The COVID-19 pandemic has changed routines and habits, raising stress and anxiety levels of individuals worldwide. The goal of this qualitative study was to advance the understanding of how pandemic-related changes affected sleep, diet, physical activity (PA), and stress among adults. We conducted semi-structured, qualitative interviews with 185 participants and selected 33 interviews from a represented sample based on age, race, and gender for coding and analysis of themes. After coding for thematic analysis, results demonstrated four primary themes: sleep, diet, PA, and stress. Sleep sub-themes such as poorer sleep quality were reported by 36% of our participants, and 12% reported increased an frequency of vivid dreams and nightmares. PA was decreased in 52% of our participants, while 33% experienced an increase and 15% experienced no change in PA. Participants also reported having an improved diet, mostly among women. Stress was elevated in 79% of our participants and was more likely to be discussed by women. Many participants reported how stress was involved in precipitating health behavior change, especially for sleep. Increased stress was also linked to elevated anxiety and depression among participants. The results of this qualitative study demonstrate how managing stress could have a beneficial effect on promoting health behaviors and mental health during the COVID-19 pandemic and beyond.

Background: Cancer survivors face long-term health challenges posttreatment. Physical activity (PA) can help manage cancer-related side effects and offer additional health benefits, yet up to 80% of survivors do not meet PA guidelines. Effective and translatable PA interventions are needed. Objective: This randomized trial assessed the feasibility, acceptability, and preliminary efficacy of a 12-week automated Internet program for increasing moderate-to-vigorous physical activity (MVPA) among cancer survivors. A secondary aim examined the effect of the intervention on physical and mental well-being. Methods: Inactive (<60 min/wk of PA) cancer survivors who completed cancer-directed treatment in the past 3‐12 months or those on a stable maintenance treatment regimen were randomized to the Energize! Exercise Program or Newsletter control condition. The Energize! Program was fully automated and involved weekly behaviorally-based video lessons, homework assignments, exercise planning and reporting, and progressive MVPA goals (75 to 200 min/wk). Algorithm-generated personalized feedback was provided based on PA goal attainment and homework completion. The newsletter group received bimonthly PA education newsletters (a total of 6). Assessments occurred at baseline, 3 months (postintervention), and 6 months (following a 3-month no-contact follow-up). Feasibility was assessed via enrollment and retention rates, acceptability was assessed via intervention engagement metrics and program satisfaction questionnaire, and MVPA was assessed via both self-report and accelerometer (min/wk of total and “bouted” MVPA [accumulated in bouts ≥10 min]). Health-related outcomes (eg, quality of life, fatigue, psychological distress, psychological symptoms, and fear of cancer recurrence) were assessed via electronic questionnaires. Results: Forty-six adults aged 55.2 (SD 8.3) years, with BMI mean 33.0 (SD 7.6) kg/m²; 42 (91.3%) female, and 37 (80.4%) non-Hispanic White enrolled in this trial. Feasibility metrics indicate that 69% (46/67) of those who screened eligible were randomized and 6-month retention among randomized participants was 94% (43/46). Acceptability was also high, as evidenced by the percentage of lessons viewed (mean 87.7%, SD 21.3%), exercise plans submitted (mean 82.6%, SD 25.8%), homework assignments completed (mean 77.2%, SD 25.2%), and weeks in which exercise minutes were logged (mean 85.9%, SD 22.1%). Program satisfaction ratings were higher in Energize (mean 5.8, SD 1.6; 1‐7 scale) versus Newsletter (mean 3.2, SD 1.6; P<.001). Energize! increased self-reported (92.7 min/wk), bouted (35.4 min/wk), and total (46.3 min/wk) MVPA at 3 months (Cohen d=0.74‐0.94), and these changes were partially maintained at 6 months. Increases in MVPA were smaller among Newsletter participants (d=0.28‐0.47). Group differences in health-related outcomes were minimal and mixed, favoring Energize! over Newsletter for vitality (d=0.63) and somatization (d=0.76) at 3 months, and for depression (d=0.59) and anxiety (d=0.51) at 6 months. Conclusions: The automated Energize! Program is feasible, acceptable, and associated with positive changes in MVPA, yet future studies are needed to improve MVPA long-term. Findings suggest that self-guided PA programs may be beneficial for increasing MVPA among cancer survivors.

Purpose: Anxiety, insomnia, and physical activity (PA) are interrelated, but the bi-directional relationships between these three variables are not well understood. Less is known of these relationships in settings of disrupted daily activities and acute stress. This study aimed to characterize and examine relationships between insomnia, anxiety, and PA throughout the first year of the COVID-19 pandemic, when many lifestyle behaviors were disrupted. Methods: Participants comprised a convenience sample of 204 adults (55.4% female; 43.85 ± 15.85 years old) who completed the Generalized Anxiety Disorder Questionnaire (GAD-7), Insomnia Severity Index (ISI), and the International Physical Activity Questionnaire (IPAQ) at three time points through the first year of the COVID-19 pandemic. A cross-lagged panel model was used to evaluate these variables’ concurrent, autoregressive, and cross-lagged relationships across time. Follow-up dynamic panel modeling using maximum likelihood and structural equation modeling was employed. Results: Approximately 64% of participants reported their work/occupation as affected by the pandemic. At baseline, associations between anxiety and insomnia were observed (β-coefficient: 15.87; p < 0.001). Insomnia was a positive future predictor of anxiety (ISI time point 2: 7.9 ± 5.6 points; GAD-7 at time point 3: 4.1 ± 4.2 points; β-coefficient: 0.16; p < 0.01). No associations were observed between PA and anxiety or insomnia (all p > 0.05). Conclusions: Insomnia and anxiety were interrelated, and effects were cross-lagged. These data can inform future work focused on improving anxiety in settings of acute stress and disruptions to daily life, such as changes in occupational structure and stability. Specifically, targeting sleep parameters may be of interest to elicit downstream positive health behaviors.

Background: Over 70% of US adults are overweight or have obesity. Internet-delivered weight loss (IDWL) treatment overcomes many common barriers to in-person weight loss (WL) programs; yet, IDWLs underperform compared to in-person treatment. Yoga is a novel intervention that targets physical and psychological health and can be delivered virtually, increasing translation potential. Yoga has been understudied as an intervention to address barriers to WL despite favorable effects in other health disciplines. Preliminary studies suggest yoga to improve self-regulation and reduce lapses from dietary recommendations, 2 factors integral to long-term WL success. Objective: The aim of the study is to conduct the first fully powered randomized controlled trial to test the added effect of yoga to IDWL treatment on weight (primary outcome), dietary lapses, potential lapse triggers, and self-regulation mediator variables (secondary outcomes). Methods: Adults that are overweight or have obesity will be recruited to participate in a 12-month IDWL program. Following a 3-month assessment, eligible participants will be randomized to (1) a yoga intervention, including 14 weeks of group-based, virtual Iyengar yoga delivered twice weekly, followed by 22 weeks of yoga delivered once per week, and then 6 months of no contact, or (2) a contact-matched wellness comparison condition. Assessments will take place at baseline, 3 months, 6 months, 12 months, and 18 months. Several questionnaires, ecological momentary assessments, and objectively measured weight and accelerometry data will be collected. This trial is registered on ClinicalTrials.gov (NCT06166225). Results: This randomized trial was funded with an original project period of July 2023-June 2028. Enrollment began in February 2024 and is ongoing with the expectation of closing enrollment in June 2026. Conclusions: This trial will examine the combined effect of yoga and WL treatment among individuals with overweight or obesity and will be the first fully powered trial to assess the combination of virtually delivered yoga and WL beyond 6 months. Findings will inform whether yoga could be considered a valuable intervention component for improving IDWL treatment.