Avg Daily Steps
Interval -2.8 to 6.8
2.9 Change (per day) in Avg Daily Steps
Interval -1.9 to 7.7
-9.8 Change (per day) in Avg Daily Steps
Interval -17.4 to -2.2
Change (Per Day) in Average Daily Steps Stratified by the International Physical Activity Questionnaire (IPAQ) - Short Form
8 week: IPAQ score 850
4.2 Change (per day) in Avg Daily Steps
Interval -0.4 to 8.9
2.7 Change (per day) in Avg Daily Steps
Interval -1.9 to 7.2
-12.5 Change (per day) in Avg Daily Steps
Interval -19.8 to -5.1
Change (Per Day) in Average Daily Steps Stratified by the International Physical Activity Questionnaire (IPAQ) - Short Form
16 week: IPAQ score 150
-3.1 Change (per day) in Avg Daily Steps
Interval -5.1 to -1.1
-1.6 Change (per day) in Avg Daily Steps
Interval -3.6 to 0.4
-1.7 Change (per day) in Avg Daily Steps
Interval -4.8 to 1.5
Change (Per Day) in Average Daily Steps Stratified by the International Physical Activity Questionnaire (IPAQ) - Short Form
16 week: IPAQ score 350
-2.8 Change (per day) in Avg Daily Steps
Interval -4.7 to -0.9
-1.8 Change (per day) in Avg Daily Steps
Interval -3.8 to 0.2
-2.2 Change (per day) in Avg Daily Steps
Interval -5.2 to 0.7
Change (Per Day) in Average Daily Steps Stratified by the International Physical Activity Questionnaire (IPAQ) - Short Form
16 week: IPAQ score 850
-2.2 Change (per day) in Avg Daily Steps
Interval -4.0 to -0.3
-2.4 Change (per day) in Avg Daily Steps
Interval -4.3 to -0.5
-3.6 Change (per day) in Avg Daily Steps
Interval -6.5 to -0.7

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change (per day) in Average Daily Steps Stratified by education. Education was self-reported in the demographics questionnaire. Education is reported as: less than 4-year college, 4-year college, and more than 4-year college

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=133 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=137 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=70 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by Education
8 weeks: less than 4 year college
-2.3 Change (per day) in Avg Daily Steps
Interval -9.3 to 4.8
-1.8 Change (per day) in Avg Daily Steps
Interval -8.2 to 4.6
-7.2 Change (per day) in Avg Daily Steps
Interval -17.3 to 2.8
Change (Per Day) in Average Daily Steps Stratified by Education
8 weeks: 4-year college
2.1 Change (per day) in Avg Daily Steps
Interval -6.9 to 11.1
5.5 Change (per day) in Avg Daily Steps
Interval -2.2 to 13.1
9.3 Change (per day) in Avg Daily Steps
Interval -5.9 to 24.5
Change (Per Day) in Average Daily Steps Stratified by Education
8 weeks: more than 4-year college
8.2 Change (per day) in Avg Daily Steps
Interval 1.3 to 15.0
7.4 Change (per day) in Avg Daily Steps
Interval -0.4 to 15.1
-15.9 Change (per day) in Avg Daily Steps
Interval -25.4 to -6.3
Change (Per Day) in Average Daily Steps Stratified by Education
16 weeks: less than 4-year college
-.1 Change (per day) in Avg Daily Steps
Interval -3.0 to 2.8
-1.8 Change (per day) in Avg Daily Steps
Interval -4.4 to 0.9
-3.9 Change (per day) in Avg Daily Steps
Interval -7.7 to 0.0
Change (Per Day) in Average Daily Steps Stratified by Education
16 weeks: 4-year college
-4.9 Change (per day) in Avg Daily Steps
Interval -8.5 to -1.3
-2.4 Change (per day) in Avg Daily Steps
Interval -5.7 to 0.9
-4.2 Change (per day) in Avg Daily Steps
Interval -10.0 to 1.5
Change (Per Day) in Average Daily Steps Stratified by Education
16 weeks: more than 4-year college
.1 Change (per day) in Avg Daily Steps
Interval -2.6 to 2.9
-.9 Change (per day) in Avg Daily Steps
Interval -3.9 to 2.1
-.6 Change (per day) in Avg Daily Steps
Interval -4.4 to 3.3

SECONDARY outcome

Timeframe: Baseline, 8 and 16 weeks

Change (per day) in Average Daily Steps Stratified by the employment. Employment was self-reported in the demographics questionnaire. Employment is reported as employed, unemployed, and other.

Outcome measures

Outcome measures
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=133 Participants
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=137 Participants
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=70 Participants
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Change (Per Day) in Average Daily Steps Stratified by Employment
8 week: employed
6.1 Change (per day) in Avg Daily Steps
Interval 0.9 to 11.4
2.4 Change (per day) in Avg Daily Steps
Interval -2.7 to 7.4
-8.4 Change (per day) in Avg Daily Steps
Interval -15.5 to -1.3
Change (Per Day) in Average Daily Steps Stratified by Employment
8 week: unemployed
-15.8 Change (per day) in Avg Daily Steps
Interval -17.6 to -4.0
11.7 Change (per day) in Avg Daily Steps
Interval 0.2 to 23.3
2.8 Change (per day) in Avg Daily Steps
Interval -21.8 to 27.5
Change (Per Day) in Average Daily Steps Stratified by Employment
8 week: other
3.2 Change (per day) in Avg Daily Steps
Interval -7.1 to 13.5
-1.0 Change (per day) in Avg Daily Steps
Interval -10.5 to 8.4
-11.5 Change (per day) in Avg Daily Steps
Interval -27.6 to 4.7
Change (Per Day) in Average Daily Steps Stratified by Employment
16 week: employed
.8 Change (per day) in Avg Daily Steps
Interval -1.3 to 2.8
-.6 Change (per day) in Avg Daily Steps
Interval -2.7 to 1.5
-2.1 Change (per day) in Avg Daily Steps
Interval -5.0 to 0.8
Change (Per Day) in Average Daily Steps Stratified by Employment
16 week: unemployed
-14.9 Change (per day) in Avg Daily Steps
Interval -19.7 to -10.0
.5 Change (per day) in Avg Daily Steps
Interval -4.2 to 5.2
-2.6 Change (per day) in Avg Daily Steps
Interval -11.7 to 6.5
Change (Per Day) in Average Daily Steps Stratified by Employment
16 week: other
1.3 Change (per day) in Avg Daily Steps
Interval -2.9 to 5.5
-7.6 Change (per day) in Avg Daily Steps
Interval -11.5 to -3.7
-4.4 Change (per day) in Avg Daily Steps
Interval -10.2 to 1.4

Adverse Events

Online Mindfulness Based Cognitive Therapy +Fitbit

Serious events: 0 serious events
Other events: 53 other events
Deaths: 0 deaths

Online Cognitive Behavioral Therapy +Fitbit

Serious events: 1 serious events
Other events: 45 other events
Deaths: 0 deaths

Fitbit Alone

Serious events: 0 serious events
Other events: 30 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=144 participants at risk
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=145 participants at risk
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=72 participants at risk
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Cardiac disorders
Angina
0.00%
0/144 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
0.69%
1/145 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
0.00%
0/72 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.

Other adverse events

Other adverse events
Measure
Online Mindfulness Based Cognitive Therapy +Fitbit
n=144 participants at risk
A central aspect of MBCT is the concept of awareness. Participants practice a variety of meditation types (e.g. breath awareness) and learn to bring mindfulness to everyday situations. Awareness will be directed to elements in participants' lives that interfere with living a more productive, physically active life (e.g. thoughts and feelings that interfere with becoming more physically active; stressful situations and circumstances that prevent them from engaging in exercise). Two hundred participants will be randomized into this group. Online Mindfulness Based Cognitive Therapy: see arm description
Online Cognitive Behavioral Therapy +Fitbit
n=145 participants at risk
1)identifying and setting realistic exercise-based goals and intermediate goals (to maximize success to increase motivation); (2) behavioral scheduling to optimize when to exercise, identify rewards for exercising, and problem solve obstacles to exercising; and (3) identify dysfunctional, maladaptive thoughts about exercise (which decrease motivation) and skills to identify more adaptive, positive thoughts (to overcome thoughts of being too tired or too stressed to exercise). Two hundred participants will be randomized into this group. Online Cognitive Behavioral Therapy: see arm description
Fitbit Alone
n=72 participants at risk
Participants assigned to the Fitbit-only control study group you will not be receiving therapy. However, they will receive a Fitbit, which they will be asked to wear over the course of 16 weeks as well as to complete the same schedule of assessments as the therapy arms. One hundred participants will be randomized into this group. Fitbit Alone: see arm description
Psychiatric disorders
Suicidal thoughts
29.9%
43/144 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
26.9%
39/145 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
31.9%
23/72 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
Psychiatric disorders
Sleeping difficulty
0.00%
0/144 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
0.00%
0/145 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
1.4%
1/72 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
Psychiatric disorders
Negative health event
4.9%
7/144 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
3.4%
5/145 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
6.9%
5/72 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
General disorders
Hip injury
0.69%
1/144 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
0.00%
0/145 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
0.00%
0/72 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
Psychiatric disorders
Hospitalized for alcoholism
0.00%
0/144 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
0.69%
1/145 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
0.00%
0/72 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
Cardiac disorders
Cardiovascular procedure
1.4%
2/144 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
0.00%
0/145 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
0.00%
0/72 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
General disorders
Chronic kidney disease
0.00%
0/144 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
0.00%
0/145 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.
1.4%
1/72 • 16 weeks
Data on adverse events were collected via a two-question survey designed to assess if participants have experienced any adverse events, related to the study, since starting to participate.

Additional Information

Dr. Andrew Nierenberg

Massachusetts General Hospital

Phone: 617-512-2641

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place