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Table 4 Connected behavioral condition: Cognitive-behavioral training (CBT) and mHealth app integration

From: Design of the WHIP-PD study: a phase II, twelve-month, dual-site, randomized controlled trial evaluating the effects of a cognitive-behavioral approach for promoting enhanced walking activity using mobile health technology in people with Parkinson-disease

Major Content and Activities
Each session builds upon the content of the previous session. Session format includes: (1) review of previous session and collaborative agenda setting; (2) discussion of success and challenges with program; (3) revisiting value-based, personal goals; (4) introduction of new cognitive-behavioral training (CBT) content through discussion; and (5) building exercise program in Wellpepper mHealth app and establishing new goals.
 Cognitive-Behavioral FeaturesConnected Health Features in App
Sessions 1 & 2
Introduction to CBT; Initiate exercise program in app and establish value-based goals
▪ Discuss personal, value-based goals and add to Wellpepper platform
▪ Identify the pros and cons of exercise & multi-level factors that affect physical activity
▪ Discuss facilitators and barriers to exercise and set an action plan
▪ Introduce relationship between situations, thoughts, and behavior
▪ Instruct in use of tablet & mHealth app
▪ Develop walking program and video exercise catalog in app
▪ Discuss rating challenge in app and how to communicate with the physical therapist
▪ Introduce self-monitoring in app through review of calendars and graphs
Sessions 3 & 4
Challenge your thoughts, Balance your thinking and progressing the program
▪ Examine thoughts around exercise and how they are linked to situations/behaviors
▪ Introduce thinking traps and discuss potential impact on exercise behaviors
▪ Introduce thought challenging
▪ Incorporate thought challenging into self-monitoring
▪ Participant encouraged to demonstrate self-monitoring, self-assessment through adherence reports in app
▪ Additional video exercises recorded as program progressed to maintain challenge
▪ Review walking and exercise goals; revise goals as needed
Sessions 5 & 6
Identifying high risk situations and developing strategies to cope; Staying healthy
▪ Consider high risk situations when it will be difficult to stick with exercise program
▪ Develop both preventative and coping strategies to manage
▪ Devise plan for staying healthy
▪ Re-assess appropriate challenge level of program
▪ Review goals and discuss readiness for gradual increase in amount of walking and dose of exercise
▪ Discuss communication plan in app through messaging
Sessions 7 & 8
▪ Reinforce benefits of program
▪ Address additional cognitive barriers
▪ Discuss/review relapse cycle and relapse prevention strategies
▪ Revisit unhelpful thoughts, cognitive restructuring, self-monitoring
▪ Discuss how to safely re-engage in the exercise program if set-backs occur
▪ Discuss adaptations to the program if set-backs occur
▪ Reinforce self-monitoring of progress
▪ Discuss how to self-monitor, determine how/when to adjust exercise level and dose over time