The purpose of this 32-week study is to use an innovative experimental design known as SMART (Sequential Multiple Assignment Randomized Trial), which will allow us to determine the best way to sequence the delivery of teleexercise (referred to as an adaptive intervention), combined with predictive analytics on participant adherence in a stepped program of physical activity interventions. All 257 participants will have access to a library of recorded video exercise content, and a weekly wellness article. Some participants will receive health coaching calls (1st randomization). Analytic data will be used to determine which participants are responding or not responding to the intervention. Participants not responding after 4 weeks will receive either live one-on-one or group exercise training (2nd randomization). After 8 weeks, the participant will receive only pre-recorded exercise content and articles for a 24-week maintenance phase (weeks 9-32). The study outcomes are: The effectiveness of the adaptive interventions; Exploring mediating and moderating variables; Sensitivity analysis of the predictive analytics.
None
None
Factorial
asynchronous content only
BehavioralReceives asynchronous exercise content and no live training
Asynchronous content and health coaching and no live training
BehavioralReceives asynchronous content, health coaching and no live training.
asynchronous content only and 1 on 1 live training
Behavioralreceives asynchronous content and live 1 on 1 training
asynchronous content and health coaching and 1 on 1 training
Behavioralreceives asynchronous content, health coaching, and live training
asynchronous content and group training
Behavioralreceives asynchronous content and live group training
Asynchronous content and health coaching and group training
Behavioralreceives asynchronous content, health coaching, and live group training
6
Treatment groupsSee each treatment group below.
Physical activity
The primary outcome is the change in physical activity (steps per day) from baseline to the end of the 32-week intervention. Participants wear Fitbit Inspire 3 trackers (Google LLC, Sacramento, CA) for continuous objective measurement, with data exported via the study dashboard. This is supplemented by the Godin Leisure-Time Exercise Questionnaire (GLETQ) at baseline, week-8 and week-16 for self-reported leisure-time activity in MET-minutes/week.
Health information technology literacy
The secondary outcome is health information technology literacy, measured by the eHealth Literacy Scale (eHEALS). The eHEALS is a validated 8-item questionnaire assessing participants' perceived skills in finding, evaluating, and applying online health information (scored 8-40). Assessments occur at baseline, week 8, week 16, and week 32 to track changes over the 32-week intervention.
Secondary Health Conditions
The secondary outcome is secondary health conditions, assessed via National Institutes of Health Patient-Reported Outcome Measurement Information System (PROMIS) questionnaires. PROMIS measures include pain interference, fatigue, sleep disturbance, and quality of life, each on a T-score metric (mean 50, SD 10) for standardized comparison. Assessments occur at baseline, week 8, week 16, and week 32 to evaluate changes over the 32-week intervention.
Activity limitations
The secondary outcome is activity limitations, measured by the Physical Functioning subscale of the 36-Item Short Form Survey (SF-36 PF). The SF-36 PF is a validated 10-item questionnaire assessing limitations in physical activities due to health problems (scored 0-100, higher scores indicate better functioning). Assessments occur at baseline, week 8, week 16, and week 32 to track changes over the 32-week intervention.
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