Publications by authors named "Ramona Wurst"

10 Publications

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A questionnaire to assess eating behavior: Structure, validity and responsiveness of a new German eating behavior scale (SEV).

Appetite 2021 Sep 11;168:105668. Epub 2021 Sep 11.

University of Freiburg, Department of Sport Psychology, Freiburg, Germany.

Numerous weight-loss interventions promoting healthy and weight-reducing eating behavior have been developed over the past years. To evaluate the effectiveness of such interventions for eating behavior change, short, validated and sensitive instruments are needed. In this study series, we developed and validated a new outcome measure to assess health-conscious and weight-controlling eating behavior for the evaluation of weight-loss interventions. The preliminary version of the German eating behavior scale (Skala zumErnährungsverhalten [SEV]) included 40 items. Three studies were conducted to (a) reduce the preliminary item pool, (b) investigate structural validity and internal consistency using exploratory and confirmatory factor analyses (EFA, CFA), as well as McDonald's ω, and (c) test construct validity with physiological and behavioral parameters. Responsiveness to change was also assessed after a 12-week weight-loss intervention. EFA indicated a two-factor solution with health-conscious (hc-EB) and weight-controlling eating behavior (wc-EB) as subscales, CFA confirmed the two-factor solution with acceptable model fit. Internal consistencies of both subscales were also acceptable to good (hc-EB: ω = 0.88; wc-EB: ω = 0.78). Significantly small to moderate correlations to the Healthy Eating Index (r = 0.51) as well as blood glucose (r = 0.31), blood lipids (r = 0.23), and vascular age (r = 0.31) were found, supporting the construct validity of the SEV and its subscales. Both subscales detected intervention-related changes in eating behavior among subjects of a weight-loss intervention with Standardized Response Means of 0.52 and 0.67, indicating good responsiveness of the SEV. In sum, findings provide evidence that the SEV is a valid and responsive measure to assess health-conscious and weight-controlling eating behavior.
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http://dx.doi.org/10.1016/j.appet.2021.105668DOI Listing
September 2021

Effectiveness of an interactive web-based health program for adults: a study protocol for three concurrent controlled-randomized trials (EVA-TK-Coach).

Trials 2021 Aug 10;22(1):526. Epub 2021 Aug 10.

Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany.

Background: A healthy lifestyle can help prevent diseases that impair quality of life and lead to premature death. The Techniker health insurance fund offers a comprehensive online health program to support users in achieving their health goals of Increasing Fitness, Losing and Maintaining Weight, or Smoking Cessation.

Methods: The aim of this study is to test the long-term effectiveness of the web-based TK-HealthCoach with regard to the primary outcomes of increased physical activity, sustainable weight reduction, and smoking abstinence. We are conducting three interconnected, randomized controlled trials (RCT), one for each health goal, within which participants are allocated to an intervention group (interactive online health program) or a control group (non-interactive online health program). The effects of the intervention groups compared to the control groups will be analyzed by multi-level models for change. Participants' data are captured via online questionnaires before the program starts (baseline t0), again when it ends (t1), and later at two follow-up surveys (t2 and t3); the latter 12 months after t1. We are documenting socio-demographic, health-related, and psychological variables as well as usage behavior data of the programs. According to our sample size calculation, we have to enroll 1114 participants in each Losing and Maintaining Weight and Increasing Fitness RCT and 339 participants in the Smoking Cessation RCT. Additionally, 15-20 participants in the interactive smoking-cessation program will be invited to qualitative telephone interviews with the aim to obtain detailed information concerning utilization, compliance, and satisfaction. The online RCTs' inclusion criteria are: adults of each gender regardless of whether they are insured with Techniker health insurance fund. Persons with impairments or pre-existing conditions require a medical assessment as to whether the program is suitable for them. Specific exclusion criteria apply to each program/RCT.

Discussion: We assume that study participants will improve their health behavior by using the offered online health programs and that each health goal's intervention group will reveal advantages regarding the outcome variables compared to the control groups. Study enrollment started on January 1, 2020.

Trial Registration: German Clinical Trials Register, Universal Trial Number (UTN): U1111-1245-0273 . Registered on 11 December 2019.
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http://dx.doi.org/10.1186/s13063-021-05470-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353439PMC
August 2021

Quality of Physical Activity Apps: Systematic Search in App Stores and Content Analysis.

JMIR Mhealth Uhealth 2021 06 9;9(6):e22587. Epub 2021 Jun 9.

Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany.

Background: Physical inactivity is a major contributor to the development and persistence of chronic diseases. Mobile health apps that foster physical activity have the potential to assist in behavior change. However, the quality of the mobile health apps available in app stores is hard to assess for making informed decisions by end users and health care providers.

Objective: This study aimed at systematically reviewing and analyzing the content and quality of physical activity apps available in the 2 major app stores (Google Play and App Store) by using the German version of the Mobile App Rating Scale (MARS-G). Moreover, the privacy and security measures were assessed.

Methods: A web crawler was used to systematically search for apps promoting physical activity in the Google Play store and App Store. Two independent raters used the MARS-G to assess app quality. Further, app characteristics, content and functions, and privacy and security measures were assessed. The correlation between user star ratings and MARS was calculated. Exploratory regression analysis was conducted to determine relevant predictors for the overall quality of physical activity apps.

Results: Of the 2231 identified apps, 312 met the inclusion criteria. The results indicated that the overall quality was moderate (mean 3.60 [SD 0.59], range 1-4.75). The scores of the subscales, that is, information (mean 3.24 [SD 0.56], range 1.17-4.4), engagement (mean 3.19 [SD 0.82], range 1.2-5), aesthetics (mean 3.65 [SD 0.79], range 1-5), and functionality (mean 4.35 [SD 0.58], range 1.88-5) were obtained. An efficacy study could not be identified for any of the included apps. The features of data security and privacy were mainly not applied. Average user ratings showed significant small correlations with the MARS ratings (r=0.22, 95% CI 0.08-0.35; P<.001). The amount of content and number of functions were predictive of the overall quality of these physical activity apps, whereas app store and price were not.

Conclusions: Apps for physical activity showed a broad range of quality ratings, with moderate overall quality ratings. Given the present privacy, security, and evidence concerns inherent to most rated apps, their medical use is questionable. There is a need for open-source databases of expert quality ratings to foster informed health care decisions by users and health care providers.
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http://dx.doi.org/10.2196/22587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8262667PMC
June 2021

Joint associations of regular exercise and healthy diet with psychobiological stress reactivity in a healthy male sample.

Stress 2021 Feb 19:1-14. Epub 2021 Feb 19.

Department of Sport Psychology, University of Freiburg, Freiburg, Germany.

Engaging in physical activity and exercise have long been shown to have beneficial effects on (psychosocial) stress reactivity. Initial studies could reveal that these positive effects on stress reactivity also exist for a healthy diet. Aim of this study was to examine whether combining a healthy diet and regular exercise can provide additional benefits on psychobiological stress levels. Forty-two men self-identifying as non-exercisers or regular exercisers between 18 and 30 years were exposed to the Trier Social Stress Test for Groups. Salivary cortisol (sCort) and alpha-amylase (sAA) as biological stress markers, and self-reported momentary stress were repeatedly examined. Questionnaires on regular exercise and dietary intake were completed once. Two-stage hierarchical multiple regressions predicting participants' stress reactivity, i.e. response and recovery, from diet quality, exercise as well as their interaction appeared inconsistent. sCort response was significantly predicted by regular exercise whereas greater sCort recovery was predicted by higher diet quality. In contrast, higher sAA reactivity was predicted by higher diet quality while participants eating less healthy and exercising more showed the most pronounced sAA recovery. None of the other outcome variables was predicted by the interaction. Subjective stress was unrelated to either health behavior. The present examination among an all-male sample emphasized the stress-buffering capabilities of regular exercise and provided initial evidence for a distinct link to healthy diet. Assumed synergistic benefits could, however, not be confirmed. Advances are needed to better understand how individuals profit the most from which behaviors as well as their interactive effects.
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http://dx.doi.org/10.1080/10253890.2021.1878496DOI Listing
February 2021

Effects of Incentives on Adherence to a Web-Based Intervention Promoting Physical Activity: Naturalistic Study.

J Med Internet Res 2020 07 30;22(7):e18338. Epub 2020 Jul 30.

Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany.

Background: Despite many advantages of web-based health behavior interventions such as wide accessibility or low costs, these interventions are often accompanied by high attrition rates, particularly in usage under real-life conditions. It would therefore be helpful to implement strategies such as the use of financial incentives to motivate program participation and increase adherence.

Objective: This naturalistic study examined real-life usage data of a 12-week web-based physical activity (PA) intervention (Fitness Coach) among insurants who participated in an additional incentive program (incentive group) and those who did not (nonincentive group). Users in the incentive group had the perspective of receiving €30 (about US $33) cash back at the end of the intervention.

Methods: Registration and real-life usage data as part of routine data management and evaluation of the Fitness Coach were analyzed between September 2016 and June 2018. Depending on the duration of use and the weekly recording of tasks, 4 adherence groups (low, occasional, strong, and complete adherence) were defined. Demographic characteristics were collected by a self-reported questionnaire at registration. We analyzed baseline predictors and moderators of complete adherence such as participation in the program, age, gender, and BMI using binary logistic regressions.

Results: A total of 18,613 eligible persons registered for the intervention. Of these, 15,482 users chose to participate in the incentive program (incentive group): mean age 42.4 (SD 14.4) years, mean BMI 24.5 (SD 4.0) kg/m, median (IQR) BMI 23.8 (21.7-26.4) kg/m; 65.12% (10,082/15,482) female; and 3131 users decided not to use the incentive program (nonincentive group): mean age 40.7 (SD 13.4) years, mean BMI 26.2 (SD 5.0) kg/m, median BMI 25.3 (IQR 22.6-28.7) kg/m; 72.18% (2260/3131) female. At the end of the intervention, participants in the incentive program group showed 4.8 times higher complete adherence rates than those in the nonincentive program group (39.2% vs 8.1%), also yielding significantly higher odds to complete the intervention (odds ratio [OR] 12.638) for the incentive program group. Gender significantly moderated the effect with men in the incentive group showing higher odds to be completely adherent than women overall and men in the nonincentive group (OR 1.761). Furthermore, older age and male gender were significant predictors of complete adherence for all participants, whereas BMI did not predict intervention completion.

Conclusions: This is the first naturalistic study in the field of web-based PA interventions that shows the potential of even small financial incentives to increase program adherence. Male users, in particular, seem to be strongly motivated by incentives to complete the intervention. Based on these findings, health care providers can use differentiated incentive systems to increase regular participation in web-based PA interventions.
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http://dx.doi.org/10.2196/18338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426800PMC
July 2020

Effects of a workplace physical activity intervention on cognitive determinants of physical activity: a randomized controlled trial.

Psychol Health 2021 Jun 16;36(6):629-648. Epub 2020 Jun 16.

Department of Sport Science, University of Freiburg, Freiburg, Germany.

Objective: The present randomized controlled trial evaluated if a workplace physical activity (PA) program that comprises both a PA component and a psychological coaching component (PA + C) is more effective in changing cognitive determinants of PA than a PA program without coaching component.  = 213 employees were cluster-randomly assigned to two groups: the PA + C group received the MoVo-work intervention, combining a psychological coaching component and a PA component. The PA group received the PA component without psychological coaching. Strength of goal intention, self-efficacy, outcome expectations, action planning and barrier management were assessed at five time points (before and at the end of the intervention, as well as 6 weeks, 6 months and 12 months after the intervention). After six weeks and one year, respectively, the PA + C group showed significantly higher goal intentions ( = .018) and self-efficacy beliefs ( = .006) than the PA group; and, at a descriptive level, a clear tendency towards better barrier management. The results indicate that a workplace PA program, including psychological coaching, may partially improve the effects of a pure PA program on critical motivational and volitional determinants of PA behavioural change among employees.
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http://dx.doi.org/10.1080/08870446.2020.1780233DOI Listing
June 2021

A group- and smartphone-based psychological intervention to increase and maintain physical activity in patients with musculoskeletal conditions: study protocol for a randomized controlled trial ("MoVo-App").

Trials 2020 Jun 8;21(1):502. Epub 2020 Jun 8.

Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Schwarzwaldstrasse 175, 79117, Freiburg, Germany.

Background: Interventions designed to increase the level of physical activity are crucial in the treatment of patients with musculoskeletal conditions. The psychological group-based intervention MoVo-LISA based on the Motivation-Volition (MoVo) Process Model has been shown to effectively promote physical activity. The aim of this study is to evaluate whether a MoVo-based app (MoVo-App) subsequent to MoVo-LISA during orthopedic inpatient care can support people to increase and maintain their amount of physical activity.

Methods/design: In this parallel-group randomized controlled trial, patients with musculoskeletal disorders will be randomized to either (a) a combination of the group-based intervention program MoVo-LISA to promote physical activity plus the MoVo-App or (b) the group-based intervention program alone without the app. The intervention group will receive the MoVo-App after discharge from inpatient rehabilitation. They receive help to increase and maintain their level of physical activity (initiated by the group program) by tracking their health goals, activity plans, major barriers, and barrier management that were developed during the group-based program. We will recruit 224 initially minimally active participants during orthopedic rehabilitation care. Outcomes are assessed at clinic admission; discharge; 6 weeks; and 3 (post-treatment), 6, and 12 months after discharge (follow-up). The primary outcome is sport activity (active/inactive and minutes of activity) at 6-month follow-up. Secondary outcomes are movement activity, cognitive mediators of behavioral change (e.g., self-efficacy, action planning), and health-related variables (e.g., pain intensity, depression). To evaluate intervention effects, linear mixed effects models (both on intention-to-treat basis with an additional per-protocol analysis) will be conducted with each outcome variable and with time as the within-subjects factor and group as the between-subjects factor, along with all two-way interactions and accounting for covariates as fixed effects.

Discussion: This is the first evaluation of the effectiveness of an app in combination with a face-to-face group intervention to promote physical activity. The approach of using an app in addition to an effective face-to-face intervention program, both based on the MoVo model, might sustain positive intervention effects introduced in routine health care.

Trial Registration: The trial "A group- and smartphone-based psychological intervention to increase physical activity in patients with musculoskeletal conditions: A randomized controlled trial" is registered at the World Health Organization International Clinical Trials Registry Platform via the German Clinical Studies Trial Register (DRKS), DRKS00014814. Registered on 18 October 2018; URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014814.
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http://dx.doi.org/10.1186/s13063-020-04438-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278049PMC
June 2020

Effects of a Worksite Group Intervention to Promote Physical Activity and Health: The Role of Psychological Coaching.

Appl Psychol Health Well Being 2019 11 18;11(3):584-605. Epub 2019 Jun 18.

University of Freiburg, Germany.

Background: This study investigates whether a worksite physical activity (PA) promotion program consisting of both a "practical" PA component and a "theoretical" (psychological) coaching component (PA+C) is more effective than the same "practical" PA component alone.

Methods: N = 213 employees were assigned to two groups by cluster-randomisation: one group received the "MoVo-work" program including a PA component and a coaching component (PA+C group). The other group received only the PA component (PA group). Assessment of PA and health was conducted at five time points.

Results: Six weeks after program completion the percentage of physically active participants was significantly higher in the PA+C group compared to the PA group (68% vs. 45%; p = .01). At 12-month follow-up, the PA+C group showed a higher percentage of physically active participants and a better health status than the PA group on the descriptive level, but these differences did not reach statistical significance.

Conclusions: Results suggest that a PA promotion program including a psychological coaching component is more effective in evoking behavior change than a practical PA program alone. However, booster interventions are required to maintain the additional effects.
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http://dx.doi.org/10.1111/aphw.12170DOI Listing
November 2019

Promoting physical activity through a psychological group intervention in cardiac rehabilitation: a randomized controlled trial.

J Behav Med 2019 Dec 7;42(6):1104-1116. Epub 2019 May 7.

Department of Sport Psychology, University of Freiburg, Schwarzwaldstrasse 175, 79117, Freiburg, Germany.

We examined the long-term effectiveness of a group-based psychological intervention ("MoVo-LISA") to promote physical activity in patients with coronary heart disease. In this randomized controlled trial, N = 202 inactive patients with coronary heart disease were assigned to the control group (n = 102; treatment as usual) or the intervention group (n = 100; treatment as usual plus MoVo-LISA). Physical activity was assessed at baseline, 6 weeks (post-treatment), 6 months, and 12 months after discharge. ANCOVA for repeated measures revealed a significant interaction effect [p < .001; η = .214] indicating a large effect [d = 1.03] of the intervention on behavior change post-treatment. At 12-month follow-up, the level of physical activity in the intervention group was still 94 min per week higher than in the control group (p < .001; d = 0.57). Results of this RCT indicate that the MoVo-LISA intervention substantially improves the level of physical activity among initially inactive patients with coronary heart disease up to 1 year after the intervention.
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http://dx.doi.org/10.1007/s10865-019-00047-yDOI Listing
December 2019

Habitual and acute exercise effects on salivary biomarkers in response to psychosocial stress.

Psychoneuroendocrinology 2019 08 25;106:216-225. Epub 2019 Mar 25.

Department of Sport Science, Albert-Ludwigs-University Freiburg, Schwarzwaldstraße 175, Freiburg 79117, Germany. Electronic address:

Objective: Previous research suggests beneficial effects of physical exercise on stress reactivity due to cross-stressor adaptions of physiological stress response systems. However, results remain inconclusive and it is unclear whether only regular engagement in exercise modulates these physiological adaptations or if acute bouts of exercise can elicit similar adaptations. Thus, the aim of the current study was to investigate and compare the effects of habitual and acute exercise on physiological stress responses.

Methods: 84 male participants between 18 and 30 years (half of them were screened to be habitually high active or low active) were randomized into one of two groups: either an acute exercise intervention group (n = 42 with 50% being habitually high active) which engaged in 30 min of moderate-to-high intensity ergometer bicycling, or a control (placebo exercise) group which engaged in 30 min of light stretching (n = 42 with 50% being habitually high active). Following the intervention period, participants took part in a well validated psychosocial stress paradigm. Saliva samples were taken repeatedly to derive alpha-amylase and cortisol as stress-specific parameters. A multilevel growth curve approach was applied to analyse changes in the stress parameters over time.

Results: Both, acute and habitual exercise have shown to be positively related to stress reactivity. In particular, a reduction in stress activation was found for both types of exercise, but only habitual engagement in exercise exhibited a beneficial effect on peak cortisol levels.

Conclusions: Taken together, people can profit from regular exercise (i.e. reduced activity of stress-response systems). However, even acute bouts of exercise preceding stress exposure showed beneficial effects on stress reactivity. This finding is particularly important as it may provide a (self-)regulatory mechanism for people facing conceivable acute stress situations.
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http://dx.doi.org/10.1016/j.psyneuen.2019.03.015DOI Listing
August 2019
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