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This open peer commentary refers to the article "Helpful Lessons and Cautionary Tales: How Should COVID-19 Drug Development and Access Inform Approaches to Non-Pandemic Diseases?" by Holly Fernandez Lynch, Arthur Caplan, Patricia Furlong and Alison Bateman-House, that was published within the issue. Topics discussed include tension between innovation and research, research and clinical ethics, and the U.S. Food and Drug Administration's Emergency Use Authorizations for COVID-19.

Background: Resistance training (RT) has been identified as an important lifestyle activity for health. While systematic reviews have examined behavior change techniques (BCTs) used in interventions and potential correlates of RT behavior, the connection between BCTs and changes in putative mediators and RT participation have yet to be linked. The purpose of this review was to examine RT intervention effects, as coded by BCT clusters, on behavior change via capability, opportunity, and motivation as putative mediators of that change., Method: Literature searches were concluded in January of 2023, using three databases. Eligible studies included a comparison group, assessed RT as an outcome, included BCTs, assessed potential mediators, and were in English. The initial search yielded 1050 hits, which was reduced to 5 to independent RT interventions. Screening of previous reviews yielded three additional papers for a total of 8 papers. Each paper was assessed for the associations between intervention effects (as BCT clusters) on mechanisms of action (a path), effects of mechanisms of action on behavior (b path), and indirect (ab path) and direct (c path) effects of BCT clusters., Results: There was support that interventions had significant effects on capability and opportunity with inconclusive effects on motivation (a path). Both capabilities and motivation had associations with RT behavior (b path). The examined studies showed that changes in capabilities have the strongest support as a mediator with some support for motivation as a mediator (ab path). Studies that used more BCT clusters seemed to have a more positive effect on behavior, yet there were no trends to suggest any one crucial BCT cluster (c path)., Conclusion: Current evidence suggests that capabilities and motivation are important to target in RT interventions. Future interventions would be well suited to utilize behavior change techniques that address these mediators., Competing Interests: Declarations. Ethical Approval and Consent to Participate: Not applicable. Competing interests: The authors declare no competing interests., (© 2023. International Society of Behavioral Medicine.)

After the near-complete cessation of commercial whaling, ship collisions have emerged as a primary threat to large whales, but knowledge of collision risk is lacking across most of the world's oceans. We compiled a dataset of 435,000 whale locations to generate global distribution models for four globally ranging species. We then combined >35 billion positions from 176,000 ships to produce a global estimate of whale-ship collision risk. Shipping occurs across 92% of whale ranges, and <7% of risk hotspots contain management strategies to reduce collisions. Full coverage of hotspots could be achieved by expanding management over only 2.6% of the ocean's surface. These inferences support the continued recovery of large whales against the backdrop of a rapidly growing shipping industry.

Introduction: Adolescence represents a critical developmental period, with changes in emotional regulation capacities influencing physical and mental health. With less than 6% of Canadian youth currently meeting the 24-hour movement guidelines for physical activity, sleep and sedentary behaviour, there is an urgent need to understand the potential association between movement behaviours, physical literacy, emotional regulation and mental health during adolescence. Additionally, there is a need to better understand these associations among equity-deserving groups. We developed the Adolescents' Daily Lives (ADL) project to identify how, when, under what contexts and to whom to promote healthy engagement in movement behaviours to optimise youth mental health., Methods and Analysis: For the ADL project, we will employ a 14-day intensive longitudinal design to investigate the associations between physical literacy, movement behaviours, emotion regulation and mental health among a diverse sample of 120 adolescents (ages 13-17 years) living in the Greater Victoria Area, British Columbia, Canada. A comprehensive baseline survey and movement competence test, assessing physical and mental well-being, 24-hour movement behaviours (ie, physical activity, sleep and sedentary behaviours) and physical literacy, will be accompanied by daily diary surveys and accelerometer-based movement tracking (ie, Fitbit Inspire 3) to assess daily fluctuations in movement behaviour, emotional regulation and mood. Multivariate analyses, including multilevel modelling, multilevel structural equation modelling and Bayesian hierarchical continuous-time SEM, will be used to model the repeated measures data and understand the simultaneous variations in daily movement behaviours, emotion regulation and mental health., Ethics and Dissemination: The ADL project received ethical approval from the University of Victoria Behavioural Research Ethics Board (protocol #22-0262). Study participation is voluntary, and data collection will be anonymised to protect participant privacy and confidentiality. Research findings will be shared through academic publications and conference proceedings. Through knowledge mobilisation resources, cocreated with the youth community advisory board, relevant findings will be shared directly with the wider community of adolescents., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Mobile app reviews are valuable for gaining user feedback on features, usability, and areas for improvement. Analyzing these reviews manually is difficult due to volume and structure, leading to the need for automated techniques. This mapping study categorizes existing approaches for automated and semi-automated tools by analyzing 180 primary studies. Techniques include topic modeling, collocation finding, association rule-based, aspect-based sentiment analysis, frequency-based, word vector-based, and hybrid approaches. The study compares various tools for analyzing mobile app reviews based on performance, scalability, and user-friendliness. Tools like KEFE, MERIT, DIVER, SAFER, SIRA, T-FEX, RE-BERT, and AOBTM outperformed baseline tools like IDEA and SAFE in identifying emerging issues and extracting relevant information. The study also discusses limitations such as manual intervention, linguistic complexities, scalability issues, and interpretability challenges in incorporating user feedback. Overall, this mapping study outlines the current state of feature extraction from app reviews, suggesting future research and innovation opportunities for extracting software requirements from mobile app reviews, thereby improving mobile app development., Competing Interests: The authors declare that they have no competing interests., (© 2024 Massenon et al.)

Background: Understanding movement patterns of rodent pests is essential for planning management strategies. Currently, for many rural village contexts, there is limited information on how rodents move between domestic and peridomestic areas, and the surrounding habitats. We investigated movement of the multimammate rat, Mastomys natalensis and the black rat, Rattus rattus in nine villages in Kilombero District, Tanzania. We used Rhodamine B (RhB) baits placed inside houses (R. rattus preferred habitat) in five villages and placed outside (M. natalensis preferred habitat) in four villages., Results: Whilst both species were rarely captured in their nonpreferred habitat (5% M. natalensis inside houses; 23% R. rattus outside houses), evidence of RhB consumption when bait was in nonpreferred habitat was high for both species (50% M. natalensis; 57% R. rattus), indicating frequent movement to nonpreferred habitats. Whilst R. rattus movement distances were consistent with previous studies (maximum 81 m), within our village context, M. natalensis moved further (maximum 132 m) compared to previous published studies. Although bait consumption rates varied seasonally, we found no evidence that utilization of nonpreferred habitat varied seasonally. M. natalensis females moved into houses more frequently than males, whilst immature R. rattus moved outside houses more than mature individuals., Conclusion: These findings highlight the dynamic movement patterns of commensal rodents with implications for control and disease transmission. © 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2024 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Importance: Numerous studies show that early palliative care improves quality of life and other key outcomes in patients with advanced cancer and their caregivers, although most lack access to this evidence-based model of care., Objective: To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non-small cell lung cancer (NSCLC)., Design, Setting, and Participants: Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers., Intervention: Participants were randomized to meet with a specialty-trained palliative care clinician every 4 weeks either via video visit or in person in the outpatient clinic from the time of enrollment and throughout the course of disease. The video visit group had an initial in-person visit to establish rapport, followed by subsequent virtual visits., Main Outcomes and Measures: Equivalence of the effect of video visit vs in-person early palliative care on quality of life at week 24 per the Functional Assessment of Cancer Therapy-Lung questionnaire (equivalence margin of ±4 points; score range: 0-136, with higher scores indicating better quality of life). Participants completed study questionnaires at enrollment and at weeks 12, 24, 36, and 48., Results: By 24 weeks, participants (mean age, 65.5 years; 54.0% women; 82.7% White) had a mean of 4.7 (video) and 4.9 (in-person) early palliative care encounters. Patient-reported quality-of-life scores were equivalent between groups (video mean, 99.7 vs in-person mean, 97.7; difference, 2.0 [90% CI, 0.1-3.9]; P = .04 for equivalence). Rate of caregiver participation in visits was lower for video vs in-person early palliative care (36.6% vs 49.7%; P < .001). Study groups did not differ in caregiver quality of life, patient coping, or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions., Conclusions and Relevance: The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC, underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery., Trial Registration: ClinicalTrials.gov Identifier: NCT03375489.

As mobile applications proliferate and user feedback becomes abundant, the task of identifying and resolving conflicts among application features is crucial for delivering satisfactory user experiences. This research, motivated to align application development with user preferences, introduces a novel methodology that leverages advanced Natural Language Processing techniques. The paper showcases the use of sentiment analysis using RoBERTa, topic modeling with Non-negative matrix factorization (NMF), and semantic similarity measures from Sentence-BERT. These techniques enable the identification of contradictory sentiments, the discovery of latent topics representing application features, and the clustering of related feedback instances. The approach detects conflicts by analyzing sentiment distributions within semantically similar clusters, further enhanced by incorporating antonym detection and negation handling. It employs majority voting, weighted ranking based on rating scores, and frequency analysis of feature mentions to resolve conflicts, providing actionable insights for prioritizing requirements. Comprehensive evaluations on large-scale iOS App Store and Google Play Store datasets demonstrate the approach's effectiveness, outperforming baseline methods and existing techniques. The research improves mobile application development and user experiences by aligning features with user preferences and providing interpretable conflict resolution strategies, thereby introducing a novel approach to the field of mobile application development., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Understanding attitudes towards genetic exceptionalism and confidentiality is important in guiding policies regarding special protections for genetic/genomic information stored in electronic health records (EHR). The goals of this study were to determine biobank participants' attitudes towards genetic exceptionalism and confidentiality and whether those attitudes are related to their preference for return of genetic results. An online questionnaire was distributed to patients with an EHR and email address who had previously enrolled in the BioMe Biobank program. Most participants responded with similar levels of concern in scenarios involving the use of genetic information and other types of health information, suggesting that participants want similar protections for genetic data as other types of sensitive health information, particularly mental health and family history records. Of the 829 respondents, the majority had genetic exceptionalist views when directly asked, even though their concerns about confidentiality were similar for their genetic information and other health information. There were no differences in genetic exceptionalist views between those who had a documented preference to have genetic results returned and those who did not. Notably, for many participants, their recall of preference did not align with their documented preference. The majority of biobank participants were most anxious about the loss of confidentiality for genetic, mental health, and family history information, indicating that certain types of health information are considered more "sensitive" than others. These findings suggest the importance of assuring people participating in biobank research that the confidentiality of their "sensitive" health information is secured., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Food system transformation requires a better understanding of the negative and positive externalities involved in food production and consumption. Although negative externalities have received substantial attention, positive externalities have been largely overlooked. True Cost Accounting (TCA) is an economic assessment aimed at accounting for externalities in food systems. The beef industry is an important part of the US food system. In the western USA, beef cattle production is a major land use and economic activity that involves direct links among the cattle, range ecosystems, range management, climate, and ranchers' decisions and welfare. We present a case study based on a TCA assessment to quantify and monetize the contribution of human, social, natural, and produced capitals, as well as farm structure, to the market value generated by cow-calf operations, a key component of the USA beef industry. We estimated an Ordinary Least Square regression model based on indicators of these capitals and of farm structure derived from publicly available data sources at the county level. From model coefficients, we estimated the marginal revenue product of these factors. Results show that nonmarket factors linked with human and social capitals support market performance by contributing to the market value of cow-calf production. These factors operate at scales above the ranch, usually remain hidden, and seldomly are considered in policy decision-making which can lead to policies that inadvertently hamper or eliminate these positive externalities., Competing Interests: The authors have declared no competing interests exist., (Copyright: © 2024 Bellon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Low levels of physical activity are associated with numerous adverse health outcomes, yet sedentary lifestyles are common among both children and adults. Physical activity levels tend to decline steeply among children aged between 8 and 12 years, even though children's behavioral patterns are largely governed by familial structures. Similarly, parents' activity levels have been generally reported as lower than those of nonparents of comparable age. For this reason, family-based physical activity promotion interventions are a potentially valuable and relatively underresearched method for mitigating physical activity declines as children develop into adolescents and for increasing physical activity in parents., Objective: This study aims to assess the efficacy, feasibility, and acceptability of a novel theory-based web-based physical activity promotion intervention among parent-child dyads in Finland who do not meet physical activity recommendations at baseline., Methods: Participants (target N=254) will be recruited from the general population using a panel company and advertisements on social media and randomly assigned to either an immediate intervention group or a waitlist control group. The intervention consists of 4 web-based group workshops over the course of 10 weeks, web-based tasks and resources, and a social support chat group. Data on physical activity behavior and constructs from the integrated behavior change model will be collected through self-report surveys assessing physical activity, autonomy support, autonomous motivation, attitude, subjective norm, perceived behavioral control, intention, self-monitoring, habit, and accelerometer measurements at baseline, post intervention, and 3 months post intervention. Exit interviews with participants will assess the feasibility and acceptability of the intervention procedures., Results: This study will reveal whether the intervention changes leisure-time physical activity among intervention participants relative to the control group and will examine the intervention's effects on important theoretical predictors of physical activity. It will also yield data that can be used to refine intervention materials and inform further implementation. Trial recruitment commenced in September 2023, and data collection should be completed by December 2024., Conclusions: The planned intervention has potential implications for both theory and practice. Practically, the use of an entirely web-based intervention may have scalable future uses for improving physical activity in 2 key populations, while also potentially informing on the value of dyadic, family-based strategies for encouraging an active lifestyle as an alternative to strategies that target either parents or children independently. Further, by assessing change in psychological constructs alongside potential change in behavior, the intervention also allows for important tests of theory regarding which constructs are most linked to favorable behavior change outcomes., Trial Registration: ClinicalTrials.gov NCT06070038; https://clinicaltrials.gov/study/NCT06070038., International Registered Report Identifier (irrid): DERR1-10.2196/55960., (©Daniel Phipps, Weldon Thomas Green, Reetta Aho, Eeva Kettunen, Stuart Biddle, Kyra Hamilton, Arto Laukkanen, Kaisa Aunola, Derwin King Chan, Nelli Hankonen, Mary Hassandra, Tommi Kärkkäinen, Virpi-Liisa Kykyri, Juho Polet, Ryan Rhodes, Montse C Ruiz, Arja Sääkslahti, Jekaterina Schneider, Hanna-Mari Toivonen, Taru Lintunen, Martin Hagger, Keegan Knittle. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 21.03.2024.)

In this case report, we describe a woman with advancing dementia who still retained decisional capacity and was able to clearly articulate her request for deactivation of her implanted cardiac pacemaker-a scenario that would result in her death. In this case, the patient had the autonomy to make her decision, but clinicians at an outside hospital refused to deactivate her pacemaker even though they were in unanimous agreement that the patient had capacity to make this decision, citing personal discomfort and a belief that her decision seemed out of proportion to her suffering. We evaluated her at our hospital, found her to have decision-making capacity, and deactivated her pacer resulting in her death about 9 days later. While some clinicians may be comfortable discussing patient preferences for device deactivation in patients who are imminently dying, we can find no reports in the literature of requests for device deactivation from patients with terminal diagnoses who are not imminently dying.

Purpose: To better understand the effects of returning diagnostic sequencing results on clinical actions and economic outcomes for pediatric patients with suspected genetic disorders., Methods: Longitudinal physician claims data after diagnostic sequencing were obtained for patients aged 0 to 21 years with neurologic, cardiac, and immunologic disorders with suspected genetic etiology. We assessed specialist consultation rates prompted by primary diagnostic results, as well as marginal effects on overall 18-month physician services and costs., Results: We included data on 857 patients (median age: 9.6 years) with a median follow-up of 17.3 months after disclosure of diagnostic sequencing results. The likelihood of having ≥1 recommendation for specialist consultation in 155 patients with positive findings was high (72%) vs 23% in 443 patients with uncertain findings and 21% in 259 patients with negative findings (P < .001). Follow-through consultation occurred in 30%. Increases in 18-month physician services and costs following a positive finding diminished after multivariable adjustment. Also, no significant differences between those with uncertain and negative findings were demonstrated., Conclusion: Our study did not provide evidence for significant increases in downstream physician services and costs after returning positive or uncertain diagnostic sequencing findings. More large-scale longitudinal studies are needed to confirm these findings., Competing Interests: Conflict of Interest Dr Kenny has received speaker honoraria from Illumina, 23andMe, Allelica, and Regeneron Pharmaceuticals, received research funding from Allelica, and serves as a scientific advisory board member for Encompass Biosciences, Overtone, and Galateo Bio. Dr Abul-Husn is an employee and equity holder of 23andMe; serves as a scientific advisory board member for Allelica; received personal fees from Genentech, Allelica, and 23andMe; received research funding from Akcea; and was previously employed by Regeneron Pharmaceuticals. All other authors declare they have no conflicts of interest to report. Ethics Declaration The NYCKidSeq and TeleKidseq studies were approved by the Icahn School of Medicine at Mount Sinai and the Albert Einstein College of Medicine Institutional Review Boards. Written informed consent was obtained from pediatric participants who were capable of providing (≥18 years of age and cognitively able) and all parent or legal guardian participants., (Copyright © 2023 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.)

Worldwide, physical inactivity is a major public health concern. Both aerobic physical activity (PA) and resistance training (RT) are forms of exercise that provide numerous health benefits. The present systematic review aimed to examine the evidence among studies that have formally compared the correlates of both aerobic PA and RT in the same sample. Literature searchers were concluded in April 2022 using four common databases. Eligible studies were selected from English language peer-reviewed journals which reported at least a bivariate correlation between the correlate and aerobic PA and RT. Findings were grouped by the correlate in accordance with the capability, opportunity, motivation, behavior (COM-B) model. The analysis identified 18 studies with 16 independent samples. Overall, evidence suggest that there are many similarities between aerobic PA and RT participation. There were positive associations for both aerobic PA and RT for physical and psychological capabilities, reflective and reflexive motivation. There were mixed associations for environmental opportunities, and social opportunities had no association for aerobic PA but mixed evidence for RT. The analyses emphasized that comparative research is lacking in certain areas, principally for environmental opportunity and reflexive motivation.

The multimammate mice (Mastomys natalensis) is the most-studied rodent species in sub-Saharan Africa, where it is an important pest species in agriculture and carrier of zoonotic diseases (e.g. Lassa virus). Here, we provide a unique dataset that consists of twenty-nine years of continuous monthly capture-mark-recapture entries on one 3 ha mosaic field (MOSA) in Morogoro, Tanzania. It is one of the most accurate and long-running capture-recapture time series on a small mammal species worldwide and unique to Africa. The database can be used by ecologists to test hypotheses on the population dynamics of small mammals (e.g. to test the effect of climate change), or to validate new algorithms on real long-term field data (e.g. new survival analyses techniques). It is also useful for both scientists and decision-makers who want to optimize rodent control strategies and predict outbreaks of multimammate mice., (© 2023. The Author(s).)

Despite apparent disagreement in the scholarly literature on standards of pediatric decision making, a recognition that similar norms underpin many of the dominant frameworks motivated a June 2022 symposium "Best Interests and Beyond: Standards of Decision Making in Pediatrics" in St Louis, MO. Over the course of this 3-day symposium, 17 expert scholars (see author list) deliberated on the question "In the context of US pediatric care, what moral precepts ought to guide parents and clinicians in medical decision making for children?" The symposium and subsequent discussion generated 6 consensus recommendations for pediatric decision making, constructed with the primary goals of accessibility, teachability, and feasibility for practicing clinicians, parents, and legal guardians. In this article, we summarize these recommendations, including their justification, limitations, and remaining concerns., (Copyright © 2023 by the American Academy of Pediatrics.)

Purpose: A community teaching hospital serving a rural population established an intensive "hospital at home" program for patients with COVID-19 utilizing disease risk stratification and pulse oximeter readings to dictate nurse and clinician contact. Herein, we report patient outcomes and provider experiences resulting from this "virtual" approach to triaging pandemic care., Methods: COVID-19-positive patients appropriate for outpatient management were enrolled in our COVID Virtual Hospital (CVH). Patients received pulse oximeters and instructions for home monitoring of vital signs. CVH nurses contacted the patient within 12-48 hours. The primary care provider was alerted of the patient's diagnosis and held a virtual visit with patient within 2-3 days. Nurses completed a triage form during each patient call; the resulting risk score determined timing of subsequent calls. CVH-relevant patient outcomes included emergency department (ED) visits, mortality, and disease-related hospitalization. Additionally, a survey of providers was conducted to assess CVH experience., Results: From April 22, 2020, to December 21, 2020, 1916 patients were enrolled in the CVH, of which 195 (10.2%) had subsequent visits to the ED. Among those 195 ED visits, 102 (52.3%) were nurse-directed while 93 (47.7%) were patient self-directed; 88 (86.3%) nurse-directed ED visits were subsequently admitted to inpatient care and 14 were discharged home. Of the 93 self-directed ED visits, 3 (3.2%) were admitted. A total of 91 CVH patients (4.7%) were ultimately admitted to inpatient care. Seven deaths occurred among CVH patients, 5 of whom had been admitted for inpatient care. Among 71 providers (23%) who responded to the survey, 94% and 93% agreed that the CVH was beneficial to providers and patients, respectively., Conclusions: Proactive in-home triage of patients with COVID-19 utilizing a virtual hospital model minimized unnecessary presentations to ED and likely prevented our rural hospital from becoming overwhelmed during year one of the pandemic., Competing Interests: Conflicts of Interest None., (© 2023 Advocate Aurora Health, Inc.)

Introduction: Influenza is highly contagious, vaccine-preventable, and may result in significant morbidity and mortality. While vaccination is the primary protection against influenza, vaccination rates remain low. Traditionally, primary care clinics, retail pharmacies, and public health departments offer influenza vaccines. However, offering influenza vaccines in new settings may increase their availability to the public and increase community uptake. This project aimed to add emergency departments as a new influenza vaccine location to increase the number of vaccines distributed during the 2020 to 2021 influenza season., Methods: Adult patients discharged from 24 emergency departments were included in this pre- post-intervention project. A nurse-driven order set was established to enhance efficiency. Education materials (scripting, fliers, etc.) were developed to help nurses feel comfortable with vaccine information., Results: Nurses indicated that education helped increase their belief that influenza vaccination was important. After completing the educational material, a higher number of nurses agreed that it was necessary to encourage others to be vaccinated (P < .05). Moreover, emergency department influenza vaccinations increased significantly throughout the 2020 to 2021 influenza season. Nurses across all 24 hospitals administered 2002 vaccines during this season compared to 9 during the previous year's season., Discussion: The project demonstrated that delivering influenza vaccinations in emergency departments is challenging yet achievable. Educational offerings were valuable resources to increase nurses' knowledge and positive attitudes about providing influenza vaccines to patients. Further studies regarding how vaccinations could be provided in more emergency departments and alternative care sites, such as urgent care and clinics other than primary care providers, are needed., (Copyright © 2023 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Background: In March 2020, the World Health Organization declared the worldwide COVID-19 outbreak a pandemic, triggering many countries, including Canada, to issue stay-at-home orders to their citizens. Research indicates that these stay-at-home orders are associated with a decline in physical activity (PA), a behavior that can reduce disease risk and improve the quality of life. Many behavioral change theories, such as the self-determination theory (SDT) of motivation, state that PA engagement is mediated by psychological constructs, such as motivation. According to the SDT, motivation exists on a continuum from more controlled (external or coerced) to more autonomous (volitional) regulatory forms. Individuals move along the continuum from more controlled to more autonomous forms through the fulfillment of 3 psychological needs: autonomy, competence, and relatedness. Research indicates that moderate-to-vigorous physical activity (MVPA) is positively associated with the autonomous regulatory form of motivation. Recently, researchers have speculated that a better method to describe motivation than movement along the continuum is to generate motivational profiles, which represent combinations of differing levels of controlled and autonomous regulation existing simultaneously., Objective: We aimed to identify distinct motivational profiles and determine their association with MVPA before, during, and after the COVID-19 pandemic., Methods: Using a cross-sectional, retrospective design, we surveyed 977 Canadian adults. We assessed motivation for PA using the Behavioral Regulations in Exercise Questionnaire-3 (BREQ-3). We assessed PA pre-, during, and post-COVID-19 stay-at-home orders in Canada using the International Physical Activity Questionnaire (IPAQ). We derived motivational profiles using latent profile analysis (LPA). Using motivational profiles as an independent variable, we assessed their effect on PA at all 3 time points with multilevel models that included the participant ID as a random variable., Results: We identified 4 profiles: high controlled and high autonomous (HCHA), low overall motivation (LOM), high autonomous and introjected (HAI), and high amotivation and external (HAE). The HCHA profile had the highest levels of weekly MVPA minutes at all 3 time points, followed by the HAI profile., Conclusions: Our results suggest that a combination of both autonomous and controlled regulatory forms may be more effective in influencing MVPA than the controlled or autonomous forms alone, particularly during times of high stress, such as a worldwide pandemic. Although the odds of another global pandemic are low, these results may also be applied to other times of stress, such as job transitions, relationship changes (eg, change in marital status), or the death of a loved one. We suggest that clinicians and practitioners consider developing PA interventions that seek to increase both controlled and autonomous regulatory forms instead of aiming to reduce controlled forms., (©Kayla Nuss, Wuyou Sui, Ryan Rhodes, Sam Liu. Originally published in JMIR Formative Research (https://formative.jmir.org), 24.04.2023.)