Physical Activity Measurement Reactivity Among Midlife Adults With Elevated Risk for Cardiovascular Disease: Protocol for Coordinated Analyses Across Six Studies

BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of death in the United States, and adults aged 40-60 years with specific health conditions are at particularly elevated risk for developing CVD. Physical activity (PA) is a key cardioprotective behavior and many interventions exist to promote PA in this group. Effective promotion requires accurate assessment of PA behavior; as PA is often estimated by averaging across multiple days, a threat to accurate assessment is measurement reactivity, or an atypical increase in PA behavior at the start of measurement periods that may bias conclusions. Evidence for PA measurement reactivity is equivocal, though concern has resulted in recommendations to add or drop PA measurement days from inclusion, which may introduce undue burden on participants. At present, the extent of PA measurement reactivity and the behaviors most likely to be affected (eg, steps vs minutes of exercise) among those at risk for CVD are unclear, as are participant characteristics such as gender and study expectations (eg, intervention vs observation only) that may contribute to differences in these patterns. OBJECTIVE: The goal of this study is to improve on the current understanding of the extent of PA measurement reactivity and potential moderators among US adults aged 40-60 years with CVD risk factors. METHODS: To achieve this goal, we will conduct coordinated multilevel analyses across 6 studies. Data are from nationally representative, publicly available datasets (observation only: 2 studies) and baseline weeks of observation from behavioral weight loss clinical trials (4 studies), all collected in the United States. The publicly available datasets National Health and Nutrition Examination Survey (NHANES; 2013-2014) and the Midlife in the United States (MIDUS) Study (2004-2009; total n=1385) were used, which are available from the Inter-university Consortium for Political and Social Research website. Behavioral weight loss trials were conducted by the Drexel University Weight Eating and Lifestyle (WELL) Center (2011-2023; total n=444), in person or remotely via Zoom. Relevant data from each study were extracted for adults aged 40-60 years who have ≥1 risk factor for CVD (total n=1832; 11,707 total days of PA measurement with 6-7 days per person). Changes in PA behavior across the measurement period will be examined at the day level, using 2-level multilevel models (days nested within persons) and cross-level interactions (for moderation effects). RESULTS: This project was funded in August 2022 and received supplementary funding in September 2023. Dataset acquisition and data cleaning were completed in October 2024. Analyses are expected to be completed in April 2025, and findings are anticipated to be shared in July 2025. CONCLUSIONS: Results from this coordinated analysis project will provide the first large-scale estimation of the extent of PA measurement reactivity in an at-risk group. Findings will inform best practices for mitigating potential measurement reactivity in multiday assessments of PA behavior. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/67438.

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