Adaptive Physical Activity Intervention

Development of the original 8-week programs, details on program skills, and exit interviews to inform the current program versions have been previously reported [23 (link)]. The final GetActive and GetActive-Fitbit programs have 10 weekly 90-min sessions (Multimedia Appendix 3). The programs teach 4 core skills: (1) weekly SMART goal setting (defined as goals that are specific, measurable, achievable, relevant and time-based) [29 (link)] for a gradual increase in physical activity paired with activities of daily living that are meaningful and important to participants (ie, walk instead of drive to the store and walk to the park with kids) and the daily practice of mind-body skills (eg, engage in meditation before going to bed and when walking), (2) individualized quota-based pacing (eg, walk for 30 min or meet a step goal of 5000), (3) mind-body skills (diaphragmatic breathing to manage intense pain flares and pain anxiety, body scan to increase body awareness and reduce reactivity to pain sensations, mindfulness exercises to understand the transience of pain and change one’s relationship with it, and self-compassion when falling short of set goals), and (4) understand the disability spiral (eg, how reducing activity perpetuates pain and disability) and correct myths about pain or automatic pain-related thoughts that interfere with meeting program goals. At each weekly session, the group leader reviewed home practice, including adherence to activity goals, and helped participants solve barriers to adherence. Participants who missed group sessions were immediately contacted by the study staff and scheduled for a make-up session.
The GetActive and GetActive-Fitbit programs are identical in content and structure. However, in the GetActive-Fitbit program, the study staff instructed participants how to consistently wear and charge the Fitbit (session 1), uploaded an individualized step goal onto each participant’s Fitbit during each weekly session through Fitbit.com, monitored Fitbit wear in real time through the Fitabase website (Fitabase) [30 ], immediately called nonadherent participants to solve problems with adherence, and encouraged participants to focus on meeting the daily activity SMART goals.