Behavior Change and Compliance Outcomes of a Novel Web-Based Health Behavior Tool Integrated Into Certified Exercise...

Healthy lifestyle behaviors, including a balanced diet, regular physical activity, adequate sleep, avoiding tobacco, moderating alcohol consumption, and stress management, are associated with reduced risk of chronic disease and improved well-being. In recent years, digital interventions have emerged as cost-effective platforms for promoting these behaviors, yet few have been integrated into services delivered by certified exercise practitioners (CEPs) or focused on multiple domains of health.

This study aimed to examine changes in health behaviors during implementation of the Food, Exercise, Sleep, and Stress (FESS) web-based questionnaire as an adjunct to traditional face-to-face services provided by CEPs and compare these changes across 2 prompting frequencies.

A 2-arm, randomized pre-post intervention design was conducted with 41 participants (23 women), with a median age of 65 (IQR 58-70) years, who were recruited from CEP clinics. Participants were randomized to complete the FESS questionnaire either 3 times per week (3-day group, n=21) or daily (everyday group, n=20) for 12 weeks. The questionnaire tracked health behaviors across 4 domains and provided health tips. Outcomes were assessed using the assessment version of the FESS questionnaire at baseline and at 6 and 12 weeks. Changes in FESS questionnaire responses were examined over time using Friedman ANOVA with Wilcoxon signed-rank post hoc tests. Group differences between prompting frequencies were assessed by calculating changes in questionnaire responses from baseline to 6 and 12 weeks and analyzing them using the Mann-Whitney U test. Compliance was assessed by calculating the proportion of completed FESS questionnaires relative to the total number of questionnaires prescribed for each participant within each intervention arm. Validity of the exercise domain was evaluated by comparing self-reported physical activity and sedentary time from daily FESS responses with accelerometer-derived measures in a subsample of participants.

Positive or no changes were observed across most behaviors, with significant improvements in vegetable consumption, water intake, stress, and sleep. Group comparisons indicated larger changes in stress and sleep behaviors in the everyday group; however, compliance was higher in the 3-day group. Compliance declined over time in both groups. Accelerometer validation of the exercise domain showed low rates of overreporting exercise (3/59, 5.1%) and underreporting sedentary behavior (11/59, 18.6%).

The FESS questionnaire demonstrated feasibility and was associated with observed changes in health behaviors, particularly in diet, stress, and sleep, when integrated into CEP services. While daily use was associated with larger observed changes, reduced compliance highlights the importance of flexible engagement strategies. These preliminary findings suggest that CEP services may benefit from embedding structured digital tools into traditional face-to-face interactions, as such tools may support education, promote reflection and accountability between sessions, and facilitate attention to a broader range of lifestyle factors within routine CEP care. Further controlled studies are required to confirm these findings.