Personalised pair-based physical activity promotion intervention for autistic adults: A trial evaluating feasibility and acceptability.

Intervention Overview: - The intervention consists of a 12-week personalised physical activity (PA) program designed for dyads, where each autistic adult invites a partner from their social network (family, friends, or support workers) to participate as their PA partner. The PA partner will provide social support and assist with action planning. - The intervention aims to (1) improve PA accumulation to at least 75 minutes of vigorous PA or 150 minutes of moderate PA, or a combination of both each week, (2) reduce sedentary behaviour (SB, e.g., sitting, lying, watching TV, playing video games) accumulation each week, and (3) improve motivation for PA. These outcomes will be measured using accelerometers and self-report questionnaires. - The intervention will be delivered by a PhD student at Curtin University. - Intervention Components: The intervention will incorporate components from the Behaviour Change Wheel (BCW), specifically focusing on education, enablement, persuasion, and incentivisation. The intervention will utilise various behaviour change techniques, including problem-solving, instruction on performing the behaviour, social support, action planning, feedback, social reward, objects, self-monitoring, verbal persuasion, and information about health, emotional and social consequences. Autistic participants will receive an Intervention Manual (developed by the researchers), and their partners will receive a Partner Guide (within the Intervention Manual) outlining the content and instructions for the program. - Intervention core components: Over 12 weeks, the autistic adults and their partners will collaborate to choose, plan, schedule and perform PA (e.g., walking, cycling, hiking...) together in person. The location, frequency and duration of PA sessions will be determined by the dyad. To enhance engagement and adherence, the research team will provide personalized prompts, reminders, achievement recognition, and support via online messages through WhatsApp, a platform recommended by the advisory group of autistic people for its acceptability. - Performance Monitoring: Every two weeks, each pair will meet with the research team in person or online for a performance review (20 minutes). During these meetings, pairs will reflect on their PA and sedentary behaviour (SB) levels and work with the research team to identify barriers and develop solutions to improve or maintain their progress. - Self-Monitoring Tools: Autistic adults will wear Fitbit 3 devices throughout the 12-week intervention to self-monitor their PA and SB. - Objective Measurement: Autistic participants will also wear the SENS accelerometer device during three seven-day periods: weeks 0 (pre-intervention week), week 7 (mid-intervention week), and week 13 (post-intervention week) to track their PA and SB objectively. SENS is a compact, discreet wireless activity sensor designed for attachment to the thigh using an adhesive patch. It measures the duration and intensity of physical activity (PA), sleep time and quality, and resting and standing time. Developed for use in both healthcare and research settings, it offers versatile and reliable applications. Intervention timeline: Week 0 (Pre-Intervention): - Participants will attend an in-person introductory session (1 hour) on the Curtin campus with the researchers to review the intervention protocol and complete pre-intervention measurements, including the International Physical Activity Questionnaire (IPAQ) and the Behavioral Regulation in Exercise Questionnaire-2 (BREQ-3). - During this session, participants will receive the Sens device (accelerometer) and be instructed to wear it for the entire week to track baseline SB, PA duration, and intensity. They will be reminded to connect the Sens device to the Motus app daily for data transfer and to return it using a prepaid envelope at the end of Week 0. - The researchers will provide educational materials and training to ensure an understanding of proper general physical activity techniques, including the importance of warm-ups and cool-downs. - Participants will be invited to join a WhatsApp group chat, which will serve as an online social support hub. The group chat will allow participants to receive any communications, such as reminders, prompts, and achievement announcements from the research team. - Participants will schedule the Week 1 online workshop with the researchers. Week 1: - An online workshop (1 hour and 30 minutes) will be held to educate participants on the content of the intervention, enhance their understanding and motivation for PA, and address any misconceptions about PA. The workshop will cover topics such as the health benefits of PA, the consequences of SB, how to share public gym/PA facilities, easy and fun PA (e.g., walking, dancing, cycling), problem-solving strategies, and co-planning PA activities. All educational content will be delivered by the researcher team. - The researchers and dyad will discuss effective communication and conflict resolution to manage potential interpersonal challenges. - Clear guidelines and training will outline the roles, responsibilities, and expectations for mutual respect within the dyad. This is the only training that the partner will receive for their role. The training will be provided by the researcher team during the week 1 online work shop. Weeks 1 to 12: - At the start of Weeks 1, 3, 5, 7, 9, and 11, participants will co-plan their PA activities for the next two weeks using action planning templates in their Intervention Manuals. They will send a copy of their plan to the research team via WhatsApp, and the PhD student will send personalised PA reminders according to their plan. The partner will provide daily encouragement to the autistic adult to complete their planned PA, and both can share achievements in the group chat to motivate each other. - The PhD student will send daily motivational messages and prompts to the group chat, encouraging PA and reducing SB (e.g., “Let’s walk around the neighbourhood for 5 minutes” or “Turn on your favourite song and dance”). - At the start of weeks 3, 5, 7, 9, 11, and 13, each pair will participate in a quick online feedback (weeks 7 and 13 will be done offline to deliver the SENS devices) meeting (20 minutes) with the PhD student. During these meetings, participants will reflect on their PA and SB levels from the previous two weeks, identify barriers, and discuss solutions to maintain or improve their PA levels. The PhD student will congratulate participants who meet their PA goals and provide additional support or guidance as needed. - The autistic adult will continuously wear the Sens device during Weeks 7 (mid-intervention) and 13 (post-intervention) and a Fitbit 3 device throughout the 12 weeks to monitor PA and SB. In their Intervention Manual, they will log the types of PA performed, total minutes of physical activity (Active Zone Minute data from Fitbit), and total minutes of SB each week (Stationary hours data from Fitbit). - The participants will complete the IPAQ and BREQ-3 in the week 7 review meeting. Week 13 (Post-Intervention): - At the beginning of Week 13, the Sens device will be distributed again in an in-person meeting. Participants will wear it for the week to track their PA and SB levels. - Participants will complete post-intervention measurements online, including the IPAQ, BREQ-3, and acceptability surveys. - At the end of Week 13, participants will return the Sens device using the prepaid envelope provided during the Week 13 meeting. - Adherence to the intervention: Measured by checking the checklists and logbook data from participants' Intervention Manuals, assessed at weeks 7 and 13. Also, Regular check-ins via WhatsApp and feedback meetings will monitor participants’ adherence.