Make Better Choices

Poor quality diet and physical inactivity are the most prevalent, preventable causes of
death in the United States. In particular, high saturated fat diet (Fat), low fruit and
vegetable intake (FV), low physical activity (PA), and high sedentary leisure screen time
(Sed) co-occur and heighten the risks of cardiovascular disease and cancers. The first Make
Better Choices (MBC1) experiment contrasted four strategies to promote healthful change
across these four risk behaviors. Each intervention targeted two behaviors (one diet, one
activity) simultaneously and either increased healthy or decreased unhealthy responding. The
intervention targeting increased FV and decreased Sed was most efficacious, yielding
unexpectedly sustained improvement in three out of the four risk behaviors (FV, Sed, Fat).
The proposed MBC2 trial tests the efficacy of MBC intervention to promote sustained,
healthful change in diet and activity at 6 and 12 months, as contrasted with a stress
management control condition. MBC2 tests competing hypotheses about the optimal way to
increase PA without undermining the maintenance of FV, Sed, and Fat by changing multiple
behaviors either sequentially or simultaneously. Furthermore, MBC2 examines mediators and
biomarkers of healthy lifestyle change. Community dwelling adults (N=250) with suboptimal
diet and inactive lifestyle will be randomized to the following conditions: 1) Sequential
MBC (increasing FV intake and decreasing Sed, followed by increasing PA), 2) Simultaneous
MBC (increasing FV, decreasing Sed, and increasing PA), or 3) Control (stress management).
Participants in all conditions will use Smartphones equipped with customized behavioral
decision support tools to self-monitor health behaviors. These handheld devices will be
programmed to automatically transmit these data to our study server to be reviewed by a
personal behavior coach. Based on theories of self-regulation and habit strength, the
Mastery hypothesis predicts superior health behavior change for participants randomized to
the sequential condition. It is anticipated that these effects will be mediated by greater
habit strength for healthy eating and physical activity. However, based on goal systems
theory, the Synergy hypothesis predicts superior health behavior change among participants
randomized to the simultaneous condition. It is anticipated that these effects will be
mediated by the establishment of superordinate healthy lifestyle goals. The results of the
MBC2 trial will assist researchers in understanding the optimal manner in which to
facilitate multiple health behavior change in this population. Furthermore, these data will
help to identify the mechanisms that underlie healthy change among prevalent risk behaviors.
If successful, this trial will also result in an innovative, highly disseminable
technology-supported minimal counseling intervention to address the American unhealthy diet
and sedentary lifestyle.

Inclusion Criteria:

- Participants must expect to reside in the Chicagoland area for the next 9 months

- Must be willing to record diet, sedentary activities, and/or stress and sleep and
wear an accelerometer for 12 weeks and intermittently thereafter for the next
9-months

- Must agree to make changes in eating and activity or in sleep and relaxation
behaviors

- Participants must report all of the following on screening questionnaires:

- Low fiber diet (< 9 FV servings/day)

- High saturated fat intake (> 8% of daily calories from fat)

- Less than 150 minutes per week of moderate intensity physical activity per week
for the past 3 months (or less than 75 minutes of vigorous intensity activity
per week)

- An average of > 120 minutes/day spent on non-work, non-education related use of
the following recreational sedentary pastimes: television, videos/movies,
videogames, and computer use

Exclusion Criteria:

- Unstable medical conditions (e.g., uncontrolled hypertension, diabetes, recent
myocardial infarction)

- Physician approval for those with existing and controlled medication conditions

- Those that require an assistive device for ambulation

- > 350 lbs

- Currently taking weight loss medications

- Psychiatric hospitalization in past 5 years

- Those at risk for adverse cardiovascular disease (CVD) events with moderate intensity
activity (e.g., CVD symptoms while walking, those scheduled for cardiac stress test
within 2 months)

- Those who cannot read English sufficiently to respond to self-report questionnaires

- Current or anticipated pregnancy

- Women who are lactating

- Current active eating disorders (anorexia, bulimia)

- Current substance abuse or dependence (other than nicotine)