Behavior change intervention targeting physical activity and diet improves stress and sleep.

Both the diet/activity and stress/sleep interventions produced significant and statistically comparable reductions in average daily stress ratings.

• The difference between interventions in stress improvement was not statistically significant (z = 1.35, p = .177).
• Reduction in average daily stress rating was 1.68 points (on an 11-point Likert scale) following the diet/activity intervention (z = -12.25, P < .001).
• Reduction in average daily stress rating was 2.08 points following the stress/sleep intervention (z = -7.83, P < .001).
• Participants (n = 212) were adults with multiple diet and activity risk behaviors, 76.4% female, 59% non-white minority, mean age 40.8 years.

The stress/sleep intervention produced statistically larger improvements in sleep duration compared to the diet/activity intervention, though both showed clinically meaningful changes.

• The between-group difference in sleep duration improvement was statistically significant (z = -3.79, P < .001).
• Sleep duration increased 26.39 minutes following the diet/activity intervention (z = 3.16, P = 0.002).
• Sleep duration increased 92.65 minutes following the stress/sleep intervention (z = 5.912, P < 0.001).
• The paper characterized changes in sleep duration for both groups as 'clinically meaningful.'

The Make Better Choices 2 trial used a randomized clinical trial design comparing a technology-assisted coaching intervention targeting diet and activity against a matched intervention targeting stress and sleep.

• Participants (n = 212) were assessed over 7 days at baseline, 3-, 6-, and 9-month time points.
• Outcomes were reported through a smartphone application including perceived sleep duration, stress, diet, and activity.
• Outcomes were evaluated using linear mixed models.
• The study was registered on clinicaltrials.gov (NCT01249989).
• This was a secondary data analysis of the trial, focused on collateral effects on stress and sleep.

Diet and activity behavior change interventions can produce collateral improvements in health outcomes outside the domains they directly target.

• The diet/activity intervention improved stress to a degree statistically comparable to the intervention directly targeting stress and sleep.
• The authors suggest 'common mechanistic pathways' may underlie changes across multiple health behavior domains.
• The authors conclude that 'diet and activity behavior change interventions can effectively improve outcomes within and between the behavior domains they directly target.'