What is the role of smartphones on physical activity promotion? A systematic review and meta-analysis

Physical activity promotion based on positive psychology: development and piloting of a novel intervention approach

BACKGROUND

Regular physical activity (PA) is associated with positive health outcomes; however, rates of regular PA are low. Positive psychology interventions are efficacious in other health contexts and may be useful for promoting regular PA.

PURPOSE

Phased development and pilot/feasibility testing of a positive psychology intervention to promote PA using the ORBIT model for behavioral treatment development.

METHODS

Positive psychology and PA promotion content was translated (phase 1a) and refined (phase 1b) into two 6-week, group-based treatments: Positive psychology for PA (PPPA), and a standard PA promotion comparison condition (SPA). A feasibility test (phase 2a) for PPPA only (n = 13) and piloting (phase 2b) of PPPA (n = 30) and SPA (n = 11) were conducted at local YMCAs.

RESULTS

In phase 2a, participants attended 59% of treatment sessions, completed 92%-100% of assessments at mid-treatment, post-treatment, and one-month post-treatment, and 83.3% had clinically meaningful increases in PA. Following refinement, phase 2b PPPA participants attended an average of 73% of the treatment sessions, 90% completed assessments at mid-treatment, post-treatment, and 1-month post-treatment, 73% at 6-month post-treatment, and 81% had clinically meaningful increases in PA. SPA participants attended 75% of sessions, completed 58%-82% of assessments across timepoints, and 66.7% had clinically meaningful increases in PA. Across timepoints, PPPA participants reported positive changes in PA enjoyment (dppc= 0.622-0.782), and positive affect (dppc= 0.162-0.407) relative to SPA, and recommended the study to others to help increase PA (95.4%) and happiness (88.6%).

CONCLUSIONS

This study supports the feasibility and acceptability of a positive-psychology-based, PA promotion intervention for increasing PA in low-active adults.

Effectiveness of a Just-In-Time Adaptive App to Increase Daily Steps: An RCT

INTRODUCTION

Addressing the public health problem of physical inactivity, this study evaluates SNapp, a just-in-time adaptive app intervention to promote walking through dynamically tailored coaching content. It assesses SNapp's impact on daily steps and how users' perceptions regarding ease of use and usefulness moderated its effectiveness.

METHODS

SNapp was evaluated in an RCT from February 2021 to May 2022.This trial was preregistered in the Dutch Trial Register (NL7064). Analyses were conducted in November 2022. A total of 176 adults (76% female, mean age of 56 years) were randomized to a control group receiving a step counter app (n=89) or an intervention group receiving the app plus coaching content (n=87). SNapp's coaching content encompasses individually tailored feedback on step counts and advice to engage in more walking, taking preferences regarding behavior change techniques into account. Additionally, SNapp provides contextualized content calling attention to suitable walking locations in the user's environment. The primary outcome was daily step count as recorded by the step counter app. User perceptions regarding ease of use and usefulness were assessed via survey at 3-month follow-up.

RESULTS

Mixed models indicated that the intervention did not significantly impact step counts on average over time (B= -202.30, 95% CI= -889.7, 485.1), with the coefficient indicating that the intervention group walked fewer steps per day on average, though this difference was not statistically significant. Perceived ease of use did not moderate the intervention effect (Bgroup × perceived ease of use=38.60, 90% CI= -276.5, 353.7). Perceived usefulness significantly moderated the intervention effect (Bgroup × perceived usefulness=344.38, 90% CI=40.4, 648.3).

CONCLUSIONS

SNapp increased steps only in users who deemed the app useful, underscoring the importance of user perceptions in app-based interventions.

Tracked Physical Activity Levels Before and After a Change in Incentive Strategy Among UK Adults Using a Rewards App: Retrospective Quasi-Experimental Study

BACKGROUND

Financial incentives delivered via apps appear to be effective in encouraging physical activity. However, the literature on different incentive strategies is limited, and the question remains whether financial incentives offer a cost-effective intervention that could be funded at the population level.

OBJECTIVE

This study aimed to explore patterns of tracked physical activity by users of an incentive-based app before and after a change in incentive strategy. A business decision to alter the incentives in a commercially available app offered a natural experiment to explore GPS-tracked data in a retrospective, quasi-experimental study. The purpose of this exploratory analysis was to inform the design of future controlled trials of incentives delivered via an app to optimize their usability and cost-effectiveness.

METHODS

Weekly minutes of tracked physical activity were explored among a sample of 1666 participants. A Friedman test was used to determine differences in physical activity before and after the change in incentive strategies. Post hoc Wilcoxon tests were used to assess minutes of physical activity in the 2 weeks before and after the change. A secondary analysis explored longitudinal patterns of physical activity by plotting the mean and median minutes of physical activity from 17 weeks before and 13 weeks after the change in incentive strategy. CIs were calculated using bias-corrected bootstraps. Demographics were also explored in this way.

RESULTS

There were significant differences in the weekly minutes of activity before and after the change in incentive strategy (Friedman χ22=42, P<.001). However, a longitudinal view of the data showed a more complex and marked variation in activity over time that undermined the conclusions of the before/after analysis.

CONCLUSIONS

Short-term before-and-after observational studies of app-tracked physical activity may result in misleading conclusions about the effectiveness of incentive strategies. Longitudinal views of the data show that important fluctuations are occurring over time. Future studies of app-tracked physical activity should explore such variations by using longitudinal analyses and accounting for possible moderating variables to better understand what an effective incentive might be, for whom, and at what cost.

The 1-min sit-to-stand test induces a significant and reliable level of neuromuscular fatigability: insights from a mobile app analysis

PURPOSE

The performance metric associated with the execution of the 1-min sit-to-stand (1STS) typically relies on the number repetitions completed in 1 min. This parameter presents certain limitations (e.g., ceiling effect, motivational factors) which can impede its interpretation. Introducing additional parameters, such as neuromuscular fatigability level, could enhance the informative value of the 1STS and facilitate its interpretation. This study aimed to assess (i) whether the 1STS induces fatigability and (ii) the reliability of the fatigability level.

METHODS

Forty young, healthy, and active participants underwent the 1STS twice during the same session. Isolated sit-to-stand maneuvers were performed before, immediately, and 1 min after completing the 1STS. A mobile app was utilized to obtain time (STST), velocity (STSV), and muscle power (STSP) from these sit-to-stand maneuvers. The pre-post change in these parameters served as the fatigability marker. Reliability was assessed using the intra-class correlation coefficient (ICC) and the coefficient of variation (CV).

RESULTS

The mean number of repetitions during the 1STS was 63 ± 9. Significant decline in performance was observed for STST (13 ± 8%), STSV (-11.2 ± 6%), and STSP (-5.2 ± 3%), with more than 74% of participants exhibiting a decline beyond the minimal detectable change. Excellent between-session reliability (ICC ≥ 0.9; CV ≤ 5.3) was observed for the mobile app variables.

CONCLUSION

The 1STS induces significant levels of fatigability. The fatigability indicators derived from the mobile app demonstrated remarkable reliability. Utilizing this user-friendly interface for computing fatigability may empower professionals to acquire insightful complementary indicators from the 1STS.

Smartphone app-based interventions on physical activity behaviors and psychological correlates in healthy young adults: A systematic review

BACKGROUND

The issue of low physical activity (PA) levels among the youth is a longstanding concern. Smartphone applications offer a promising avenue for delivering interventions that are both accessible and engaging. Up to now, there appears to be a gap in the literature, with no systematic reviews assessing the efficacy of smartphone apps in encouraging increased physical activity among healthy young adults.

OBJECTIVE

To synthesize the effects of a smartphone app-based intervention on PA and PA-related psychological correlates in healthy young adults (18-35 years old).

METHODS

A search was conducted on eighteen databases: PubMed, Medline, Web of Science, SPORTDiscus, Scopus, Academic Search Premier, Communication and Mass Media Complete, Article First, Biomed Central, BioOne, EBSCOHost, JSTOR, ProQuest, SAGE Reference Online, ScienceDirect, SpringerLink, Taylor&Francis, and Wiley Online. The search covered the period up until December 2023. This research included all randomized controlled trials (RCTs) that evaluated the effectiveness of smartphone app-based interventions on PA and PA related psychological outcomes in healthy young adults. The overall impact was determined by vote counting based on the direction of effect and aggregating p values. The quality of the evidence was evaluated using an 8-item scale. This study has been registered in the PROSPERO database with the identification number CRD42023390033.

RESULTS

A total of 8403 articles were retrieved, and based on the predefined inclusion and exclusion criteria, seven articles were selected for inclusion. Among these articles, four high-quality RCTs were identified, and the results of vote counting and combining p values methods suggested that smartphone-based app interventions did not demonstrate significant effectiveness in improving PA and PA-related psychological outcomes. However, some improvements were observed. The analysis results, which were categorized into fitness apps and health apps based on the characteristics of the interventions, also failed to demonstrate significant intervention effects.

CONCLUSION

The findings indicate that, currently, there are no significant effects of smartphone app interventions on improving PA and PA-related psychological outcomes in healthy young adults aged 18-35 years. It is important to note that these findings should be interpreted with caution due to the limited number of included studies. Future research should focus on employing high-quality study designs to determine the true effects of interventions and analyze various smartphone app interventions. These analyses should encompass different app characteristics (e.g., fitness app and health app), various combinations (e.g., fitness app alone and fitness app in combination with other interventions), diverse intervention goals (e.g., PA and PA along with other outcomes), and multiple intervention characteristics (e.g., frequency and duration).

Effectiveness of a Smartphone App to Promote Physical Activity Among Persons With Type 2 Diabetes: Randomized Controlled Trial

BACKGROUND

Physical activity is well known to have beneficial effects on glycemic control and to reduce risk factors for cardiovascular disease in persons with type 2 diabetes. Yet, successful implementation of lifestyle interventions targeting physical activity in primary care has shown to be difficult. Smartphone apps may provide useful tools to support physical activity. The DiaCert app was specifically designed for integration into primary care and is an automated mobile health (mHealth) solution promoting daily walking.

OBJECTIVE

This study aimed to investigate the effect of a 3-month-long intervention promoting physical activity through the use of the DiaCert app among persons with type 2 diabetes in Sweden. Our primary objective was to assess the effect on moderate to vigorous physical activity (MVPA) at 3 months of follow-up. Our secondary objective was to assess the effect on MVPA at 6 months of follow-up and on BMI, waist circumference, hemoglobin A1c, blood lipids, and blood pressure at 3 and 6 months of follow-up.

METHODS

We recruited men and women with type 2 diabetes from 5 primary health care centers and 1 specialized center. Participants were randomized 1:1 to the intervention or control group. The intervention group was administered standard care and access to the DiaCert app at baseline and 3 months onward. The control group received standard care only. Outcomes of objectively measured physical activity using accelerometers, BMI, waist circumference, biomarkers, and blood pressure were assessed at baseline and follow-ups. Linear mixed models were used to assess differences in outcomes between the groups.

RESULTS

A total of 181 study participants, 65.7% (119/181) men and 34.3% (62/181) women, were recruited into the study and randomized to the intervention (n=93) or control group (n=88). The participants' mean age and BMI were 60.0 (SD 11.4) years and 30.4 (SD 5.3) kg/m2, respectively. We found no significant effect of the intervention (group by time interaction) on MVPA at either the 3-month (β=1.51, 95% CI -5.53 to 8.55) or the 6-month (β=-3.53, 95% CI -10.97 to 3.92) follow-up. We found no effect on any of the secondary outcomes at follow-ups, except for a significant effect on BMI at 6 months (β=0.52, 95% CI 0.20 to 0.84). However, mean BMI did not differ between the groups at the 6-month follow-up.

CONCLUSIONS

We found no evidence that persons with type 2 diabetes being randomized to use an app promoting daily walking increased their levels of MVPA at 3 or 6 months' follow-up compared with controls receiving standard care. The effect of the app on BMI was unclear, and we found nothing to support an effect on secondary outcomes. Further research is needed to determine what type of mHealth intervention could be effective to increase physical activity among persons with type 2 diabetes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03053336; https://clinicaltrials.gov/study/NCT03053336.

Mobile health technologies to improve walking distance in people with intermittent claudication

BACKGROUND

Peripheral arterial disease (PAD) is the obstruction or narrowing of the large arteries of the lower limbs, which can result in impaired oxygen supply to the muscle and other tissues during exercise, or even at rest in more severe cases. PAD is classified into five categories (Fontaine classification). It may be asymptomatic or various levels of claudication pain may be present; at a later stage, there may be ulceration or gangrene of the limb, with amputation occasionally being required. About 20% of people with PAD suffer from intermittent claudication (IC), which is muscular discomfort in the lower extremities induced by exertion and relieved by rest within 10 minutes; IC causes restriction of movement in daily life. Treatment for people with IC involves addressing lifestyle risk factors. Exercise is an important part of treatment, but supervised exercise programmes for individuals with IC have low engagement levels and high attrition rates. The use of mobile technologies has been suggested as a new way to engage people with IC in walking exercise interventions. The novelty of the intervention, low cost for the user, automation, and ease of access are some of the advantages mobile health (mhealth) technologies provide that give them the potential to be effective in boosting physical activity in adults.

OBJECTIVES

To assess the benefits and harms of mobile health (mhealth) technologies to improve walking distance in people with intermittent claudication.

SEARCH METHODS

The Cochrane Vascular Information Specialist conducted systematic searches of the Cochrane Vascular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and CINAHL, and also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. The most recent searches were carried out on 19 December 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) in people aged 18 years or over with symptomatic PAD and a clinical diagnosis of IC. We included RCTs comparing mhealth interventions to improve walking distance versus usual care (no intervention or non-exercise advice), exercise advice, or supervised exercise programmes. We excluded people with chronic limb-threatening ischaemia (Fontaine III and IV).

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were change in absolute walking distance from baseline, change in claudication distance from baseline, amputation-free survival, revascularisation-free survival. Our secondary outcomes were major adverse cardiovascular events, major adverse limb events, above-ankle amputation, quality of life, and adverse events. We used GRADE to assess the certainty of the evidence.

MAIN RESULTS

We included four RCTs involving a total of 614 participants with a clinical diagnosis of IC. The duration of intervention of the four included RCTs ranged from 3 to 12 months. Participants were randomised to either mhealth or control (usual care or supervised exercise programme). All four studies had an unclear or high risk of bias in one or several domains. The most prevalent risk of bias was in the area of performance bias, which was rated high risk as it is not possible to blind participants and personnel in this type of trial. Based on GRADE criteria, we downgraded the certainty of the evidence to low, due to concerns about risk of bias, imprecision, and clinical inconsistency. Comparing mhealth with usual care, there was no clear evidence of an effect on absolute walking distance (mean difference 9.99 metres, 95% confidence interval (CI) -27.96 to 47.93; 2 studies, 503 participants; low-certainty evidence). None of the included studies reported on change in claudication walking distance, amputation-free survival, or revascularisation-free survival. Only one study reported on major adverse cardiovascular events (MACE) and found no clear difference between groups (risk ratio 1.37, 95% CI 0.07 to 28.17; 1 study, 305 participants; low-certainty evidence). None of the included studies reported on major adverse limb events (MALE) or above-ankle amputations.

AUTHORS' CONCLUSIONS

Mobile health technologies can be used to provide lifestyle interventions for people with chronic conditions, such as IC. We identified a limited number of studies that met our inclusion criteria. We found no clear difference between mhealth and usual care in improving absolute walking distance in people with IC; however, we judged the evidence to be low certainty. Larger, well-designed RCTs are needed to provide adequate statistical power to reliably evaluate the effects of mhealth technologies on walking distance in people with IC.

Boosts for walking: how humorous messages increase brisk walking among cognitively fatigued individuals

BACKGROUND

A well-studied internal barrier to regular physical activity, and more specifically brisk walking, is cognitive fatigue. However, thus far little research examined how cognitively fatigued individuals can be motivated to exercise, more specifically to engage in brisk walking. This study investigates whether humorous intervention messages might be an effective strategy to motivate cognitively fatigued individuals to brisk walk, and through which underlying processes.

METHODS

An online experiment was performed in which variation in cognitive fatigue was induced through mental arithmetic questions. Afterwards, participants (n = 250) recruited through Prolific, randomly received either humorous or non-humorous intervention messages related to brisk walking. Potential mediators of the relations between physical activity, humour and cognitive fatigue were measured, were self-efficacy, self-control, and motivation.

RESULTS

First, regression analyses confirmed that cognitive fatigue negatively influences brisk walking intentions and that the perceived humour of the intervention messages moderated this relationship. Second, results showed that self-control and self-efficacy are mediators explaining the relationship between cognitive fatigue and brisk walking intentions. Lastly, this study found that perceived humour of the intervention messages moderated the relationship between cognitive fatigue and self-control, indicating that perceptions of self-control were positively changed after receiving messages that were perceived as humorous compared to messages that were not perceived as humorous, subsequently increasing brisk walking intentions.

CONCLUSIONS

This study is the first to unravel the underlying relationship between humorous intervention messages and brisk walking intentions through positive changes in perceptions of self-control within a cognitively fatigued sample. Results of this study suggest that existing smartphone applications monitoring and promoting brisk walking should integrate tailored message strategies within their cues to brisk walk by implementing humour as a strategy to motivate users when they are cognitively fatigued.

mHealth Intervention to Promote Physical Activity Among Employees Using a Deep Learning Model for Passive Monitoring of Depression and Anxiety: Single-Arm Feasibility Trial

BACKGROUND

Physical activity effectively prevents depression and anxiety. Although mobile health (mHealth) technologies offer promising results in promoting physical activity and improving mental health, conflicting evidence exists on their effectiveness, and employees face barriers to using mHealth services. To address these problems, we recently developed a smartphone app named ASHARE to prevent depression and anxiety in the working population; it uses a deep learning model for passive monitoring of depression and anxiety from information about physical activity.

OBJECTIVE

This study aimed to preliminarily investigate (1) the effectiveness of the developed app in improving physical activity and reducing depression and anxiety and (2) the app's implementation outcomes (ie, its acceptability, appropriateness, feasibility, satisfaction, and potential harm).

METHODS

We conducted a single-arm interventional study. From March to April 2023, employees aged ≥18 years who were not absent were recruited. The participants were asked to install and use the app for 1 month. The ideal usage of the app was for the participants to take about 5 minutes every day to open the app, check the physical activity patterns and results of an estimated score of psychological distress, and increase their physical activity. Self-reported physical activity (using the Global Physical Activity Questionnaire, version 2) and psychological distress (using the 6-item Kessler Psychological Distress Scale) were measured at baseline and after 1 month. The duration of physical activity was also recorded digitally. Paired t tests (two-tailed) and chi-square tests were performed to evaluate changes in these variables. Implementation Outcome Scales for Digital Mental Health were also measured for acceptability, appropriateness, feasibility, satisfaction, and harm. These average scores were assessed by comparing them with those reported in previous studies.

RESULTS

This study included 24 employees. On average, the app was used for 12.54 days (44.8% of this study's period). After using the app, no significant change was observed in physical activity (-12.59 metabolic equivalent hours per week, P=.31) or psychological distress (-0.43 metabolic equivalent hours per week, P=.93). However, the number of participants with severe psychological distress decreased significantly (P=.01). The digitally recorded duration of physical activity increased during the intervention period (+0.60 minutes per day, P=.08). The scores for acceptability, appropriateness, and satisfaction were lower than those in previous mHealth studies, whereas those for feasibility and harm were better.

CONCLUSIONS

The ASHARE app was insufficient in promoting physical activity or improving psychological distress. At this stage, the app has many issues that are to be addressed in terms of both implementation and effectiveness. The main reason for this low effectiveness might be the poor evaluation of the implementation outcomes by app users. Improving acceptability, appropriateness, and satisfaction are identified as key issues to be addressed in future implementation.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry UMIN000050430; https://tinyurl.com/mrx5ntcmrecptno=R000057438.

Analysing features of home-based workout during COVID-19 pandemic: a systematic review

OBJECTIVE

Since the beginning of the COVID-19 pandemic, a decrease in physical activity (PA) related to home confinement has been reported worldwide. However, some individuals were able to engage in physical activities at home. Thus, in a perspective of public health, it may be useful to analyse the available evidence regarding PA adopted during home restrictions, in order to identify possible strategies to help people stay active even during emergency situations. The aim of this review was to analyse how healthy individuals spontaneously exercised at home in the course of the pandemic, in order to detect possible factors associated with this behaviour.

STUDY DESIGN

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

METHODS

The protocol was registered in PROSPERO, an international prospective register of systematic reviews, with the registration number CRD42023394673. A literature search was conducted in PubMed, Scopus, and Web of Science. Cross-sectional studies published in English from the inception of each database to February 06th 2023 and focused on healthy individuals practicing spontaneous PA/exercise at home during the pandemic were considered eligible. The quality assessment was performed using the adapted Newcastle-Ottawa Quality Assessment Scale. Bibliographic information, sample size, study paricipant/population with age, gender, ethnicity, socioeconomic status, education, smart workers or not, anthropometric parameters, characteristics of at home exercises, athletic status and sedentariness, associated health-related effects, and main findings were synthetised.

RESULTS

From 504 articles, 19 were included. Notwithstanding the differences in the studies examined, the majority of them reported that previous PA level was associated with exercise in such challenging conditions. Furthermore, technologies aimed at supporting exercise were shown to be a useful resource.

CONCLUSIONS

Being habitually active and using digital supports may be associated with a positive attitude towards exercise at home during isolation. This suggests that in emergency situations, exercise should be promoted, also through digital media, especially among those groups who are usually less engaged in PA. Further analyses of longitudinal studies are needed to confirm these findings.

Keeping Active with Texting after Stroke (KATS): development of a text message intervention to promote physical activity and exercise after stroke

BACKGROUND

Post-stroke physical activity reduces disability and risk of further stroke. When stroke rehabilitation ends, some people feel abandoned by services and struggle to undertake physical activities that support recovery and health. The aim of this study was to codesign a novel text message intervention to promote physical activity among people with stroke and provide support when formal rehabilitation ends. This manuscript describes the intervention development processes that will inform future pilot and feasibility studies.

METHODS

The planned intervention was a series of text messages to be sent in a predetermined sequence to people with stroke at the end of rehabilitation. The intervention, underpinned by behaviour change theory and using salient behaviour change techniques, would provide daily messages offering encouragement and support for the uptake and maintenance of physical activity following stroke. The intervention was codesigned by a Collaborative Working Group, comprised of people with stroke, rehabilitation therapists, representatives from stroke charities and academics. A four-step framework was used to design the intervention: formative research on physical activity post-stroke, creation of the behaviour change text message intervention, pre-testing and refinement. Formative research included a review of the scientific evidence and interviews with community-dwelling people with stroke. Data generated were used by the Collaborative Working Group to identify topics to be addressed in the intervention. These were mapped to constructs of the Health Action Process Approach, and salient behaviour change techniques to deliver the intervention were identified. The intervention was rendered into a series of text messages to be delivered over 12 weeks. The draft intervention was revised and refined through an iterative process including review by people with stroke, their spouses, rehabilitation therapists and experts in the field of stroke. The messages encourage regular physical activity but do not prescribe exercise or provide reminders to exercise at specific times. They use conversational language to encourage engagement, and some are personalised for participants. Quotes from people with stroke provide encouragement and support and model key behaviour change techniques such as goal setting and coping planning.

DISCUSSION

Co-design processes were critical in systematically developing this theory and evidence-based intervention. People with stroke and rehabilitation therapists provided insights into perceived barriers post-rehabilitation and identified strategies to overcome them. The structured multistep approach highlighted areas for improvement through successive rounds of review. The intervention will be tested for acceptability, feasibility and effectiveness in future studies. This co-design approach could be used for interventions for other heath behaviours and with different populations.

A Digital Platform and Smartphone App to Increase Physical Activity in Patients With Type 2 Diabetes: Overview Of a Technical Solution

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-018-5026-4.

Physical Activity and Sedentary Behavior in High School Students: A Quasi Experimental Study via Smartphone during the COVID-19 Pandemic

The objective of this study was to evaluate whether exposure to information about physical activity and its barriers can increase the level of physical activity and reduce the time exposed to sedentary behaviors in high school students involved in integrated professional and technological education during the coronavirus disease 2019 pandemic. This quasi experimental study was conducted with integrated education high school students, divided into two groups: Intervention Group (IG; n = 59) and Control Group (CG; n = 54). Physical activity and sedentary behavior were identified and measured using the International Physical Activity Questionnaire pre-and post-intervention for both groups. IG students received educational material thrice a week for four weeks. The focus of the material was the importance of physical activity and need to reduce the time exposed to sedentary behavior. The results revealed that IG students showed an average daily reduction of 47.14 min in time exposed to sedentary behaviors, while the CG students showed an increase of 31.37 min. Despite this, the intervention was not effective in improving physical activity levels in the IG and the mean reduction in the time exposed to sedentary behavior was not significant (p = 0.556). The intervention was ineffective in increasing the practice of physical activity and reducing the time exposed to sedentary behavior.

Smart Walk: A Culturally Tailored Smartphone-Delivered Physical Activity Intervention for Cardiometabolic Risk Reduction among African American Women

This article reports the results of Smart Walk: a randomized pilot trial of an 8-month culturally tailored, smartphone-delivered physical activity (PA) intervention for African American women with obesity. Sixty participants (age range = 24−49 years; BMI range = 30−58 kg/m2) were randomized to the Smart Walk intervention (n = 30) or a wellness comparison intervention (n = 30). Results supported the acceptability and feasibility of the intervention, as demonstrated by participant retention (85% at 4 months and 78% at 8 months), Smart Walk app use, and intervention satisfaction (i.e., 100% of PA participants completing the intervention [n = 24] reported they would recommend it to friend). Smart Walk participants also reported greater increases in moderate-to-vigorous PA (4-month between-arm difference in change [b] = 43.3 min/week; p = 0.018; Cohen’s d = 0.69; 8-month b = 56.6 min/week; p = 0.046; d = 0.63) and demonstrated clinically relevant, although not statistically significant (p-values > 0.05), baseline to 4 months improvements in cardiorespiratory fitness (b = 1.67 mL/kg/min; d = 0.40), systolic blood pressure (b = −3.33 mmHg; d = 0.22), diastolic blood pressure (b = −4.28 mmHg; d = 0.37), and pulse wave velocity (b = −0.46 m/s; d = 0.33). Eight-month cardiometabolic outcomes followed similar trends, but had high rates of missing data (45−53%) due to COVID-19 restrictions. Collectively, findings demonstrated favorable outcomes for acceptability and feasibility, while also highlighting key areas for refinement in future research.

Exercise & Sports Science Australia (ESSA) updated Position Statement on exercise and physical activity for people with hip/knee osteoarthritis

This Position Statement is an update to the existing statement. It is intended for all health practitioners who manage people with hip/knee osteoarthritis. It synthesises the most recent evidence (with a focus on clinical guidelines and systematic reviews) for exercise in people with hip/knee osteoarthritis, and provides guidance to practitioners about how best to implement exercise in clinical practice. Clinical practice guidelines for hip/knee osteoarthritis advocate physical activity and exercise as fundamental core components of evidence-based management. Research evidence indicates that exercise can reduce joint pain, increase physical function, and improve quality of life in hip/knee osteoarthritis, and that a range of exercise types (both supervised and unsupervised) may be beneficial. Exercise dosage should be guided by the principles of the American College of Sports Medicine. As people with osteoarthritis experience many barriers to exercise, practitioners should take an active role in monitoring and promoting adherence to exercise in order to optimise therapeutic benefits.

Assessing the Acceptability and Effectiveness of Mobile-Based Physical Activity Interventions for Midlife Women During Menopause: Systematic Review of the Literature

BACKGROUND

Midlife women with menopausal symptoms are less likely to meet the recommended level of physical activity (PA). Promoting PA among women in midlife could reduce their risk of cardiovascular diseases and perhaps improve menopausal symptoms. Mobile PA interventions in the form of smartphone apps and wearable activity trackers can potentially encourage users to increase PA levels and address time and resource barriers to PA. However, evidence on the acceptability and effectiveness of these interventions among midlife women is unclear.

OBJECTIVE

This systematic review evaluated the effectiveness, acceptability, and active behavior change techniques (BCTs) of mobile PA technologies among midlife menopausal women.

METHODS

A mixed methods systematic review of qualitative and quantitative studies was conducted. MEDLINE (Ovid), Embase, Scopus, CINAHL, Web of Science, SPORTDiscus, CENTRAL, PsycINFO, and the ProQuest Sports Medicine and Education Index were systematically searched. Studies were selected and screened according to predetermined eligibility criteria. In total, 2 reviewers independently assessed the risk of bias using the Mixed Methods Appraisal Tool and completed BCT mapping of the included interventions using the BCT Taxonomy v1.

RESULTS

A total of 12 studies were included in this review. Overall risk of bias was "Moderate to high" in 58% (7/12) of the included studies and "low" in 42% (5/12) of the studies. Of the 12 studies, 7 (58%) assessed changes in PA levels. The pooled effect size of 2 randomized controlled trials resulted in a small to moderate increase in moderate to vigorous PA of approximately 61.36 weekly minutes among midlife women, at least in the short term (95% CI 17.70-105.01; P=.006). Although a meta-analysis was not feasible because of heterogeneity, positive improvements were also found in a range of menopause-related outcomes such as weight reduction, anxiety management, sleep quality, and menopause-related quality of life. Midlife women perceived mobile PA interventions to be acceptable and potentially helpful in increasing PA and daily steps. The average number of BCTs per mobile PA intervention was 8.8 (range 4-13) according to the BCT Taxonomy v1. "Self-monitoring of behaviour," "Biofeedback," and "Goal setting (behaviour)" were the most frequently described BCTs across the included interventions.

CONCLUSIONS

This review demonstrated that mobile PA interventions in the form of smartphone apps and wearable trackers are potentially effective for small to moderate increases in moderate to vigorous PA among midlife women with menopausal symptoms. Although menopause is a natural condition affecting half the population worldwide, there is a substantial lack of evidence to support the acceptability and effectiveness of mobile PA interventions on menopause-related outcomes, which needs further investigation.

TRIAL REGISTRATION

PROSPERO CRD42021273062; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=273062.

A Clinical Preventive Strategy Based on a Digital Tool to Improve Access to Endocrine Disruptors Exposure Prevention: The MEDPREVED Study

Introduction: The digitalized PREVED (PREgnancy, PreVention, Endocrine Disruptor) questionnaire was used in the clinical practices of health professionals (HP) who adhered to the MEDPREVED strategy. The objectives were to assess the strategy and to determine if it could improve access to endocrine disruptor (ED) exposure prevention. Methods: After having filled in the digital questionnaire in HP waiting rooms, patients were invited to talk about ED exposure during the consultation. HPs were previously trained in ED and had received a prevention kit for their patients. After the seven-month implementation phase, the evaluation phase consisted of five mixed assessments: interviews with: (i) patients who were young children's parents; (ii) patients in the general population; (iii) paediatricians; (iv) midwives; and a quantitative study on GPs. Assessment concerned feasibility, accessibility, and usefulness of the strategy; we then used the Levesque model to evaluate how it could improve access to ED exposure prevention. Results: The study included 69 participants. The strategy appeared feasible for the filling-out step due to digital and environment access. However, it depended on patient and HP profiles. The strategy seemed useful insofar as it facilitated reflexive investment, an intention to healthy behaviour and, rather rarely, talk about ED exposure. The beginning of this discussion depended on time, prioritizing of the topic and HP profile. The strategy has confirmed the Levesque model's limiting factors and levers to access ED prevention. Conclusions: The MEDPREVED strategy is feasible, accessible, and useful in clinical prevention practice. Further study is needed to measure the impact on knowledge, risk perception and behavior of beneficiaries of the MEDPREVED strategy in the medium and long term.

Do physical activity interventions combining self-monitoring with other components provide an additional benefit compared with self-monitoring alone? A systematic review and meta-analysis

Objective

To determine the net effect of different physical activity intervention components on step counts in addition to self-monitoring.

Design

A systematic review with meta-analysis and meta-regression.

Data sources

Five databases (PubMed, Scopus, Web of Science, ProQuest and Discus) were searched from inception to May 2022. The database search was complemented with backward and forward citation searches and search of the references from relevant systematic reviews.

Eligibility criteria

Randomised controlled trials comparing an intervention using self-monitoring (active control arm) with an intervention comprising the same treatment PLUS any additional component (intervention arm).

Data extraction and synthesis

The effect measures were mean differences in daily step count. Meta-analyses were performed using random-effects models, and effect moderators were explored using univariate and multivariate meta-regression models.

Results

Eighty-five studies with 12 057 participants were identified, with 75 studies included in the meta-analysis at postintervention and 24 at follow-up. At postintervention, the mean difference between the intervention and active control arms was 926 steps/day (95% CI 651 to 1201). At a follow-up, the mean difference was 413 steps/day (95% CI 210 to 615). Interventions with a prescribed goal and involving human counselling, particularly via phone/video calls, were associated with a greater mean difference in the daily step count than interventions with added print materials, websites, smartphone apps or incentives.

Conclusion

Physical activity interventions that combine self-monitoring with other components provide an additional modest yet sustained increase in step count compared with self-monitoring alone. Some forms of counselling, particularly remote phone/video counselling, outperformed other intervention components, such as websites and smartphone apps.

PROSPERO registered number

CRD42020199482.

Effects of Attitudes towards Exercise Behaviour, Use of Sports Apps and COVID-19 on Intentions to Exercise

The sudden outbreak of the novel coronavirus pandemic in 2019 disrupted the normal order of life and work, and the virus is still a major threat prevailing the globe. Confronted with the unknown virus, citizens have been following government policies of COVID-19 treatment and containment, and actively improving their immunity through physical activity (PA). This paper is concerned with ways to guide or promote people's willingness to exercise, one of the most effective means to boost immunity. Based on the "attitude-intention" correlation defined in the theory of planned behaviour (TPB), this study, by synchronizing online data about workouts, explores the influence of people's attitudes towards PA behaviour in promoting their intentions to engage in such behaviours as a means to fight the pandemic. In addition, the attitudes towards the use of sports apps and the epidemic are also reckoned with to investigate influencing factors promoting physical activity during the lockdown. The results of the study have been derived from the data of 1223 valid questionnaires, which are subjected to hierarchical regression analysis. Attitudes towards exercise and the use of sports apps are proven to have a significant impact on PA intentions, and the two variables are in direct proportion, with more positive attitudes leading to higher intentions; in contrast, attitudes towards the epidemic do not exhibit an obvious effect. In this light, it is advisable that when clinicians treat COVID-19 patients and medical departments respond to the epidemic, they actively make affirmative influences on peoples' attitudes towards exercise and formulate appropriate exercise plans based on indicators detected and recorded by sports apps such as vital capacity, heart rate, respiratory index and self-perceived intensity to help them face the risk of the epidemic with more confidence.

Effects of Family-Based Interventions Using Mobile Apps on Youth’s Physical Activity: A Systematic Review

Objective. This review synthesized the currently available literature on the effects of family-based interventions using smartphone apps on youth physical activity. Design. Systematic review. Data Sources. 1037 studies from eight databases were retrieved. Eligibility Criteria for Selecting Studies. The seven articles included in this review met the following inclusion criteria: (1) experimental studies, (2) using smartphone apps, and (3) involving families with healthy children/adolescents. Results. Studies were stratified according to whether they used smartphone apps only or the combination of sports wearables and their associated companion app. The smartphone app interventions showed significant improvements in youth’s PA levels. All but one of the studies reported no significant improvement in PA levels after the intervention. However, positive PA-related outcomes were found, and the combination of sports wearables and their associated companion app showed inconclusive results due to the small number of studies. A trend of the relevance of families in improving the PA levels of youths was found. Conclusions. The findings of this review indicate that more research is needed on the effects of family-based interventions using mobile apps on youth’s physical activity. Mixed results were found for variables related to the PA of the youth involved in these programs. Although strong evidence was found that youth’s physical activity levels do not always improve with the implementation of these programs, promising results were found for a positive impact on different variables related to physical activity. Therefore, more experimental studies using only a mobile app to promote PA as the main outcome are needed to understand the real effect of mobile apps on youth’s PA levels. Future studies need to further explore this topic by developing programs based on designs of high methodological quality.

Blended Care Interventions to Promote Physical Activity: A Systematic Review of Randomized Controlled Trials

BACKGROUND

Blended care interventions combine therapeutic guidance with digital care. Current research results show the promising role of the blended care approach in clinical care. This new way of delivering health care could have the potential to effectively promote physical activity in different public health settings.

OBJECTIVE

The aim of the systematic review is to investigate the varieties of intervention characteristics of blended care interventions to promote physical activity in terms of structure, behavior change goals, behavior change techniques, and effectiveness of blended care interventions compared to a control group.

METHODS

We searched for randomized controlled trials published from 2000 to March 2021 in MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycINFO, and Web of Science according to the PRISMA guidelines. Risk of bias was assessed using the Cochrane Collaboration tool. Study characteristics, intervention characteristics, and outcome data were extracted. Furthermore, the effect size on the outcome of physical activity was examined or calculated.

RESULTS

In total, the number of reports identified from the database searches was 4828. Of these, 25 studies were included in the review, with a total of 5923 study participants. Results indicated that the characteristics of blended care interventions showed a high heterogeneity. The combinations of therapist-guided interventions and digital interventions allowed the identification of specific subgroups, but they varied in length (range 8-52 weeks, SD 16.6), intensity, and the combination of the components. The most used combination of blended care interventions to promote physical activity was the combination of one-on-one meetings via telephone and Web-based interventions. Motivational models of behavior change were used most frequently as underlying theoretical foundations. Certain behavior change techniques were used consistently across the individual components, e.g., "problem solving" in the therapist-guided component and "feedback on behavior" in the digital component. Considering the effect size of blended care interventions compared with control groups, most studies showed a small effect.

CONCLUSIONS

It can be concluded that blended care interventions have potential to promote physical activity. In the future, further high-quality studies should investigate which type of blended care intervention is effective for which target group. Additionally, insights are required on which intervention characteristics are most effective, taking into account new evidence on behavior change. Registration This systematic literature review was registered in PROSPERO ( CRD42020188556 ).

SNapp, a Tailored Smartphone App Intervention to Promote Walking in Adults of Low Socioeconomic Position: Development and Qualitative Pilot Study (Preprint)

BACKGROUND

Adults of low socioeconomic position (SEP) are generally less physically active than those who are more socioeconomically advantaged, which increases their cardiovascular disease incidence risk. Moreover, individuals of low SEP are often less easily reached with physical activity (PA) interventions than individuals of higher SEP. Smartphone apps have been presented as a promising platform for delivering PA interventions to difficult-to-reach individuals of low SEP. Although PA apps are widely available, they are rarely based on health behavior theories and most predominantly offer generic PA advice. Consequently, it is unlikely that available apps are the most effective PA intervention tools.

OBJECTIVE

To respond to these areas for improvement, we developed SNapp, an app-based intervention encouraging adults of low SEP to increase PA by providing tailored coaching messages targeting walking behavior. This study aimed to describe SNapp's stepwise development and pilot evaluation process.

METHODS

We applied a stepwise approach: analyzing the health problem, developing a program framework, developing tailoring assessments, writing tailored messages, automating the tailoring process, and implementing and evaluating the program in a qualitative pilot study (11 participants).

RESULTS

SNapp consisted of several elements. First, an app was developed to collect step count and geolocation data using smartphone sensor functionalities. In addition, a survey measure was created to assess users' behavior change technique (BCT) preferences. These 3 data types were used to tailor SNapp's coaching messages to stimulate walking. This allows SNapp to offer feedback on performance levels, contextually tailored prompts when users are near green spaces, and coaching content that aligns with individual BCT preferences. Finally, a server-based Python program that interacts with databases containing user data and tailored messages was built using Microsoft Azure to select and automatically send messages to users through Telegram messenger. Pilot study findings indicated that SNapp was rated positively, with participants reporting that its design, technical functioning, and message content were acceptable. Participants suggested additional functionalities that are worth considering for future updates.

CONCLUSIONS

SNapp is an app-based intervention that aims to promote walking in adults of low SEP by offering tailored coaching messages. Its development is theory based, and it is among the first to incorporate contextualized feedback and content tailored to individual BCT preferences. The effectiveness of SNapp will be evaluated in a 12-month real-life parallel cluster-randomized controlled trial.

How do different interventions impact stair climbing? A systematic review and meta-analysis

OBJECTIVES

This study aimed to analyze the effect of interventions to increase stair use.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

An online search was conducted in January 2021 in five databases (Web of Science, SPORTDiscus, MedLine/PubMed, PsycINFO, and CINAHL). Experimental studies (randomized and non-randomized) conducted in adults, which provided stair use measures with pre- and post-intervention periods were included. A random-effect meta-analysis, as well as subgroup analyses were conducted to evaluate the quantitative effect of interventions on stair use.

RESULTS

Overall, 34 studies were included in qualitative analyses, and 15 in the meta-analysis. Most of the studies were conducted in Europe and private settings (e.g., office buildings). Overall, interventions increased stair use in adults (odds ratio (OR) 1.48; 95% confidence intervals (CI) 1.38-1.58; I2 = 99.6%). Subgroup analyses showed that interventions increased stair use regardless of the continent and observer type (manual or electronic). However, different settings (shopping malls and office buildings), as well as studies (time of intervention) and intervention characteristics (sign size and location, message characters) were associated with increased stair use.

CONCLUSIONS

Different interventions can increase stair use in several continents and settings. Sign and message characteristics should be considered when designing interventions or policies to promote physical activity by increasing stair use.

Effectiveness of a personal health coaching intervention (diabetescoach) in patients with type 2 diabetes: protocol for an open-label, pragmatic randomised controlled trial

INTRODUCTION

The widespread prevalence of type 2 diabetes (T2D) not only influences patients' daily lives but also has an economic impact on society. Increasing physical activity and a healthy diet can delay the progression of T2D. Although there are evidence-based recommendations on diet and physical activity, patients with T2D have difficulties implementing them. An appropriate lifestyle intervention can address this problem.

METHODS AND ANALYSIS

This study is based on the need to develop an intervention that helps patients to establish behavioural changes in order to achieve glycaemic control. The intervention will be evaluated in a monocentric, open-label, pragmatic, two-arm randomised controlled trial with a sample ratio of 1:1 and a parallel design. This superiority study will be conducted in Switzerland. All enrolled patients (n=90) will receive the standard medical treatment for T2D. The intervention group will receive personal health coaching by telephone and access to a smartphone and web application for 1 year. The control group will receive access to the application for 1 year and a one-time written diet and exercise recommendation. The primary outcomes are objectively measured physical activity and glycated haemoglobin. Secondary outcomes are self-reported physical activity, nutrition, cognitive mediators of changes in sport-related behaviour, blood values, medication and nutritional supplements, anthropometric data, quality of life, neuropathy and cost-effectiveness. All outcomes will be measured at baseline, at 27 weeks after inclusion and at 54 weeks after inclusion. The recruitment of participants and the measurements will be completed after 2 years. Linear mixed-effects models will be applied for each outcome variable to analyse the intervention effects.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee North-western and Central Switzerland in February 2021 (ref: 2020-02755). All participants will be required to provide written informed consent. The results will be published in international peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ISRCTN79457541.

Developing Mobile Health Interventions With Implementation in Mind: Application of the Multiphase Optimization Strategy (MOST) Preparation Phase to Diabetes Prevention Programming

With thousands of mobile health (mHealth) solutions on the market, patients and health care providers struggle to identify which solution to use and prescribe. The lack of evidence-based mHealth solutions may be because of limited research on intervention development and the continued use of traditional research methods for mHealth evaluation. The Multiphase Optimization Strategy (MOST) is a framework that aids in developing interventions that produce the best-expected outcomes (ie, effectiveness), given constraints imposed on affordability, scalability, and efficiency (also known as achieving intervention EASE). The preparation phase of the MOST highlights the importance of formative intervention development-a stage often overlooked and rarely published. The aim of the preparation phase of the MOST is to identify candidate intervention components, create a conceptual model, and define the optimization objective. Although the MOST sets these 3 targets, no guidance is provided on how to conduct quality research within the preparation phase and what specific steps can be taken to identify potential intervention components, develop the conceptual model, and achieve intervention EASE with the implementation context in mind. To advance the applicability of the MOST within the field of implementation science, this study provides an account of the methods used to develop an mHealth intervention using the MOST. Specifically, we provide an example of how to achieve the goals of the preparation phase by outlining the formative development of an mHealth-prompting intervention within a diabetes prevention program. In addition, recommendations are proposed for future researchers to consider when conducting formative research on mHealth interventions with implementation in mind. Given its considerable reach, mHealth has the potential to positively affect public health by decreasing implementation costs and improving accessibility. The MOST is well-suited for the efficient development and optimization of mHealth interventions. By using an implementation-focused lens and outlining the steps in developing an mHealth intervention using the preparation phase of the MOST, this study may guide future intervention developers toward maximizing the impact of mHealth outside academia.

Efficacy of Mobile Health Applications to Improve Physical Activity and Sedentary Behavior: A Systematic Review and Meta-Analysis for Physically Inactive Individuals

Physical inactivity and sedentary behavior (SB) have attracted growing attention globally since they relate to noninfectious chronic diseases (NCDs) and could further result in the loss of life. This systematic literature review aimed to identify existing evidence on the efficacy of mobile health (mHealth) technology in inducing physical activity and reducing sedentary behavior for physically inactive people. Studies were included if they used a smartphone app in an intervention to improve physical activity and/or sedentary behavior for physically inactive individuals. Interventions could be stand-alone interventions or multi-component interventions, including an app as one of several intervention components. A total of nine studies were included, and all were randomized controlled trials. Two studies involved interventions delivered solely via a mobile application (stand-alone intervention) and seven studies involved interventions that used apps and other intervention strategies (multi-component intervention). Methodological quality was assessed, and the overall quality of the studies was ensured. The pooled data favored intervention in improving physical activity and reducing sedentary behavior. This review provided evidence that mobile health intervention improved physical activity and reduced sedentary behavior among inactive individuals. More beneficial effects can be guaranteed when interventions include multiple components. Further studies that maintain the effectiveness of such interventions are required to maximize user engagement and intervention efficacy.

mHealth interventions targeting movement behaviors in Asia: A scoping review

mHealth interventions can promote healthy movement behaviors (physical activity, sedentary behavior, and sleep). However, recent reviews include few studies from Asia, despite it being home to over 60% of the world population. The aim is to map the current evidence for mHealth interventions targeting movement behaviors in Asia. Six databases were searched up until August 2021. Included studies described an mHealth intervention targeting one or more movement behaviors, delivered in a country/territory in Asia, to a general population. A total of 3986 unique records were screened for eligibility in duplicate. Eighty studies with 1,413,652 participants were included. Most were randomized (38.8%) or quasi-experimental (27.5%) trials. Studies were from 17 countries/territories (out of 55); majority were high- (65.0%) or upper middle-income (28.7%). Physical activity was targeted most often (93.8%), few targeted sedentary behavior (7.5%), or sleep (8.8%). Most targeted one movement behavior (90.0%), and none targeted all three together. Interventions typically incorporated a single mHealth component (70.0%; app, pedometer, text messages, wearable) and were delivered remotely (66.3%). The average intervention length was 121.8 (SD 127.6) days. mHealth interventions in Asia have primarily targeted physical activity in high- and upper middle-income countries. There are few interventions targeting sedentary behavior or sleep, and no interventions in low-income countries.

Temporal and Spatial Trends From Counterfactual Scenarios of Physical Activity on Mortality, Years of Life Lost, and Life Expectancy Due to Noncommunicable Diseases in Argentina

BACKGROUND

This study estimates the spatial distribution and trends in preventable deaths, years of life lost (YLL), and life expectancy (LE), associated with noncommunicable diseases under alternative distributions of physical activity in Argentina.

METHODS

Potential impact fractions were used to calculate the preventable deaths and YLL attributable to various scenarios of physical activity. Cause-eliminated life tables were used to estimate LE gains, and Monte Carlo simulations were performed for uncertainty analysis.

RESULTS

From 2005 to 2018, physical activity could have prevented up to 7544 to 8220 potential deaths (≈4.27% of major noncommunicable diseases and ≈2.66% of all causes) and about 221 to 219 YLL per 100,000 inhabitants; between 0.67 and 0.71 years of LE could have been gained. If the World Health Organization recommendations (at least 600 metabolic equivalent tasks minutes per week) had been achieved, between 2813 and 3111 potential deaths could have been prevented, about 80 fewer years of life (per 100,000 inhabitants) would have been lost, and 0.23 years of LE could have been gained. A 15% reduction in insufficient physical activity has shown a small impact on outcomes.

CONCLUSION

Public health initiatives aimed at increasing population-wide physical activity could reduce noncommunicable disease deaths in Argentina.

Changes in Physical Activity and Depressive Symptoms During COVID-19 Lockdown: United States Adult Age Groups

This study investigates: (1) the changes in three major health-related factors—physical activity, non-physical-activity health behavior (i.e., diet quality, alcohol consumption, smoking, sleep quality), and depressive symptoms, and (2) how changes in physical activity were associated with changes in one’s depressive symptoms among young adults, middle-aged adults, and older adults while controlling non-physical-activity health behavior and sociodemographic characteristics among young, middle-aged, and older adults before and after the COVID-19 outbreak lockdown in the United States. A total of 695 participants completed an online questionnaire via MTurk, and participants were asked to recall their physical activity, depressive symptoms, and non-physical-activity health behavior status in January and May of 2020. The IPAQ-SF was used to evaluate individuals’ physical activity, while the CES-D-10 was used to assess depressive symptoms. Covariates included non-physical-activity health behavior and sociodemographic factors. A Bayesian significance testing of changes was used to examine significant changes in physical activity, non-physical-activity behavior, and depressive symptoms in each age group while Bayesian regression analysis was employed to examine how the changes in physical activity were associated with respondents’ depressive symptoms while controlling for individual NHB and sociodemographic characteristics. The results showed that the participants tended to maintain their physical activity levels after the lockdown despite significant increases in sitting time among young and older adults. Decreases in moderate physical activity frequency were associated with a higher level of depressive symptoms (R² = 17.1%). Although young and middle-aged cohorts experienced fewer differences in depressive symptoms compared to their counterparts in the older group, we found no significant heterogeneity effects in the relationships of interest across all age groups. Considering different influences of physical activity on depressive symptoms depending on different levels of activity and ages, more randomized clinical trials with program-based intervention studies should be conducted with different physical activity programs for different age populations.

Promoting Physical Activity and Weight Loss With mHealth Interventions Among Workers: Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Physical activity (PA) is a vital factor in promoting health in the workforce. Mobile health (mHealth) interventions have recently emerged in workplace health promotion as an effective strategy for inducing changes in health behaviors among workers; however, the effectiveness of mHealth interventions in promoting PA and weight loss for workers is unclear.

OBJECTIVE

This study aims to provide a comprehensive analysis of current evidence on the effectiveness of mHealth interventions in promoting PA and weight loss among workers.

METHODS

We searched relevant databases, including PubMed, Embase, CINAHL Complete, and the Cochrane Library, for publications on mHealth interventions in the English or Korean language from inception to December 2020. Randomized controlled trials that evaluated the effectiveness of mHealth in improving PA and weight loss were retrieved. A meta-analysis with a random effects model and subgroup analyses was performed on PA types and mHealth intervention characteristics.

RESULTS

A total of 8 studies were included in this analysis. More than half of the studies (5/8, 63%) were identified as having a high risk of bias. The mHealth intervention group showed a significant improvement in PA (standardized mean difference [SMD] 0.22, 95% CI 0.03-0.41; P<.001; I2=78%). No significant difference in weight loss was observed when comparing the intervention group with the control groups (SMD 0.02, 95% CI -0.07 to 0.10; P=.48; I2=0%). A subgroup analysis was also performed; walking activity (SMD 0.70, 95% CI 0.21-1.19; P<.001; I2=83.3%), a multicomponent program (SMD 0.19, 95% CI 0.05-0.33; P=.03; I2=57.4%), objective measurement (SMD 0.58, 95% CI 0.05-1.10; P<.001; I2=87.3%), and 2 or more delivery modes (SMD 0.44, 95% CI 0.01-0.87; P<.001; I2=85.1%) were significantly associated with an enhancement in PA.

CONCLUSIONS

This study suggests that mHealth interventions are effective for improving PA among workers. Future studies that assess long-term efficacy with a larger population are recommended.

Moving from intention to behaviour: a randomised controlled trial protocol for an app-based physical activity intervention (i2be)

INTRODUCTION

Efficacy tests of physical activity interventions indicate that many have limited or short-term efficacy, principally because they do not sufficiently build on theory-based processes that determine behaviour. The current study aims to address this limitation.

METHODS AND ANALYSIS

The efficacy of the 8-week intervention will be tested using a three-condition randomised controlled trial delivered through an app, in women with a prior hypertensive pregnancy disorder. The intervention is based on the integrated behaviour change model, which outlines the motivational, volitional and automatic processes that lead to physical activity. The mechanisms by which the behaviour change techniques lead to physical activity will be tested.Following stratification on baseline factors, participants will be randomly allocated in-app to one of three conditions (1:1:1). The information condition will receive information, replicating usual care. Additionally to what the information condition receives, the motivation condition will receive content targeting motivational processes. Additionally to what the motivation condition receives, the action condition will receive content targeting volitional and automatic processes.The primary outcome is weekly minutes of moderate-to-vigorous physical activity, as measured by an activity tracker (Fitbit Inspire 2). Secondary outcomes include weekly average of Fitbit-measured daily resting heart rate, and self-reported body mass index, waist-hip ratio, cardiorespiratory fitness and subjective well-being. Tertiary outcomes include self-reported variables representing motivational, volitional, and automatic processes. Outcome measures will be assessed at baseline, immediately post-intervention, and at 3 and 12 months post-intervention. Physical activity will also be investigated at intervention midpoint. Efficacy will be determined by available case analysis. A process evaluation will be performed based on programme fidelity and acceptability measures.

ETHICS AND DISSEMINATION

The Medical Ethics Committee of the Erasmus MC has approved this study (MEC-2020-0981). Results will be published in peer reviewed scientific journals and presented at scientific conferences.

TRIAL REGISTRATION NUMBER

Netherlands trial register, NL9329.

Prescribing Smartphone Apps for Physical Activity Promotion in Primary Care: Modeling Study of Health Gain and Cost Savings

Background

Inadequate physical activity is a substantial cause of health loss worldwide, and this loss is attributable to diseases such as coronary heart disease, diabetes, stroke, and certain forms of cancer.

Objective

This study aims to assess the potential impact of the prescription of smartphone apps in primary care settings on physical activity levels, health gains (in quality-adjusted life years [QALYs]), and health system costs in New Zealand (NZ).

Methods

A proportional multistate lifetable model was used to estimate the change in physical activity levels and predict the resultant health gains in QALYs and health system costs over the remaining life span of the NZ population alive in 2011 at a 3% discount rate.

Results

The modeled intervention resulted in an estimated 430 QALYs gained (95% uncertainty interval 320-550), with net cost savings of 2011 NZ $2.2 million (2011 US $1.5 million) over the remaining life span of the 2011 NZ population. On a per capita basis, QALY gains were generally larger in women than in men and larger in Māori than in non-Māori. The health impact and cost-effectiveness of the intervention were highly sensitive to assumptions on intervention uptake and decay. For example, the scenario analysis with the largest benefits, which assumed a 5-year maintenance of additional physical activity levels, delivered 1750 QALYs and 2011 NZ $22.5 million (2011 US $15.1 million) in cost savings.

Conclusions

The prescription of smartphone apps for promoting physical activity in primary care settings is likely to generate modest health gains and cost savings at the population level in this high-income country. Such gains may increase with ongoing improvements in app design and increased health worker promotion of the apps to patients.

Is it worth it? Cost-effectiveness analysis of a commercial physical activity app

BACKGROUND

Government interest in investing in commercial physical activity apps has increased with little evidence of their cost-effectiveness. This is the first study to our knowledge to examine the cost-effectiveness of a commercial physical activity app (Carrot Rewards) despite there being over 100,000 in the major app stores.

METHODS

A cost-effectiveness analysis was performed to calculate the incremental cost-effectiveness ratio (ICER) of the app compared to a no-intervention reference scenario using a five-year time horizon. Primary data was collected between 2016 and 2017. Data synthesis, model creation, and statistical analyses were conducted between 2019 and 2020. An age-, sex-, and geography-dependent Markov model was developed assuming a public healthcare payer perspective. A closed cohort (n = 38,452) representing the population reached by Carrot Rewards in two Canadian provinces (British Columbia, Newfoundland & Labrador) at the time of a 12-month prospective study was used. Costs and effects were both discounted at 1.5% and expressed in 2015 Canadian dollars. Subgroup analyses were conducted to compare ICERs between provinces, sexes, age groups, and engagement levels.

RESULTS

Carrot Rewards had an ICER of $11,113 CAD per quality adjusted life year (QALY), well below a $50,000 CAD per QALY willingness-to-pay (WTP) threshold. Subgroup analyses revealed that the app had lower ICERs for British Columbians, females, highly engaged users, and adults aged 35-64 yrs., and was dominant for older adults (65 + yrs). Deterministic sensitivity analyses revealed that the ICER was most influenced by the relative risk of diabetes. Probabilistic sensitivity analyses revealed varying parameter estimates predominantly resulted in ICERs below the WTP threshold.

CONCLUSIONS

The Carrot Rewards app was cost-effective, and dominant for older adults. These results provide, for the first time, rigorous health economic evidence for a commercial physical activity app as part of public health programming.

eHealth interventions targeting nutrition, physical activity, sedentary behavior, or obesity in adults: A scoping review of systematic reviews

A vast body of evidence regarding eHealth interventions for nutrition, physical activity, sedentary behavior, and obesity exists. This scoping review of systematic reviews aimed to evaluate the current level of evidence in this growing field. Seven electronic databases were searched for systematic reviews published until October 27, 2019. The systematic reviews must have included adult participants only and have evaluated eHealth behavioral interventions with the primary aim of changing nutrition, physical activity, and sedentary behavior or treating or preventing overweight and obesity. One hundred and six systematic reviews, published from 2006 to 2019, were included. Almost all (n = 98) reviews evaluated the efficacy of interventions. Over half (n = 61) included interventions focused on physical activity, followed by treatment of obesity (n = 28), nutrition (n = 22), prevention of obesity (n = 18), and sedentary behavior (n = 6). Many reviews (n = 46) evaluated one type of eHealth intervention only, while 60 included two or more types. Most reviews (n = 67) were rated as being of critically low methodological quality. This scoping review identified an increasing volume of systematic reviews evaluating eHealth interventions. It highlights several evidence gaps (e.g., evaluation of other outcomes, such as reach, engagement, or cost effectiveness), guiding future research efforts in this area.

Physical activity influences the mobile phone addiction among Chinese undergraduates: The moderating effect of exercise type

BACKGROUND AND AIMS

Mobile phone addiction (MPA) has recently aroused much attention due to its high incidence and considerable health hazards. Although some existing studies have documented that physical activity is negatively associated with MPA, it is little known about the potential effects underlying this relation. The aim of this study was to investigate the relationship between physical activity and MPA among undergraduates in China, and to further examine the moderating effect of exercise type in the relation between them.

METHODS

By the quota sampling, a total of 650 participants engaged in this survey and completed relevant measurements including physical activity rating scale-3 (PARS-3) and mobile phone addiction tendency scale (MPATS).

RESULTS

Gender (β = 0.271, P < 0.05) and major (β = -0.169, P < 0.05) could significantly predict MPA, respectively, and physical activity was an imperative protective factor to decrease MPA (β = -0.266, P < 0.001). While the physical activity level enhanced from none exercise to medium exercise, an optimum dose-response relationship would emerge between physical activity and MPA (F (3,604) = 4.799, P < 0.01). Most important, the relation between physical activity and MPA can be moderated by exercise type. Especially in terms of aerobic endurance exercise, the higher level of physical activity the undergraduates performed, the lower degree of MPA would be suffered by them (β = -0.266, P < 0.001).

DISCUSSION

These findings could be conducive to better understand the positive and potential effects of physical activity on the intervention in MPA, and served as a persuasive evidence that as for university students, actively engaging in aerobic endurance exercise with the medium activity level would be a practicable exercise strategy to deal with MPA in daily lifestyle behavior.

A Short, Multimodal Activity Break Incorporated Into the Learning Context During the Covid-19 Pandemic: Effects of Physical Activity and Positive Expressive Writing on University Students' Mental Health-Results and Recommendations From a Pilot Study

Physical inactivity, sedentary behavior and mental ill health, due to high levels of perceived stress or self-reported depressive symptoms, are highly prevalent among university students. There are concerns that these behaviors and mental symptoms have significantly increased during the current Covid-19 pandemic, partly because academic life has changed considerably from face-to-face communication to e-learning and studying at home. Self-regulation and physical activity are hard to maintain during pandemic lockdowns. Short activity breaks could be helpful to avoid physical inactivity and sustain mental health. The breaks should comprise short and easy-implementable physical activity exercises that can be integrated into the learning context. Moreover, cognitive interventions, such as writing about positive events and feelings might help as coping strategy for self-regulation during study breaks. This study investigated and compared the effects of a physical activity intervention and a cognitive intervention (positive expressive writing) on mental health among university students. Both interventions are particularly suitable for use at home. N = 20 university students, studying in Germany, were assigned to a physical activity group or a cognitive intervention group. The physical activity intervention consisted of a mix of physical exercises including endurance exercises, muscular strength, relaxation, and ballroom dance movements. The interventions were carried out guided, once a week, for 5-10 mins at the beginning of classes. The effects of group × time showed no significant interaction on self-reported perceived stress, mood, quality of life (QoL) assessed online and compared at the beginning of the term before the intervention (T0) and at the end of the term after the intervention (T3). However, the physical activity group reported a similar physical activity level per day over time, while the cognitive intervention group showed a decrease in physical activity from T0 to T3. Low-dose, short physical activity interventions as well as cognitive interventions consisting of positive expressive writing could buffer university students' perceived stress, mood, and QoL across the term. Moreover, both interventions seem to be promising in buffering the negative side effects of stress during the Covid-19 pandemic.

Physical Activity during the First Lockdown of the COVID-19 Pandemic: Investigating the Reliance on Digital Technologies, Perceived Benefits, Barriers and the Impact of Affect

The measures to fight the spread of the COVID-19 pandemic have been concentrated on inviting people to stay at home. This has reduced opportunities to exercise while also shedding some light on the importance of physical health. Based on an online survey, this paper investigated physical activity behaviours of a Belgians sample (n = 427) during the lockdown period between the end of May 2020 and the beginning of June 2020 and found that, during this period, the gap between sufficiently and insufficiently active individuals widened even more. This paper analysed important moderators of physical activity behaviours, such as barriers and benefits to exercise, digital support used to exercise, and individuals’ emotional well-being. Descriptive analysis and analyses of variance indicated that, generally, individuals significantly increased their engagement in exercise, especially light- and moderate-intensity activities, mostly accepted the listed benefits but refused the listed barriers, increased their engagement in digital support and did not score high on any affective measures. A comparison between sufficiently active and insufficiently active individuals during the lockdown showed that the former engaged even more in physical activity, whereas the latter exercised equally (i.e., not enough) or even less compared to before the lockdown. By means of a logistic regression, five key factors of belonging to the sufficiently active group were revealed and discussed. Practical implications for government and policies are reviewed.

Results of a Culturally Tailored Smartphone-Delivered Physical Activity Intervention Among Midlife African American Women: Feasibility Trial

BACKGROUND

Regular aerobic physical activity (PA) is an important component of healthy aging. However, only 27%-40% of African American women achieve national PA guidelines. Available data also show a clear decline in PA as African American women transition from young adulthood (ie, 25-44 years) into midlife. This decline in PA during midlife coincides with an increased risk for African American women developing cardiometabolic disease conditions, including obesity, type 2 diabetes, and cardiovascular disease. Thus, effective efforts are needed to promote PA among sedentary African American women during midlife.

OBJECTIVE

This study aims to examine the acceptability and feasibility of a culturally tailored, smartphone-delivered PA intervention, originally developed to increase PA among African American women aged 24-49 years, among a slightly older sample of midlife African American women aged 50-65 years.

METHODS

A single-arm pretest-posttest study design was implemented. In total, 20 insufficiently active African American (ie, ≤60 min per week of PA) women between the ages of 50-65 years participated in the 4-month feasibility trial. The Smart Walk intervention was delivered through the study Smart Walk smartphone app and text messages. Features available on the Smart Walk app include personal profile pages, multimedia PA promotion modules, discussion board forums, and an activity tracking feature that integrates with Fitbit activity monitors. Self-reported PA and social cognitive theory mediators targeted by the intervention (ie, self-regulation, behavioral capability, outcome expectations, self-efficacy, and social support) were assessed at baseline and at 4 months. Feasibility and acceptability were assessed using a postintervention satisfaction survey that included multiple-choice and open-ended questions evaluating participant perceptions of the intervention and suggestions for intervention improvement. Wilcoxon signed-rank tests were used to examine pre- and postintervention changes in the PA and social cognitive theory variables. The effect size estimates were calculated using the Pearson r test statistic.

RESULTS

Participants increased moderate-to-vigorous PA (median 30 minutes per week increase; r=0.503; P=.002) and reported improvements in 2 theoretical mediators (self-regulation: r=0.397; P=.01; behavioral capability: r=0.440; P=.006). Nearly all participants (14/15, 93% completing the satisfaction survey) indicated that they would recommend the intervention to a friend. Participants' suggestions for improving the intervention included enhancing the intervention's provisions of social support for PA.

CONCLUSIONS

The results provide preliminary support for the feasibility of the smartphone-based approach to increase PA among midlife African American women. However, before larger-scale implementation among midlife African American women, enhancements to the social support components of the intervention are warranted.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04073355; https://clinicaltrials.gov/ct2/show/NCT04073355.

Left to Their Own Devices? A Mixed Methods Study Exploring the Impacts of Smartphone Use on Children's Outdoor Experiences

The growing use of smartphones has been pointed out as one of the main reasons for the decrease in children’s outdoor time. However, there is still a gap in our understanding of how smartphone use affects children’s outdoor experiences and activities. The aim of the study is to explore children’s dependency on their smartphones, what smartphone functions children use when outdoors and how smartphone use affects children’s outdoor experiences. The study uses a mixed methods design which implements interviews with a small sample of children (N = 34) in order to help develop a questionnaire for a larger sample (N = 1148). Both datasets are included in the analysis with a complimentary perspective. The results suggest that children are highly dependent on having their smartphones available as an integrated part of their lives. However, smartphones also create favorable conditions for rich and valuable outdoor lives by expanding children’s and parents’ sense of security, children’s outdoor sociality, and children’s opportunities to mold their outdoor experiences. We stress that children’s passion for the digital world needs to be reconsidered as not ‘all bad’, but more as a condition in modern children’s lives and an asset to embrace in future strategies for actively engaging children in outdoor activities.

Evidence Synthesis of Digital Interventions to Mitigate the Negative Impact of the COVID-19 Pandemic on Public Mental Health: Rapid Meta-review

Background

Accumulating evidence suggests the COVID-19 pandemic has negative effects on public mental health. Digital interventions that have been developed and evaluated in recent years may be used to mitigate the negative consequences of the pandemic. However, evidence-based recommendations on the use of existing telemedicine and internet-based (eHealth) and app-based mobile health (mHealth) interventions are lacking.

Objective

The aim of this study was to investigate the theoretical and empirical base, user perspective, safety, effectiveness, and cost-effectiveness of digital interventions related to public mental health provision (ie, mental health promotion, prevention, and treatment of mental disorders) that may help to reduce the consequences of the COVID-19 pandemic.

Methods

A rapid meta-review was conducted. The MEDLINE, PsycINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews and meta-analyses that investigated digital tools for health promotion, prevention, or treatment of mental health conditions and determinants likely affected by the COVID-19 pandemic.

Results

Overall, 815 peer-reviewed systematic reviews and meta-analyses were identified, of which 83 met the inclusion criteria. Our findings suggest that there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions. Evidence on mHealth apps is promising, especially if social components (eg, blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on process quality, cost-effectiveness, and long-term effects is very limited.

Conclusions

There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. In times of physical distancing, quarantine, and restrictions on social contacts, decision makers should develop digital strategies for continued mental health care and invest time and efforts in the development and implementation of mental health promotion and prevention programs.

Effects of Smartphone-Based Interventions on Physical Activity in Children and Adolescents: Systematic Review and Meta-analysis

Background

About 70% of children and adolescents worldwide do not meet the recommended level of physical activity (PA), which is closely associated with physical, psychological, and cognitive well-being. Nowadays, the use of technologies to change PA is of interest due to the need for novel, more effective intervention approaches. The previous meta-analyses have examined smartphone-based interventions and their impact on PA in adults, but evidence in children and adolescents still needs further research.

Objective

This systematic review and meta-analysis aimed to determine the effectiveness of smartphone-based interventions for improving PA in children and adolescents.

Methods

Five electronic databases (PubMed, Web of Science, OVID, Scopus, and the China National Knowledge Infrastructure) were searched up to June 29, 2020. Randomized controlled trials with a control group that examine the effect of smartphone interventions on PA among children and adolescents were included. Bias risks were assessed using the Cochrane collaboration tool. Meta-analysis was performed to assess the pooled effect on PA using a random effects model. Subgroup analyses were conducted to examine the potential modifying effects of different factors (eg, types of intervention, intervention duration, age, measurement, study quality).

Results

A total of 9 studies were included in this review, including 4 mobile app interventions, 3 SMS text messaging interventions, and 2 app + SMS text messaging interventions. In general, the risk of bias of included studies was low. Compared with the control group, the use of smartphone intervention significantly improved PA (standardized mean difference [SMD] 0.44, 95% CI 0.11-0.77, P=.009), especially for total PA (TPA; weighted mean difference [WMD] 32.35, 95% CI 10.36-54.33, P=.004) and daily steps (WMD 1185, 95% CI 303-2068, P=.008), but not for moderate-to-vigorous PA (WMD 3.91, 95% CI –1.99 to 9.81, P=.19). High statistical heterogeneity was detected (I²=73.9%, P<.001) for PA. Meta-regression showed that duration (β=–.08, 95% CI –0.15 to –0.01, n=16) was a potential factor for high heterogeneity. The results of subgroup analyses indicated that app intervention (SMD 0.76, 95% CI 0.23-1.30, P=.005), children (SMD 0.64, 95% CI 0.10-1.18, P=.02), “≤8 weeks” (SMD 0.76, 95% CI 0.23-1.30, P=.005), objective measurement (SMD 0.50, 95% CI 0.09-0.91, P=.02), and low risk of bias (SMD 0.96, 95% CI 0.38-1.54, P=.001) can significantly improve PA.

Conclusions

The evidence of meta-analysis shows that smartphone-based intervention may be a promising strategy to increase TPA and steps in children and adolescents. Currently, app intervention may be a more effective strategy among smartphone intervention technologies. To extend the promise of smartphone intervention, the future needs to design comparative trials among different smartphone technologies.

Trial Registration

PROSPERO CRD42019148261; https://tinyurl.com/y5modsrd

Using an activity tracker to increase motivation for physical activity in patients with type 2 diabetes in primary care: a randomized pilot trial

BACKGROUND

Adopting healthy lifestyle habits reduces the risk of type 2 diabetes (T2D) and its complications. The use of an activity tracker to monitor physical activity (PA) could favor behavior changes in patients with chronic diseases such as diabetes. The aims of this study were: (I) to evaluate the impact of an activity tracker on PA and cardiometabolic risk variables in patients with T2D; (II) to assess the feasibility of its implantation in a primary care setting.

METHODS

This 3-month study was a pilot randomized controlled trial of 30 patients with T2D followed at a university-affiliated Family Medicine Group. Patients were randomly assigned to either: (I) control group, including a PA promotion intervention supported by a kinesiologist or (II) intervention group, including a PA promotion intervention supported by a kinesiologist with the addition of an activity tracker (Fitbit). Cardiometabolic risk variables, PA and motivation were assessed at baseline and after three months. Satisfaction and acceptability of wearing the activity tracker were measured in the intervention group.

RESULTS

PA assessed by questionnaires increased in both groups, change being greater in the intervention group (P<0.05). Autonomous motivation in both groups was higher than controlled motivation (P<0.001). Eighty-six percent of the participants in the intervention group were satisfied with their activity tracker use and the compliance remained high. High-density lipoprotein cholesterol increased in the intervention group and decreased in the control group (P=0.014). Resting systolic and diastolic blood pressure decreased over time in both groups (P<0.05) whereas glycated hemoglobin tended to decrease in both groups (P=0.080). Significant correlations were observed between average steps per day and changes in waist circumference (pre: -0.721, P=0.044; post: -0.736, P=0.038), body mass index (pre: -0.764, P=0.010; post: -0.771, P=0.009) and fat percentage (pre: -0.654, P=0.040; post: -0.686, P=0.028) in the intervention group.

CONCLUSIONS

Our pilot study shows that the use of an activity tracker improves cardiometabolic risk variables in patients with T2D and could potentially be a motivation tool to increase PA in primary care setting.

Do smartphone applications and activity trackers increase physical activity in adults? Systematic review, meta-analysis and metaregression

OBJECTIVE

To determine the effectiveness of physical activity interventions involving mobile applications (apps) or trackers with automated and continuous self-monitoring and feedback.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed and seven additional databases, from 2007 to 2020.

STUDY SELECTION

Randomised controlled trials in adults (18-65 years old) without chronic illness, testing a mobile app or an activity tracker, with any comparison, where the main outcome was a physical activity measure. Independent screening was conducted.

DATA EXTRACTION AND SYNTHESIS

We conducted random effects meta-analysis and all effect sizes were transformed into standardised difference in means (SDM). We conducted exploratory metaregression with continuous and discrete moderators identified as statistically significant in subgroup analyses.

MAIN OUTCOME MEASURES

Physical activity: daily step counts, min/week of moderate-to-vigorous physical activity, weekly days exercised, min/week of total physical activity, metabolic equivalents.

RESULTS

Thirty-five studies met inclusion criteria and 28 were included in the meta-analysis (n=7454 participants, 28% women). The meta-analysis showed a small-to-moderate positive effect on physical activity measures (SDM 0.350, 95% CI 0.236 to 0.465, I²=69%, T ²=0.051) corresponding to 1850 steps per day (95% CI 1247 to 2457). Interventions including text-messaging and personalisation features were significantly more effective in subgroup analyses and metaregression.

CONCLUSION

Interventions using apps or trackers seem to be effective in promoting physical activity. Longer studies are needed to assess the impact of different intervention components on long-term engagement and effectiveness.

Managing Asthma and Obesity Related Symptoms (MATADORS): An mHealth Intervention to Facilitate Symptom Self-Management among Youth

Youth with multi-morbidity (one or more chronic diseases) are at increased risk of further morbidity and early mortality as they enter their adult years. Recent increases in both asthma and obesity among youth have led to high health care utilization, increased health related complications, and expanded risks of subsequent cardiovascular disease burden. Common symptoms seen with asthma and obesity include fatigue, pain, depression, and anxiety. These symptoms can result in decreased physical activity, social isolation, and poor quality of life, which also may contribute to increased morbidity and mortality over time. Youth ages 10–17 are in a transitionary period where their overall health and disease management shifts from one of parental oversight to one where the youth gradually experience increased autonomy over their health and care management. Managing Asthma and Obesity Related Symptoms (MATADORS), is a mHealth technology-enhanced nurse-guided intervention that incorporates a novel mobile health application and motivational enhancement principles within a behavioral activation framework. Providing high-risk youth with strategies to enhance symptom self-management may result in decreased symptom prevalence, improved quality of life, and long-term reduction of cardiovascular morbidity and mortality as they move into adulthood. Moreover, developing low-cost, scalable tools with end-user input may facilitate promote early intervention and improved access to care, and reduce overall disease burden and healthcare costs.

Examining Responsiveness to an Incentive-Based Mobile Health App: Longitudinal Observational Study

BACKGROUND

The Carrot Rewards app was developed as part of a public-private partnership to reward Canadians with loyalty points for downloading the app, referring friends, completing educational health quizzes, and health-related behaviors with long-term objectives of increasing health knowledge and encouraging healthy behaviors. During the first 3 months after program rollout in British Columbia, a number of program design elements were adjusted, creating observed differences between groups of users with respect to the potential impact of program features on user engagement levels.

OBJECTIVE

This study examines the impact of reducing reward size over time and explored the influence of other program features such as quiz timing, health intervention content, and type of reward program on user engagement with a mobile health (mHealth) app.

METHODS

Participants in this longitudinal, nonexperimental observational study included British Columbia citizens who downloaded the app between March and July 2016. A regression methodology was used to examine the impact of changes to several program design features on quiz offer acceptance and engagement with this mHealth app.

RESULTS

Our results, based on the longitudinal app use of 54,917 users (mean age 35, SD 13.2 years; 65.03% [35,647/54,917] female), indicated that the key drivers of the likelihood of continued user engagement, in order of greatest to least impact, were (1) type of rewards earned by users (eg, movies [+355%; P<.001], air travel [+210%; P<.001], and grocery [+140%; P<.001] relative to gas), (2) time delay between early offers (-64%; P<.001), (3) the content of the health intervention (eg, healthy eating [-10%; P<.001] vs exercise [+20%, P<.001] relative to health risk assessments), and (4) changes in the number of points offered. Our results demonstrate that reducing the number of points associated with a particular quiz by 10% only led to a 1% decrease in the likelihood of offer response (P<.001) and that each of the other design features had larger impacts on participant retention than did changes in the number of points.

CONCLUSIONS

The results of this study demonstrate that this program, built around the principles of behavioral economics in the form of the ongoing awarding of a small number of reward points instantly following the completion of health interventions, was able to drive significantly higher engagement levels than those demonstrated in previous literature exploring the intersection of mHealth apps and financial incentives. Previous studies have demonstrated the presence of incentive matters to user engagement; however, our results indicate that the number of points offered for these reward point-based health interventions is less important than other program design features such as the type of reward points being offered, the timing of intervention and reward offers, and the content of the health interventions in driving continued engagement by users.

Health Gain, Cost Impacts, and Cost-Effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Physical Activity: Modeling Study

BACKGROUND

Physical activity smartphone apps are a promising strategy to increase population physical activity, but it is unclear whether government mass media campaigns to promote these apps would be a cost-effective use of public funds.

OBJECTIVE

We aimed to estimate the health impacts, costs, and cost-effectiveness of a one-off national mass media campaign to promote the use of physical activity apps.

METHODS

We used an established multistate life table model to estimate the lifetime health gains (in quality-adjusted life years [QALYs]) that would accrue if New Zealand adults were exposed to a one-off national mass media campaign to promote physical activity app use, with a 1-year impact on physical activity, compared to business-as-usual. A health-system perspective was used to assess cost-effectiveness. and a 3% discount rate was applied to future health gains and health system costs.

RESULTS

The modeled intervention resulted in 28 QALYs (95% uncertainty interval [UI] 8-72) gained at a cost of NZ $81,000/QALY (2018 US $59,500; 95% UI 17,000-345,000), over the remaining life course of the 2011 New Zealand population. The intervention had a low probability (20%) of being cost-effective at a cost-effectiveness threshold of NZ $45,000 (US $32,900) per QALY. The health impact and cost-effectiveness of the intervention were highly sensitive to assumptions around the maintenance of physical activity behaviors beyond the duration of the intervention.

CONCLUSIONS

A mass media campaign to promote smartphone apps for physical activity is unlikely to generate much health gain or be cost-effective at the population level. Other investments to promote physical activity, particularly those that result in sustained behavior change, are likely to have greater health impacts.

A group- and smartphone-based psychological intervention to increase and maintain physical activity in patients with musculoskeletal conditions: study protocol for a randomized controlled trial ("MoVo-App")

Abstract

Background

Interventions designed to increase the level of physical activity are crucial in the treatment of patients with musculoskeletal conditions. The psychological group-based intervention MoVo-LISA based on the Motivation-Volition (MoVo) Process Model has been shown to effectively promote physical activity. The aim of this study is to evaluate whether a MoVo-based app (MoVo-App) subsequent to MoVo-LISA during orthopedic inpatient care can support people to increase and maintain their amount of physical activity.

Methods/design

In this parallel-group randomized controlled trial, patients with musculoskeletal disorders will be randomized to either (a) a combination of the group-based intervention program MoVo-LISA to promote physical activity plus the MoVo-App or (b) the group-based intervention program alone without the app. The intervention group will receive the MoVo-App after discharge from inpatient rehabilitation. They receive help to increase and maintain their level of physical activity (initiated by the group program) by tracking their health goals, activity plans, major barriers, and barrier management that were developed during the group-based program. We will recruit 224 initially minimally active participants during orthopedic rehabilitation care. Outcomes are assessed at clinic admission; discharge; 6 weeks; and 3 (post-treatment), 6, and 12 months after discharge (follow-up). The primary outcome is sport activity (active/inactive and minutes of activity) at 6-month follow-up. Secondary outcomes are movement activity, cognitive mediators of behavioral change (e.g., self-efficacy, action planning), and health-related variables (e.g., pain intensity, depression). To evaluate intervention effects, linear mixed effects models (both on intention-to-treat basis with an additional per-protocol analysis) will be conducted with each outcome variable and with time as the within-subjects factor and group as the between-subjects factor, along with all two-way interactions and accounting for covariates as fixed effects.

Discussion

This is the first evaluation of the effectiveness of an app in combination with a face-to-face group intervention to promote physical activity. The approach of using an app in addition to an effective face-to-face intervention program, both based on the MoVo model, might sustain positive intervention effects introduced in routine health care.

Trial registration

The trial “A group- and smartphone-based psychological intervention to increase physical activity in patients with musculoskeletal conditions: A randomized controlled trial” is registered at the World Health Organization International Clinical Trials Registry Platform via the German Clinical Studies Trial Register (DRKS), DRKS00014814. Registered on 18 October 2018; URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014814.

Objectively-Measured Light-Intensity Physical Activity and Risk of Cancer Mortality: A Meta-analysis of Prospective Cohort Studies

BACKGROUND

The impact of light-intensity physical activity (LPA) in preventing cancer mortality has been questioned. To address this concern, the present meta-analysis aimed to quantify the association between objectively-measured LPA and risk of cancer mortality.

METHODS

We conducted a systematic literature search in PubMed and Scopus to January 2020. Prospective cohort studies reporting the association between objectively-measured LPA using activity monitors (e.g., accelerometers) and risk of cancer mortality in the general population were included. The summary hazard ratios (HR) per 30 min/day of LPA and 95% confidence intervals (CI) were obtained using a random-effects model. Dose-response analysis was used to plot their relationship.

RESULTS

Five prospective cohort studies were included, in which the definition of LPA based on accelerometer readings was mainly set within 100 to 2,100 counts/min. The summary HR for cancer mortality per 30 min/day of LPA was 0.86 (95% CI, 0.79-0.95; I 2 < 1%), and the association between LPA and risk reduction in cancer mortality was linearly shaped (P nonlinearity = 0.72). LPA exhibited a comparable magnitude of risk reduction in cancer mortality of moderate-to-vigorous physical activity regardless of equal time-length (0.87 per 30 min/day vs. 0.94 per 30 min/day, P interaction = 0.46) or equal amount (0.74 vs. 0.94 per 150 metabolic equivalents-min/day, P interaction = 0.11). Furthermore, replacing sedentary time by LPA of 30 min/day decreased the risk of cancer mortality by 9%.

CONCLUSIONS

Objectively-measured LPA conferred benefits in decreasing the risk of cancer mortality.

IMPACT

LPA should be considered in physical activity guidelines to decrease the risk of cancer mortality.