# Motivation toward physical activity and nutrition in older cancer patients: the MONAGE protocol using ecological momentary assessment and accelerometers

## TL;DR

This study uses real-time data collection to understand how motivation affects physical activity and nutrition in older cancer patients.

## Contribution

The study introduces a novel protocol combining EMA and accelerometers to identify motivational clusters in older cancer patients.

## Key findings

- EMA and accelerometers are used to track physical activity and nutrition in real time among older cancer patients.
- The study aims to identify clusters of motivational variables influencing health behaviors in this population.
- Multilevel Vector Autoregressive Models and k-means clustering will be used for data analysis.

## Abstract

Older adults with cancer struggle to maintain recommended levels of physical activity and nutrition during treatments. Collecting data in a real-life context provides a better understanding of the motivational and behavioral dynamics of this population, which is underrepresented in clinical trials. Ecological momentary assessment (EMA) is a frequently used approach to collect repeated measures in real time in a naturalistic environment. This approach can provide insights into the temporal dynamics of psychological processes, such as motivation toward health behaviors. The aim of this study is to identify clusters based on predictive motivational variables related to physical activity and nutritional behaviors among older patients with cancer, via repeated measures.

In this project, older patients with a cancer (≥ 70 years old) complete physical capacity assessments, malnutrition identification, and a comprehensive geriatric assessment with G-code. After that, participants engage in a 2-week data collection protocol combining EMA and sensor-based monitoring of behavior. The participants wear an ActiGraph GT3X-BT accelerometer (ActiGraph, LLC) on their nondominant waist to measure physical activity. EMA questionnaires are delivered 3 times per day - morning (between 8am and 10am), midday (between 12pm and 2pm) and evening (between 7pm and 8pm) - via smartphones or computers with the UniQ digital application. Motivational constructs based on the Theory of Planned Behavior are collected in the morning and at midday. Nutritional behavior data are collected at midday and in the evening. Fatigue is collected in the morning, at midday and in the evening. The data analysis strategy shall include Multilevel Vector Autoregressive Models with k-means clustering.

This project seeks to identify clusters in older patients with cancer based on key motivational predictors related to physical activity and nutritional behaviors, via approaches for collecting repeated measurements in real time within a naturalistic environment. This research into the mechanisms of action between motivation and behaviors could optimize care pathways by designing appropriate intervention content, under conditions where the content will be most effective, to promote sustained behavior change among older adults with cancer.

ClinicalTrials.gov (NCT06445140). Registered on 06 June 2024.

The online version contains supplementary material available at 10.1186/s12877-025-06130-1.