Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses

Digital health technology use among people aged 55 years and over: Findings from the 45 and up study

PURPOSE

Digital technologies, including wearable activity trackers and smartphone applications, offer tools to support behaviours in healthy ageing interventions. This study aimed to describe utilisation patterns and correlates of digital technology use among middle-aged and older Australians.

METHODS

We used data from 45 and Up Study 2019 follow-up questionnaire (originally 267,357 participants aged ≥45 years recruited 2005-2009). We considered three categories of digital technology use: broad digital technology use (e.g. computers, tablets), small portable devices (e.g. smartphones, smart watches, activity trackers), and digital applications to track health (e.g. step count, nutrition, medication). We used multivariable logistic regression to examine the associations between participants' sociodemographic, health status and behavioural characteristics with digital health technology use.

RESULTS

31,965 participants completed the 2019 follow-up questionnaire (47 % response rate), with a median age of 69 years (interquartile range: 63-76). Among participants, 87.0 % reported broad digital technology use, 34.9 % active use of small portable devices, and 29.8 % monthly digital application use to track health. For all three categories, digital technology use was significantly associated with relatively younger age (highest for 55-64 years), major cities, private health insurance, higher socioeconomic status, greater physical function, higher physical activity, higher fruit and vegetable intake, lower psychological distress, and lower red and processed meat intake. There were no associations between digital technology use and marital status, cancer, osteoporosis, cardiovascular disease, and depression/anxiety.

CONCLUSION

In this Australian cohort, digital technology use was highly common among participants aged 55 to 74 years, but reduced among those aged over 75 years. Targeted interventions leveraging digital technologies are warranted with the goal of advancing public health.

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Effects of Integrating Wearable Activity Trackers With a Home-Based Multicomponent Exercise Intervention on Fall-Related Parameters and Physical Function in Older Adults: Randomized Controlled Trial

Background

Older adults with a history of falling often encounter challenges in participating in group exercise programs. Recent technological advances, such as activity trackers, can potentially enhance home-based exercise programs by providing continuous physical activity monitoring and feedback.

Objective

The aim of the study is to explore whether integrating wearable activity trackers with a home-based exercise intervention is effective in reducing fear of falling and improving physical function in older adults.

Methods

This was a 12-week, parallel-group, randomized controlled trial involving 30 older adults (≥60 years) with a history of falling. Participants were randomly assigned in a 1:1 ratio to either a group combining an activity tracker with a home-based multicomponent exercise intervention, which included in-person exercise sessions, exercise videos, and objective feedback via phone calls (AT+EX group) or to a group using the activity tracker only for self-monitoring (AT-only group). The primary and secondary outcomes included fall-related parameters (fear of falling assessed by the Activities-Specific Balance Confidence [ABC] and the Falls Efficacy Scale-International [FES-I] scales), depression (Short Geriatric Depression Scale), cognition (Montreal Cognitive Assessment), physical function (grip strength, Short Physical Performance Battery, Timed Up and Go [TUG] test, and 2-Minute Step Test), and body composition. Changes in the average daily step count were monitored and analyzed.

Results

Overall, 28 (mean age 74.0, SD 6.4 years; n=23, 77% female) participants completed the 12-week follow-up period (28/30, 93%). In the activity tracker and exercise group (AT+EX group), significant improvements were observed in fear of falling (15.5 points of ABC: P=.002; -5.1 points of FES-I: P=.01). The activity tracker alone group (AT-only group) also showed a significant improvement in FES-I score (-5.5 points: P=.01). Physical function significantly improved in the AT+EX group (1.1 points of Short Physical Performance Battery: P=.004; -1.4 seconds of TUG; P=.008; and 26.7 steps of 2-Minute Step Test: P=.001), whereas the AT-only group showed significant improvement only in the TUG test (-1.3 seconds: P=.002). However, no significant between-group differences were observed in the ABC score, FES-I score, or physical function. Despite no significant increase in daily step counts, both groups maintained close to 10,000 steps per day throughout the 12 weeks.

Conclusions

Both groups showed improvements in the FES-I and TUG test scores without significant between-group differences. Wearable technology, with or without an exercise intervention, seems to be an effective tool in reducing the fear of falling and improving physical function in older adults susceptible to falls.

Feasibility of Long-Term Physical Activity Measurement With a Wearable Activity Tracker in Patients With Axial Spondyloarthritis: 1-Year Longitudinal Observational Study

Background

Using wearable activity trackers shows promise in measuring physical activity in patients with axial spondyloarthritis (axSpA). However, little is known regarding the feasibility of long-term use.

objectives

This study aimed to explore the feasibility of recording physical activity using a wearable activity tracker and describe wear-time patterns among patients with axSpA.

Methods

Data from a randomized controlled trial (NCT: 05031767) were analyzed. Patients with axSpA and low disease activity were recruited from an outpatient clinic and asked to wear a Garmin vívosmart 4 activity tracker for 1 year. The activity tracker measured steps and heart rate. Trial feasibility (eligibility, inclusion rate, and patient characteristics), technical feasibility (data recorded, tracker adherence, ie, days worn, and missing data), and operational feasibility (synchronization reminders and tracker replacements) were analyzed. Tracker adherence was calculated as the percentage of recorded minutes of the maximum possible minutes. Unsupervised hierarchical clustering was used to explore tracker wear-time patterns.

Results

Of the 160 patients screened, 75 (47%) agreed to use the tracker and 64 (85%) were analyzed (11 had insufficient data). The median activity tracker adherence over 1 year was 66% (IQR 30-86). There was 30% missing step and 0.01% heart rate data in the physical activity dataset. A median of 18 (IQR 9-25) reminders per patient to synchronize activity data were distributed. Analysis of wear-time patterns resulted in 3 groups: Adherent (33/64, 51% of patients), Minimal Use (17/64, 27%), and Intermittently adherent (14/64, 22%).

Conclusions

Trial feasibility was low, while technical and operational feasibility were acceptable. Only 51% of the patients were highly adherent. Activity trackers, though trendy, have low to moderate feasibility over 1 year in patients with axSpA. Automated synchronization and adherence barriers should be further explored.

Exercise Recommendations and Practical Considerations for Asthma Management-An EAACI Position Paper

Exercise is an important treatment for people with asthma and should be considered alongside pharmacological therapy when developing personalised asthma management plans. Despite this, there remains limited guidance concerning the practicalities of asthma-specific exercise prescription. This European Academy of Allergy and Clinical Immunology task force was therefore established to achieve three fundamental aims: first, to provide an up-to-date perspective concerning the role of exercise for asthma management (i.e., describe the disease modifying potential of exercise and associated impact on asthma-related extrapulmonary comorbidities); second, to develop pragmatic recommendations to facilitate safe and effective exercise prescription; and third, to identify key unmet needs and provide focused direction for future research. The position paper is structured as a practically focused document, with recommendations formulated according to best available scientific evidence and expert opinion, with an emphasis on providing healthcare providers with pragmatic advice that can be implemented during routine asthma review.

Working Women Walking Program: A Sequential Multiple Assignment Randomized Trial

BACKGROUND

Different interventions have shown efficacy in improving physical activity in women. This study aimed to determine the most effective adaptive intervention combining 4 efficacious treatments (Fitbit, text messages, personal calls, and group meetings) for improving physical activity.

METHODS

The Working Women Walking program used a Sequential Multiple Assignment Randomized Trial (SMART) design with 3 phases: initial (weeks 1-8), augmented (weeks 9-34), and maintenance (weeks 35-50). Low-active women aged 18-70 working at an academic medical center were recruited. In the initial phase, participants were randomized to Fitbit or Fitbit + text messages. After 8 weeks, nonresponders were rerandomized to an augmented treatment (personal calls or group meetings). The primary outcomes (steps/day and minutes of moderate/vigorous physical activity [MVPA]/day via ActiGraph) were assessed at baseline and 8, 34, and 50 weeks.

RESULTS

The study had 301 women (age: 45.1 [11.6] y). During the initial phase, there were no differences by initial treatment for change in steps (P = .78) or MVPA (P = .60). During the augmented phase, there were no differences by augmented treatment among nonresponders for change in steps (P = .95) or MVPA (P = .78). A significant overall increase was seen in steps (752/d; P < .001, d = 0.56) and MVPA at 8 weeks (4.1 min/d; P < .001, d = 0.48), and this was sustained at 34 and 50 weeks.

CONCLUSIONS

Text messages, personal calls, and group meetings did not lead to increased physical activity. Using Fitbit and goal setting (a constant) appeared to have some benefit for many of the women in improving physical activity.

The future of healthy ageing: Wearables in public health, disease prevention and healthcare

Wearables have evolved into accessible tools for sports, research, and interventions. Their use has expanded to real-time monitoring of behavioural parameters related to ageing and health. This paper provides an overview of the literature on wearables in disease prevention and healthcare over the life course (not only in the older population), based on insights from the Future of Diagnostics Workshop (Leiden, January 2024). Wearable-generated parameters include blood glucose, heart rate, step count, energy expenditure, and oxygen saturation. Integrating wearables in healthcare is protracted and far from mainstream implementation, but promises better diagnosis, biomonitoring, and assessment of medical interventions. The main lifestyle factors monitored directly with wearables or through smartphone applications for disease prevention include physical activity, energy expenditure, gait, sleep, and sedentary behaviour. Insights on dietary consumption and nutrition have resulted from continuous glucose monitors. These factors are important for healthy ageing due to their effect on underlying disease pathways. Inclusivity and engagement, data quality and ease of interpretation, privacy and ethics, user autonomy in decision making, and efficacy present challenges to but also opportunities for their use, especially by older people. These need to be addressed before wearables can be integrated into mainstream medical and public health strategies. Furthermore, six key considerations need to be tackled: 1) engagement, health literacy, and compliance with personalised feedback, 2) technical and standardisation requirements for scalability, 3) accountability, data safety/security, and ethical concerns, 4) technological considerations, access, and capacity building, 5) clinical relevance and risk of overdiagnosis/overmedicalisation, and 6) the clinician's perspective in implementation.

An umbrella review of efficacy of digital health interventions for workers

Efficacy of digital health (d-Health) interventions on workers' physical activity (PA), sedentary behavior, and physiological outcomes remains unclear. This umbrella review searched PubMed, Cochrane Library, and Google Scholar up to October 25, 2024. We identified 24 systematic reviews (SRs) and selected 130 individual studies from these SRs for analysis. The AMSTAR 2 tool rated the quality of most SRs as critically low. Narrative syntheses suggested that d-Health interventions could potentially improve all outcomes compared with no intervention. However, whether d-Health interventions outperform non-d-Health interventions remains uncertain. Meta-analyses showed a significantly small effect of d-Health interventions on step counts, sedentary/sitting time, and weight compared with no intervention, while d-Health interventions slightly improved only moderate-to-vigorous PA compared with non-d-Health interventions. Subgroup analyses identified potential sources of heterogeneity (e.g., risk of bias, control conditions), which may vary between outcomes. Further high-quality studies are needed to evaluate the efficacy of d-Health interventions.

Wearing WHOOP More Frequently Is Associated with Better Biometrics and Healthier Sleep and Activity Patterns

Wearable devices are increasingly used for health monitoring, yet the impact of consistent wear on physiological and behavioral outcomes is unclear. Leveraging nearly a million days and nights of longitudinal data from 11,914 subscribers, we examined the associations between the frequency of wearing a wrist-worn wearable device (WHOOP Inc., Boston, MA, USA) and 12-week changes in biometric, sleep, and activity profiles, modeling both between- and within-person effects. Higher average wear frequency and week-to-week increases in wear were associated with a lower resting heart rate (RHR), higher heart rate variability (HRV), longer and more consistent sleep, and greater weekly and daily physical activity duration (Ps < 0.01). A within-person multiple mediation analysis indicated that increased sleep duration partially mediated the association between wear frequency and a standardized (z-scored) RHR (indirect effect = -0.0387 [95% CI: -0.0464, -0.0326]), whereas physical activity minutes did not (indirect effect = 0.0003 [95% CI: -0.0036, 0.0040]). A Granger causality analysis revealed a modest but notable association between prior wear frequency and future RHR in participants averaging ≤5 days of weekly wear (p < 0.05 in 10.92% of tests). While further research is needed, our findings provide real-world evidence that sustained wearable engagement may support healthier habits and improved physiological outcomes over time.

Design and baseline characteristics of an implementation study to increase activity with social incentives: The STEP together trial

BACKGROUND

The majority of people in the United States do not achieve recommended levels of physical activity. Even small, daily increases can have health benefits. Wearable devices paired with social incentives increased daily steps in pilot studies but have not been tested for long-term effectiveness in community settings. This paper describes the study design and baseline participant characteristics of a trial testing these approaches to increase physical activity among families in the Philadelphia area.

METHODS

The trial, called STEP Together, is a Hybrid Type 1 effectiveness-implementation study. Participants enroll on family teams of 2-10 people, including at least one person 60 years old or older. Each participant receives a Fitbit device, establishes a baseline daily step count, and selects a daily step goal 1500 to 3000 steps greater than their baseline. Family teams are stratified based on family size and randomized to Control, Social Incentive Gamification, or Social Goals through Incentives to Charity. Participation is 18-months: a 12-month intervention and 6-month follow up.

RESULTS

779 participants on 285 family teams were randomized. Recruitment was more difficult than anticipated due to the COVID-19 pandemic and higher-than expected numbers of participants who were already physically active and therefore ineligible. Changes to the eligibility criteria that did not impact the underlying intent or conceptual basis for the trial improved recruitment feasibility.

CONCLUSION

The results from this study will contribute to the growing body of evidence about scalable, effective strategies to motivate individuals and families to increase their daily physical activity.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04942535.

Changes in Physical Activity, Heart Rate, and Sleep Measured by Activity Trackers During the COVID-19 Pandemic Across 34 Countries: Retrospective Analysis

BACKGROUND

The COVID-19 pandemic disrupted behavior within populations, affecting physical activity (PA), heart rate (HR), and sleep characteristics in particular. Activity trackers provide unique insights into these changes, enabling large-scale, real-time monitoring.

OBJECTIVE

This study aims to analyze the associations between the features of the COVID-19 pandemic worldwide and PA, HR, and sleep parameters, using data collected from activity trackers over a 3-year period.

METHODS

We performed a retrospective analysis using anonymized data collected from the 208,818 users of Withings Steel HR activity trackers, spanning 34 countries, over a 3-year period from January 2019 to March 2022. Key metrics analyzed included daily step counts, average heart rate, and sleep duration. The statistical methods used included descriptive analyses, time-trend analysis, and mixed models to evaluate the impact of restriction measures, controlling for potential confounders such as sex, age, and seasonal variations.

RESULTS

We detected a significant decrease in PA, with a 12.3% reduction in daily step count (from 5802 to 5082 steps/d) over the 3 years. The proportion of sedentary individuals increased from 38% (n=14,177) in 2019 to 52% (n=19,510) in 2020 and remained elevated at 51% (n=18,972) in 2022, while the proportion of active individuals dropped from 8% (n=2857) to 6% (n=2352) in 2020 before returning to 8% (n=2877) in 2022. In 2022, the global population had not returned to prepandemic PA levels, with a noticeable persistence of inactivity. During lockdowns, HR decreased by 1.5%, which was associated with lower activity levels. Sleep duration increased during restrictions, particularly in the countries with the most severe lockdowns (eg, an increase of 15 min in countries with stringent measures compared to 5 min in less restricted regions).

CONCLUSIONS

The sustained decrease in PA and its physiological consequences highlight the need for public health strategies to mitigate the long-term effects of the measures taken during the pandemic. Despite the gradual lifting of restrictions, PA levels have not fully recovered, with lasting implications for global health. If similar circumstances arise in the future, priority should be given to measures for effectively increasing PA to counter the increase in sedentary behavior, mitigate health risks, and prevent the rise of chronic diseases.

Wearable Activity Tracker-Based Interventions for Physical Activity, Body Composition, and Physical Function Among Community-Dwelling Older Adults: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

The global aging population faces great challenges. Wearable activity trackers have emerged as tools to promote physical activity among older adults, potentially improving health outcomes. However, the effectiveness of such interventions on physical activity, body composition, and physical function among community-dwelling older adults remains debated.

OBJECTIVE

This study conducted a systematic review and meta-analysis to evaluate the impact of wearable activity tracker-based interventions on physical activity, body composition, and physical function among community-dwelling older adults.

METHODS

We searched the PubMed, Embase, Web of Science, and CENTRAL databases from inception until January 2025 to identify related randomized controlled trials. The outcomes were focused on physical activity (physical activity time, daily step count, and daily sedentary time); body composition (BMI and body fat); and physical function (timed up and go test and chair stand test). Subgroup analysis by different controls (usual care or conventional interventions) and different follow-ups (immediate or short term) were performed.

RESULTS

In total 23 trials with 4566 participants were eligible for analysis. Compared to usual care, there was lo- to moderate-certainty evidence that the wearable activity tracker-based interventions significantly increased physical activity time (standardized mean difference [SMD]=0.28, 95% CI 0.10-0.47; P=.003) and daily step counts (SMD=0.58, 95% CI 0.33-0.83; P<.001) immediately after intervention, while no significant improvements were observed in daily sedentary time (mean difference [MD]=-1.56, 95% CI -10.88 to 7.76; I2=0%; P=.74). These interventions were at least as effective as conventional interventions but did not show superiority. Compared with usual care, the interventions using wearable activity trackers only demonstrated a notable increase in daily step count over short-term follow-up (SMD=0.23, 95% CI 0.11-0.36; P<.001). As for body composition and physical function, there was low- to moderate-certainty evidence that the wearable activity tracker-based interventions did not have a greater impact on BMI (MD=0.40, 95% CI -0.08 to 0.89; P=.11), body fat (MD=0.67, 95% CI -0.54 to 1.87; P=.28), the timed up and go test (MD=0.14, 95% CI -0.87 to 1.16; P=.78), or the chair stand test (SMD=-0.31, 95% CI -0.62 to 0; P=.05).

CONCLUSIONS

This systematic review and meta-analysis indicate that wearable activity tracker-based interventions were effective in enhancing physical activity with low to moderate certainty, but did not significantly impact body composition or physical function, with low to moderate certainty, among community-dwelling older adults, particularly immediately after intervention. This intervention showed a more pronounced impact when compared to usual care, rather than to conventional interventions, with low to moderate certainty. It is important to note that this intervention showed moderate-certainty evidence toward improving daily step count, supporting its sustained impact during short-term follow-up.

TRIAL REGISTRATION

PROSPERO CRD42024516900; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024516900.

Identifying Concepts of Physical Activity Which Are Clinically Meaningful to Patients and Care Providers: A Systematic Review of Qualitative Research

Physical activity (PA) is indispensable for overall health. Sub-optimal PA is linked to reduced quality of life (QOL) and premature death. In clinical research and therapeutics development, defining aspects of PA that are meaningful to patients and care providers is essential for designing tailored interventions, identifying individual contextual factors, and enhancing patient satisfaction and engagement in their own well-being. As digital health technologies (DHTs) measuring PA rapidly evolve, there is an opportunity to further define concepts. A systematic review of qualitative studies to identify concepts of PA that are meaningful to patients and care providers was conducted. Conditions covered included Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, cancer, Duchenne muscular dystrophy, chronic heart failure, sickle cell disease, osteoarthritis, and sarcopenia. We analyzed studies published in the last 20 years utilizing qualitative or mixed methods techniques to describe aspects of PA that patients want to prevent from worsening or improve. Among the 5228 articles returned, 105 studies were included. Thematic synthesis revealed five meaningful aspects of health (MAH) related to PA: ambulation-dependent activities, balance-dependent activities, activities needing upper limb function, changing body positions, and participating in activities of different intensities. Patients also reported PA as important to QOL and influenced by internal and external facilitators and barriers. This research presents new findings related to PA MAHs across various therapeutic areas, which go beyond walking. The findings provide a foundation for defining concepts of interest, measures, and endpoints, with applications in clinical research and care, including patient-focused development of digitally derived measures.

Effects of workplace interventions on sedentary behaviour and physical activity: an umbrella review with meta-analyses and narrative synthesis

BACKGROUND

Physical inactivity is rising globally, exacerbating the burden of preventable deaths and diseases. Despite extensive research on promoting physical activity in the workplace, synthesising the existing literature is challenging due to the wide variety of interventions and outcomes. This study aims to provide a comprehensive synthesis of intervention effects to inform health promotion initiatives and guide future research efforts.

METHODS

In this umbrella review, we conducted systematic searches of six databases (Cochrane, MEDLINE, Embase, CINAHL, Scopus, and Web of Science) for systematic reviews and meta-analyses published between Jan 1, 2000, and May 31, 2024, evaluating workplace interventions targeting sedentary behaviour or physical activity in working adults aged 18 years and older without specific health conditions or mobility impairments. Outcomes encompassed any behavioural changes related to sedentary behaviour or physical activity. Evidence for each relevant combination of intervention and outcome categories was summarised using either meta-analysis or narrative synthesis, with primary study data extracted as needed. This study is registered with PROSPERO, CRD42020171774.

FINDINGS

We included 36 systematic reviews and meta-analyses covering 214 unique primary studies. Despite considerable heterogeneity in the evidence, several effect trends emerged with moderate-to-high confidence. First, sit-to-stand workstations produced the largest reductions in sedentary time, decreasing it by up to 75 min per day (95% CI -109 to -41) when used alone, with reductions increasing by up to 33% when paired with psychosocial strategies. However, these interventions did not significantly increase physical activity at any intensity. Second, self-monitoring combined with psychosocial strategies yielded the largest increases in step count, with average gains of 1056 steps per day (371 to 1740). Third, no specific strategy consistently increased moderate-to-vigorous physical activity, although the available evidence remains sparse. Additional trends were observed but with lower confidence levels. Analysis of publication bias suggested an inflated effect of environmental-level interventions on occupational sedentary time. Adjusting for this bias using the trim-and-fill method only slightly reduced the effect size, but this result should be interpreted with caution due to high heterogeneity (I2=84·80%).

INTERPRETATION

Current evidence highlights the modest effect of existing workplace interventions on physical activity. Some strategies, such as sit-to-stand workstations and gamified interventions, effectively reduce sedentary behaviour and encourage lighter forms of physical activity, but none consistently improves moderate-to-vigorous physical activity, which provides the greatest health benefits. With many countries falling short of the WHO target to reduce physical inactivity prevalence by 15% from 2010 levels by 2030, intensified efforts are needed to address this gap, meet global goals, and alleviate the health burden of physical inactivity.

FUNDING

None.

Bright light therapy versus physical exercise to prevent co-occurring depression in adolescents and young adults with attention-deficit/hyperactivity disorder: a multicentre, three-arm, randomised controlled, pilot phase-IIa trial

Depression is common in attention-deficit/hyperactivity disorder (ADHD), but preventive behavioural interventions are lacking. This randomised controlled, pilot phase-IIa trial aimed to study a physical exercise intervention (EI) and bright light therapy (BLT)-both implemented and monitored in an individual, naturalistic setting via a mobile health (m-health) system-for feasibility of trial design and interventions, and to estimate their effects on depressive symptoms in young people with ADHD. Two hundred seven participants aged 14-45 years were randomised to 10-week add-on intervention of either BLT (10,000 lx; daily 30-min sessions) (n = 70), EI (aerobic and muscle-strengthening activities 3 days/ week) (n = 69), or treatment-as-usual (TAU) (n = 68), of whom 165 (80%) were retained (BLT: n = 54; EI: n = 52; TAU: n = 59). Intervention adherence (i.e. ≥ 80% completed sessions) was very low for both BLT (n = 13, 22%) and EI (n = 4, 7%). Usability of the m-health system to conduct interventions was limited as indicated by objective and subjective data. Safety was high and comparable between groups. Changes in depressive symptoms (assessed via observer-blind ratings, Inventory of Depressive Symptomatology) between baseline and end of intervention were small (BLT: -0.124 [95% CI: -2.219, 1.971], EI: -2.646 [95% CI: -4.777, -0.515], TAU: -1.428 [95% CI: -3.381, 0.526]) with no group differences [F(2,153) = 1.45, p = 0.2384]. These findings suggest that the m-health approach did not achieve feasibility of EI and BLT in young people with ADHD. Prior to designing efficacy studies, strategies how to achieve high intervention adherence should be specifically investigated in this patient group. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03371810, 13 December 2017.

Challenges in Promoting Physical Activity for Managing MASLD in Canadian Children: Insights and Barriers

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in children, closely linked to the rise in pediatric obesity. Physical activity (PA) is critical for MASLD management, yet many children fail to meet PA guidelines due to various barriers. This study quantifies PA levels and identifies barriers in Canadian children with MASLD.

METHODS

This prospective cohort study included 25 pediatric MASLD patients (≤ 18 years) recruited from a tertiary care center between spring and fall 2023. Participants completed the Habitual Activity Estimation Scale (HAES) and a modified PA Barrier Survey. Clinical, demographic, and laboratory data were collected.

RESULTS

The median age was 13 years, with 64% male participants. While 96% recognized the importance of PA, only 56% met the WHO-recommended 60 min of daily moderate-to-vigorous PA. Barriers included fatigue (84%), discomfort (56%), fear of injury (32%), and ridicule (36%). Participants who met PA guidelines were more likely to feel supported by healthcare providers (79% vs. 45%). Moderate technology use (52% used activity trackers) suggests potential for greater integration to boost engagement.

CONCLUSION

Children with MASLD face significant barriers to PA despite high awareness of its benefits. Tailored strategies incorporating technology and healthcare support are essential to improving PA adherence. Future research should explore larger cohorts and the influence of socioeconomic and cultural factors on PA behaviors.

Mobile Health Biometrics to Enhance Exercise and Physical Activity Adherence in Type 2 Diabetes (MOTIVATE-T2D): a decentralised feasibility randomised controlled trial delivered across the UK and Canada

OBJECTIVES

Assess the feasibility of a mobile health (mHealth)-supported home-delivered physical activity (PA) intervention (MOTIVATE-T2D) in people with recently diagnosed type 2 diabetes (T2D).

DESIGN

Feasibility multicentre, parallel group, randomised controlled trial (RCT).

SETTING

Participants were recruited from England and Canada using a decentralised design.

PARTICIPANTS

Adults (40-75 years) recently diagnosed with T2D (5-24 months).

INTERVENTIONS

Participants were randomised 1:1 to intervention (MOTIVATE-T2D) or active control groups. Participants codesigned 6month- home-delivered, personalised, progressive PA programmes supported by virtual behavioural counselling. MOTIVATE-T2D used biofeedback from wearable technologies to support the programme. The active control group received the same intervention without wearables.

OUTCOMES

The primary outcomes were recruitment rate, retention and adherence to purposeful exercise. Clinical data on effectiveness were collected as exploratory outcomes at baseline, 6 and 12 months, with HbA1c and systolic blood pressure (BP) proposed as primary outcomes for a future full RCT.

RESULTS

n=135 eligible participants expressed an interest in the trial, resulting in 125 participants randomised (age 55±9 years, 48% female, 81% white), a recruitment rate of 93%. Retention at 12 months was 82%. MOTIVATE-T2D participants were more likely to start (OR 10.4, CI 3.4 to 32.1) and maintain purposeful exercise at 6 (OR 7.1, CI 3.2 to 15.7) and 12 months (OR 2.9, CI 1.2 to 7.4). Exploratory clinical outcomes showed a potential effect in favour of MOTIVATE-T2D, including proposed primary outcomes HbA1c and systolic BP (between-group mean differences: HbA1c: 6 months: -5% change from baseline, CI -10 to 2: 12 months: -2% change from baseline, CI -8 to -4; systolic BP: 6 months: -1 mm Hg, CI -5 to 3: 12 months: -4 mm Hg, CI -8 to 1).

CONCLUSIONS

Our findings support the feasibility of delivering the MOTIVATE-T2D mHealth-supported PA intervention for people with recently diagnosed T2D and progression to a full RCT to examine its clinical and cost-effectiveness.

TRIAL REGISTRATION NUMBER

ISRCTN: 14335124; ClinicalTrials.gov: NCT0465353.

A circadian and app-based personalized lighting intervention for the reduction of cancer-related fatigue

Lighting interventions can mitigate fatigue by promoting circadian rhythmicity. We test whether individualized, wearable-based lighting interventions delivered via a mobile app reduce cancer-related fatigue in a randomized controlled trial with 138 breast cancer, prostate cancer, and hematopoietic stem cell transplant patients. Participants are randomized to tailored lighting intervention or control. The primary endpoint is PROMIS fatigue 4a at trial end, with secondary endpoints including change in daily fatigue, sleep, anxiety, depression, physical function, and overall health. Fatigue T-scores at week 11 do not differ between groups but decrease significantly from week 1 to week 11 (3.07 points, p = 0.001) in the intervention group, with a significant final-week treatment effect (p = 0.014). Daily fatigue, anxiety, sleep disturbance, and physical function improve within intervention. Further studies are needed to see if these results generalize in broader cancer care. The trial is registered at ClinicalTrials.gov (trial registration number: NCT04827446).

Digital Physical Activity and Sedentary Behavior Interventions for Community-Living Adults: Umbrella Review

BACKGROUND

Digital interventions hold significant potential for improving physical activity (PA) and reducing sedentary behavior (SB) in adults. Despite increasing interest, there remain surprising gaps in the current knowledge of how best to deliver these interventions, including incorporating appropriate theoretical frameworks and behavior change techniques. Following numerous systematic reviews, there is now significant potential for umbrella reviews to provide an overview of the current evidence.

OBJECTIVE

This umbrella review aimed to explore digital PA and SB interventions for community-living adults across effectiveness, key components, and methodological quality.

METHODS

This review followed the Joanna Briggs Institute framework for umbrella reviews. Key search terms were developed iteratively, incorporating physical and sedentary activity alongside digital interventions. We searched 7 online databases (Web of Science Core Collection, CINAHL, APA PsycINFO, Inspec, the Cochrane Library, MEDLINE [Ovid], and PROSPERO) alongside gray literature databases. Information was extracted and tabulated from each included article on intervention effectiveness, key components, and content acknowledging both the digital and human elements. The study quality was appraised using A Measurement Tool to Assess systematic Reviews 2 (AMSTAR 2). The corrected covered area method was used to assess the overlap of primary studies included in the systematic reviews. All relevant research findings were extracted and reported.

RESULTS

Search terms identified 330 articles, of which 5 (1.5%) met the inclusion criteria. The most common PA outcomes identified were daily steps, moderate-to-vigorous PA, total PA, and PA change. Reviews with meta-analysis reported that digital interventions improved multiple PA outcomes (daily steps, moderate-to-vigorous PA time, and total PA time). However, findings from the remaining systematic reviews were mixed. Similarly, the findings for SB were contrasting. Regarding intervention components, monitor- and sensor-only intervention delivery methods were most frequently implemented. Eleven theoretical frameworks were identified, with social cognitive theory being the most prominent theory. In total, 28 different behavior change techniques were reported, with goal setting, self-monitoring, feedback, and social support being the most frequently used. All 5 systematic reviews were of low or critically low quality, each incorporating unique primary studies (corrected covered area=0%).

CONCLUSIONS

This umbrella review highlights the potential of digital interventions to increase PA and reduce SB among community-living adults. However, the disparate nature of current academic knowledge means potentially efficacious research may not realistically translate to real work impact. Our review identified a lack of consensus around outcomes and components at both individual (eg, difficult to collate and compare findings) and multiple study (poor reported quality of systematic reviews) levels. Collective, concerted action is required to standardize outcomes and improve systematic review reporting to optimize future learning around digital interventions to increase PA and reduce SB in community-living adults, including traditionally overlooked populations, like informal carers.

TRIAL REGISTRATION

PROSPERO CRD42023450773; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023450773.

Improved glycemic outcomes in people with type 2 diabetes using smart blood glucose monitoring integrated with popular digital health therapeutics

The increasing prevalence of metabolic syndrome and type 2 diabetes places a burden on healthcare systems, necessitating cost-effective, engaging and accessible interventions to address the underlying behavioral and lifestyle drivers. Our study evaluated combining Bluetooth connected OneTouch blood glucose meters (BGM) and the OneTouch Reveal mobile app with one of four digital therapeutic apps. Each group was independent, with people with type 2 diabetes (PwT2D) themselves choosing their therapeutic intervention, to better reflect real-world use. Our 3-month decentralized study screened 912 subjects, with 612 returning mail-in A1cs, providing 191 subjects (Noom = 68, Fitbit = 31, Cecelia Health = 47, Welldoc = 45) who met all inclusion criteria, including entry A1c 7.5 to 12.0%. The primary endpoint of A1c change showed improvement in the overall group by - 0.77% (95% CI - 0.98 to - 0.56, n = 141) after 3-months, Noom - 1.03% (CI - 1.4 to - 0.61, n = 49), Fitbit - 0.56% (CI - 1.0 to - 0.11, n = 24), Cecelia Health - 0.76% (CI - 1.2 to - 0.36, n = 36), Welldoc - 0.55% (CI - 0.94 to - 0.17, n = 32). In terms of secondary endpoints, more than half (56%) of these PwT2D lowered A1c by ≥ 0.5% and more than a third (36%) lowered A1c by ≥ 1.0%, with similar improvements across each of the four independent groups. Our real-world approach shows the potential for connected BGMs and widely accessible digital therapeutics to contribute to improvements in glycemic outcomes.

Applying AI in the Context of the Association Between Device-Based Assessment of Physical Activity and Mental Health: Systematic Review

BACKGROUND

Wearable technology is used by consumers worldwide for continuous activity monitoring in daily life but more recently also for classifying or predicting mental health parameters like stress or depression levels. Previous studies identified, based on traditional approaches, that physical activity is a relevant factor in the prevention or management of mental health. However, upcoming artificial intelligence methods have not yet been fully established in the research field of physical activity and mental health.

OBJECTIVE

This systematic review aims to provide a comprehensive overview of studies that integrated passive monitoring of physical activity data measured via wearable technology in machine learning algorithms for the detection, prediction, or classification of mental health states and traits.

METHODS

We conducted a review of studies processing wearable data to gain insights into mental health parameters. Eligibility criteria were (1) the study uses wearables or smartphones to acquire physical behavior and optionally other sensor measurement data, (2) the study must use machine learning to process the acquired data, and (3) the study had to be published in a peer-reviewed English language journal. Studies were identified via a systematic search in 5 electronic databases.

RESULTS

Of 11,057 unique search results, 49 published papers between 2016 and 2023 were included. Most studies examined the connection between wearable sensor data and stress (n=15, 31%) or depression (n=14, 29%). In total, 71% (n=35) of the studies had less than 100 participants, and 47% (n=23) had less than 14 days of data recording. More than half of the studies (n=27, 55%) used step count as movement measurement, and 44% (n=21) used raw accelerometer values. The quality of the studies was assessed, scoring between 0 and 18 points in 9 categories (maximum 2 points per category). On average, studies were rated 6.47 (SD 3.1) points.

CONCLUSIONS

The use of wearable technology for the detection, prediction, or classification of mental health states and traits is promising and offers a variety of applications across different settings and target groups. However, based on the current state of literature, the application of artificial intelligence cannot realize its full potential mostly due to a lack of methodological shortcomings and data availability. Future research endeavors may focus on the following suggestions to improve the quality of new applications in this context: first, by using raw data instead of already preprocessed data. Second, by using only relevant data based on empirical evidence. In particular, crafting optimal feature sets rather than using many individual detached features and consultation with in-field professionals. Third, by validating and replicating the existing approaches (ie, applying the model to unseen data). Fourth, depending on the research aim (ie, generalization vs personalization) maximizing the sample size or the duration over which data are collected.

Exercise and Fitness Quantification in Clinical Practice: Why and How; and Where Are We Going?

Exercise and fitness quantification is increasingly recognized as a critical component in clinical practice, particularly within preventive cardiology. In this article we explore the multifaceted importance of exercise quantification in clinical settings, addressing preventive care, cost-effectiveness, psychosocial benefits, treatment planning, and monitoring progress. Quantifying exercise habits allows clinicians to evaluate risk profiles, prescribe tailored interventions, and monitor patient progress. The methodologies for exercise quantification are discussed. In preventive cardiology, adherence to guidelines from organizations such as the American Heart Association, the European Society of Cardiology, and the Canadian Cardiovascular Society is emphasized, with particular focus on high-intensity interval training and the central role of physical therapists/kinesiologists. Special populations, such as weekend warriors, those reflecting the "fat and fit" concept, athletes, and those at risk of overtraining syndrome, are considered in prescribing exercise. Future directions in exercise and fitness quantification include the integration of advanced wearable technology, personalized medicine, telemedicine, and promotion of active, walkable communities. The incorporation of behavioral science is highlighted as a missing component that can enhance long-term adherence to exercise regimens through motivation, behavior change techniques, patient-centered approaches, and continuous monitoring and feedback. This comprehensive approach aims to optimize cardiovascular health and overall well-being through individualized, evidence-based exercise interventions that are both effective and sustainable.

Feasibility of collecting objective data and exploring patient's experiences on physical activity in persistent spinal pain syndrome type 2 patients receiving spinal cord stimulation: A mixed feasibility study

BACKGROUND

Patients with chronic pain due to persistent spinal pain syndrome Type 2 (PSPS Type 2) experience daily limitations in their physical activities. Physical, emotional, and social well-being changes are usually measured with standardized, validated self-reporting questionnaires. These reported data are subjective and are answered at a particular moment, which may not accurately reflect the patient's overall condition. Moreover, questionnaires could be misinterpreted, leading to potential inaccuracies in the reported data. This highlights the need for objective measurement tools that report longitudinal real-life data, which could be helpful in evaluating physical activity in spinal cord stimulation (SCS). However, objective measurement tools in SCS therapy are scarce.

OBJECTIVE

We aimed to investigate the feasibility of collecting objective data from an activity tracker and a neurostimulator device to evaluate physical activity. As this is a feasibility study, we also aimed to evaluate the experiences of participating patients and healthcare professionals to explore the viability and practicality of future studies.

METHODS

We performed a mixed-methods feasibility study with quantitative and qualitative data collection. Alongside the standardized questionnaires, we collected objective data on different bodily functions as measured by the activity tracker and on different body positions as measured with the neurostimulator device, starting 1 month before the trial spinal cord stimulation and with a follow-up of 3 months. Additionally, we performed face-to-face, in-depth interviews exploring patients' experiences of physical activity using the six dimensions of the diagram of positive health as a topic list. At the end of the study, patients and participating healthcare professionals were asked to evaluate their experiences on a five-point Likert scale expressing satisfaction. The study was performed in two Dutch hospitals.

RESULTS

We included 20 patients with PSPS Type 2, of whom 17 (85%) completed the three-month follow-up with a nearly complete personalized real-time data set. Most of the missing data was due to the wear of the watch. One patient developed an allergic reaction to the watch strap. According to the interviews, patients mentioned feeling motivated to be physically active by wearing an activity tracker. The evaluation form showed that 84% of the patients and 75% of the healthcare professionals were very satisfied and would participate in a study with a similar design. The activity tracker remotely collected objective data on physical activity at baseline, trial, and three-month follow-up.

CONCLUSION

Collecting objective data on physical activities and health status of PSPS Type 2 patients receiving SCS appeared feasible with a neuromodulation device and an activity tracker if the watch was correctly worn on the wrist or with clear instructions. The personalized data could add value to the standardized questionnaires evaluating holistic SCS outcomes. Participating patients and healthcare professionals supported a future prospective study with objective measurement tools in a similar design.

The role of digital health in respiratory diseases management: a narrative review of recent literature

This review provides a detailed overview of how digital health can be utilized in the management of Interstitial Lung Disease (ILD), and Chronic Obstructive Pulmonary Disease (COPD). ILD encompasses a diverse range of lung disorders characterized by inflammation and scarring of lung tissue, leading to restrictive lung physiology and impaired gas exchange, with symptoms including progressive dyspnoea, cough, and hypoxia. COPD which ranks as the third leading cause of death globally, is characterized by chronic lung inflammation causing irreversible airflow obstruction, recurrent exacerbations. While recent advances in digital health have shown promise, predicting disease progression in patients with ILD and exacerbation in patients with COPD remains challenging. This review explores the role of digital health in managing ILD and COPD, particularly focusing on telehealth and digital health technologies. Telehealth, defined broadly as the use of electronic information and telecommunications technologies in healthcare, has become increasingly relevant, especially during the COVID-19 pandemic. This review examines the role of digital health technologies in the management of ILD and COPD, with particular focus on telemedicine, and digital health tools. Remote monitoring technologies, including home spirometry and wearable devices, have demonstrated feasibility in managing respiratory diseases. However, challenges such as evidence, data reliability, varying adherence, education, and the high costs of data collection and lack of qualified clinicians present barriers for many national health systems.

Digital Health Interventions to Improve Mental Health in Patients With Cancer: Umbrella Review

BACKGROUND

Mental health plays a key role across the cancer care continuum, from prognosis and active treatment to survivorship and palliative care. Digital health technologies offer an appealing, cost-effective tool to address psychological needs.

OBJECTIVE

This umbrella review aims to summarize and evaluate the available evidence on the efficacy of digital health interventions for improving mental health and psychosocial outcomes for populations with cancer.

METHODS

Literature searches were conducted in Embase, PsycINFO, PubMed, CINAHL, the Cochrane Library, and Web of Science from their inception to February 4, 2024. Systematic reviews (with or without meta-analysis) investigating the efficacy of digital health interventions for psychosocial variables in patients with cancer were included. Quality was assessed using the Assessing the Methodological Quality of Systematic Reviews-2 tool.

RESULTS

In total, 78 systematic reviews were included in this review. Among diverse delivery modalities and types of digital interventions, websites and smartphone apps were the most commonly used. Depression was the most frequently addressed, followed by quality of life, anxiety, fatigue, and distress. The qualities of the reviews ranged from critically low to high. Generally, despite great heterogeneity in the strength and credibility of the evidence, digital health interventions were shown to be effective for mental health in patients with cancer.

CONCLUSIONS

Taken together, digital health interventions show benefits for patients with cancer in improving mental health. Various gaps were identified, such as little research specifically focusing on older adult patients with cancer, a scarcity of reporting high-precision emotion management, and insufficient attention to other certain mood indicators. Further exploration of studies with standardized and rigorous approaches is required to inform practice.

TRIAL REGISTRATION

PROSPERO CRD42024565084; https://tinyurl.com/4cbxjeh9.

Usage Trends and Data Sharing Practices of Healthcare Wearable Devices Among US Adults: Cross-Sectional Study

BACKGROUND

Health care wearable devices can transform health care delivery by enabling real-time, continuous monitoring that facilitates early disease detection, personalized treatments, and improved patient engagement. The COVID-19 pandemic has heightened awareness of the importance of health technology, accelerating interest in wearables as tools for monitoring health and managing chronic conditions. As we navigate the postpandemic era, understanding the adoption and data-sharing behaviors associated with wearable devices has become increasingly critical. Despite their potential, challenges and low adoption rates persist, with significant gaps in understanding the impact of sociodemographic factors, health conditions, and digital literacy on the use and data-sharing behaviors of these devices.

OBJECTIVE

This study aimed to explore the usage and data-sharing practices (willingness to share wearable data and actual data-sharing behavior) of wearable devices among US adults specifically during the later phases of the COVID-19 pandemic.

METHODS

Using cross-sectional data from the National Cancer Institute's Health Information National Trends Survey 6, conducted from March to November 2022, this study uses responses from 5591 US adults to examine wearable use, willingness to share wearable data with providers, family, and friends, and the wearable data-sharing behavior.

RESULTS

The results indicate an increase in wearable device adoption to 36.36% (2033/5591) in 2022, up from 28%-30% in 2019. We also find a significant discrepancy between the willingness to share data, with 78.4% (1584/2020) of users open to sharing with health care providers, and the actual sharing behavior, where only 26.5% (535/ 2020) have done so. Higher odds of using wearables were associated with female gender (odds ratio [OR] 1.49, 95% CI 1.17-1.90, P<.01) and higher income levels (OR 2.65, 95% CI 1.42-4.93, P<.01 for incomes between US $50,000 and US $75,000, and OR 3.2, 95% CI 1.71-5.97, P<.01 for incomes above US $75,000). However, the likelihood of usage and data sharing declines significantly with age. Compared with African American respondents, Hispanic respondents were more willing to share wearable data with providers (OR 1.92, 95% CI 1.02-3.62, P<.05), though the odds of their actual sharing of wearable data with providers was relatively less (OR 0.44, 95% CI 0.20-0.97, P<.05). Frequency of provider visits (OR 1.23, 95% CI 1.08-1.39, P<.01), and total medical conditions (OR 1.35, 95% CI 1.05-1.73, P<.01) were significant predictors of data-sharing behavior. The study also identified weight, frequency of provider visits, technological self-efficacy and frequent physical activity as predictors for higher wearable use.

CONCLUSIONS

Insights from this study are crucial for health care providers and policy makers aiming to leverage wearable technology to enhance health outcomes. Addressing the disparities and barriers identified can lead to more effective integration of these technologies in health care systems, thereby maximizing the potential of digital health tools to improve public health outcomes.

Participant perspectives about decentralised trial procedures in a remote delivery nutrition intervention trial

Participant recruitment and retention are consistently recognised as significant, costly challenges in nutrition intervention trials. Decentralised study procedures address some of the recruitment and retention limitations in traditional trial methodology. Understanding participant perceptions and experiences of decentralised methods in nutrition studies is key to improving trial design and conduct. The aim of this study was to explore participant opinions about remote delivery of a dietary supplement intervention trial. Adults enrolled in a clinical trial of a milk fat globule membrane nutritional supplement for improvement of psychological wellbeing were invited to take part in a post-intervention interview. Interviews were conducted over video conferencing and transcribed. Using a semi-structured interview format six aspects of trial design were discussed: general processes, written instructions, contact throughout the study, self-collection of saliva samples, wearable device use, and cognitive assessment. Thematic analysis derived themes from the data for each of the aspects of trial conduct discussed. Seventy-three participants completed the interview. Interviewees reported a positive overall experience of the remote delivery procedures used. Accessible communication between researchers and participants and clear written instructions were identified as key to participant experience. Recall of instructions and adherence to the nutritional intervention was difficult for some respondents with suggestions made for facilitating this in future remote delivery nutrition studies. Use of wearables, in-home saliva sampling, and self-administered cognitive assessments were feasible and acceptable to most participants. The remote delivery of a nutritional intervention trial, including self-collected biological samples, is feasible and positively viewed by participants.

Obesity and cardiovascular disease: an ESC clinical consensus statement

The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.

Is There a Correlation Between Objective Measurement Tools and Self-Reporting Questionnaires To Evaluate Physical Activity and Health Status in Patients With Persistent Spinal Pain Syndrome Type 2 Before and After Spinal Cord Stimulation? Outcomes of a Feasibility Study

INTRODUCTION

The effect of spinal cord stimulation (SCS) on physical activity in patients with persistent spinal pain syndrome (PSPS) type 2 is commonly evaluated with standardized, validated self-reporting questionnaires. However, questionnaires are susceptible to subjective bias and may not align with objective data.

OBJECTIVE

We investigated the correlation among objective measurement devices, the Oswestry Disability Index (ODI), and patient's health status regarding physical activity in patients with PSPS type 2 receiving SCS.

MATERIALS AND METHODS

Alongside the ODI, we used an activity tracker to objectively measure physical activity and a neurostimulator device to objectively measure body positions at baseline and three-month follow-up. In addition, health status was measured using the positive model of health.

RESULTS

We included 20 patients, of whom 17 completed the three-month follow-up period. At three months follow-up, we found a significant correlation between the activity tracker's steps (r = -0.636, p = 0.006) and distance per day (r = -0.649, p = 0.005) with the ODI and a significant correlation of the neurostimulator's mobile position with the ODI (r = -0.497, p = 0.043). Furthermore, the activity tracker showed a significant increase in strenuous physical activity at three-month follow-up (p = 0.039). We also observed a substantial improvement across the domains of bodily function, social and societal participation, and daily functioning of the positive model of health.

CONCLUSIONS

This study showed significant correlations among objective measurement devices, the ODI, and health status, which could contribute to a more holistic approach to evaluating the effect of SCS. Prospective powered studies with a control group are needed to better understand this area.

CLINICAL TRIAL REGISTRATION

The protocol was registered in the Dutch Trial Register (NTR) on March 13, 2021 under registration number NL 9301 (number NL-OMON21829).

Changing User Experience of Wearable Activity Monitors Over 7 Years: Repeat Cross-Sectional Survey Study

BACKGROUND

Lifestyle behaviors, including physical inactivity, sedentary behavior, poor sleep, and unhealthy diet, significantly impact global population health. Wearable activity trackers (WATs) have emerged as tools to enhance health behaviors; however, their effectiveness and continued use depend on their user experience.

OBJECTIVE

This study aims to explore changes in user experiences, preferences, and perceived impacts of WATs from 2016 to 2023.

METHODS

We conducted a cross-sectional online survey among an international cohort of adults (n=475, comprising 387 current and 88 former WAT users). Results were compared with a 2016 cross-sectional online survey (n=237, comprising 200 current and 37 former WAT users) using descriptive statistics and chi-square tests. The survey examined brand preference, feature usefulness, motivations, perceived health behavior change, social sharing behaviors, and technical issues.

RESULTS

In 2023, Apple (210/475, 44%) and Fitbit (101/475, 21%) were the most commonly used devices, compared with the 2016 survey where Fitbit (160/237, 68%) and Garmin devices (39/237, 17%) were most common. The median usage duration in 2023 was 18 months, significantly longer than the 7 months reported in 2016, with most users planning ongoing use. Users in both survey years reported greater improvements in physical activity than diet or sleep, despite lower improvement in physical activity in 2023 compared with 2016, contrasted with greater perceived improvements in diet and sleep. Social media sharing of WAT data notably rose to 73% (283/387) in 2023 from 35% (70/200) in 2016. However, reports of technical issues and discomfort increased, alongside a decrease in overall positive experiences. There was also a noticeable shift in discontinuation reasons, from having learned everything possible in 2016 to dissatisfaction in 2023.

CONCLUSIONS

The study highlights significant shifts in WAT usage, including extended use and evolving preferences for brands and features. The rise in social media sharing indicates a deeper integration of WATs into everyday life. However, user feedback points to a need for enhanced design and functionality despite technological progress. These findings illustrate WAT's potential in health promotion, emphasizing the need for user-focused design in diverse populations to fully realize their benefits in enhancing health behaviors.

Can Wearable Device Promote Physical Activity and Reduce Pain in People with Chronic Musculoskeletal Conditions?

Objective: The purpose of this systematic review is to identify and appraise the evidence on the effectiveness of using wearable devices to promote physical activity and reduce pain in people with chronic musculoskeletal pain. Methods: Systematic searches of electronic databases PubMed, CINAHL, and Medline (Ovid) were undertaken for randomised control trials and observational studies of wearable-based interventions in patients with chronic musculoskeletal conditions. Result: Thirteen studies were included in this review. The methodological quality of the included articles was found to vary between moderate and high quality. Studies included patients with osteoarthritis hip/knee (number; n = 5), low back pain (n = 3), rheumatoid arthritis (n = 1), juvenile idiopathic arthritis (n = 1), inflammatory arthritis (n = 1), spondylarthritis (n = 1), and ankylosing spondylitis (n = 1). The intervention group of some of the studies included additional components associated with the use of wearable devices such as step or diet diary, motivational interviewing or counselling, goal setting, and multidimensional and tailored exercise programme interventions delivered in person, remotely, or in a hybrid format. Intervention duration ranged from 1 week to 28 weeks. There were no serious adverse events related to the use of wearables. Overall, evidence from this systematic review shows that wearable technology intervention was effective in increasing physical activity significantly, especially where extra components (counselling, coaching, prescribed physical activity, goal setting, physiotherapist) were used among clinical and non-clinical populations. However, no significant effect was found in pain reduction with the use of wearable devices. Conclusions: It is concluded that the use of wearable technology should be encouraged in patients with chronic musculoskeletal conditions. Additional research is needed, such as increasing the duration of the intervention, which may have an impact on pain.

Physical activity interventions: an update on advancing sedentary time, technology, and dissemination and implementation research

Approximately 28% of American adults meet both the physical activity (PA) and strength training guidelines despite the numerous health benefits associated with a physically active lifestyle. The purpose of this paper is to provide an update of the 2017 Society of Behavioral Medicine PA Special Interest Group article that outlined future directions in sedentary time reduction interventions, technology-based PA interventions, and the dissemination and implementation of PA interventions. Since the prior review, there has been significant progress on effective interventions for reducing sedentary time. However, there has been less progress for improving the specificity of sedentary time guidelines. There has been a dramatic increase in the number of studies examining PA mHealth interventions and support for mHealth intervention has generally been positive, though sustaining engagement in mHealth interventions remains a challenge. Promising newer technologies that have been explored more extensively since the prior review including artificial intelligence (AI). Knowledge of how to implement and scale-up effective PA interventions has also increased. Several current trends in PA intervention research that continue to advance the field include examining the moderating effect of the built environment on the effectiveness of behavioral interventions, cultural tailoring of interventions, Just in Time Adaptive Interventions (JITAIs), and exercise snacks (vigorous intensity PA sessions that are less than one minute). Overall, there has been significant progress in the PA intervention field but significant work remains for creating effective interventions that can be readily implemented into real world settings.

A Motivational Technology Perspective on the Use of Smart Wrist-Worn Wearables for Postpartum Exercise and Weight Management

Exercise and weight management is crucial in preventing postpartum depression and long-term obesity that carries the risk of chronic illness among postpartum women. Although communication devices, such as a smart wrist-worn wearable (SWW), can help users be more physically active, the extent to which postpartum women might benefit from this technology is unknown. We examined how SWWs promoted exercise and helped postpartum women return to pre-pregnancy weight. We tested a model based on the premise that a motivational device that prompts users to engage with it can establish healthy daily routines. An online survey of 309 postpartum women who were living in the United States and were current users of SWWs revealed that the device encouraged them to spend time completing workout goals. Technological affordances (i.e. customization, navigability, and interactivity) and subsequent user engagement with the device positively predicted total workout hours among postpartum women. We present practical implications for postpartum care programs and smart wearable developers.

Integrating AI-driven wearable devices and biometric data into stroke risk assessment: A review of opportunities and challenges

Stroke is a leading cause of morbidity and mortality worldwide, and early detection of risk factors is critical for prevention and improved outcomes. Traditional stroke risk assessments, relying on sporadic clinical visits, fail to capture dynamic changes in risk factors such as hypertension and atrial fibrillation (AF). Wearable technology (devices), combined with biometric data analysis, offers a transformative approach by enabling continuous monitoring of physiological parameters. This narrative review was conducted using a systematic approach to identify and analyze peer-reviewed articles, reports, and case studies from reputable scientific databases. The search strategy focused on articles published between 2010 till date using pre-determined keywords. Relevant studies were selected based on their focus on wearable devices and AI-driven technologies in stroke prevention, diagnosis, and rehabilitation. The selected literature was categorized thematically to explore applications, opportunities, challenges, and future directions. The review explores the current landscape of wearable devices in stroke risk assessment, focusing on their role in early detection, personalized care, and integration into clinical practice. The review highlights the opportunities presented by continuous monitoring and predictive analytics, where AI-driven algorithms can analyze biometric data to provide tailored interventions. Personalized stroke risk assessments, powered by machine learning, enable dynamic and individualized care plans. Furthermore, the integration of wearable technology with telemedicine facilitates remote patient monitoring and rehabilitation, particularly in underserved areas. Despite these advances, challenges remain. Issues such as data accuracy, privacy concerns, and the integration of wearables into healthcare systems must be addressed to fully realize their potential. As wearable technology evolves, its application in stroke care could revolutionize prevention, diagnosis, and rehabilitation, improving patient outcomes and reducing the global burden of stroke.

Effects of Physical Activity and Exercise Interventions on Health Outcomes in Occupational Drivers: A Systematic Review

BACKGROUND

Occupational drivers are exposed to a wide range of risk factors, including sedentary behavior and physical inactivity, which can contribute to various chronic diseases. However, exercise interventions are likely to alleviate the negative associations and reduce chronic disease risks. This systematic review aimed to inventorize research studies investigating the effects of physical activity and exercise interventions on health outcomes in occupational drivers, and to assess interventions that have demonstrated effectiveness on health outcomes in occupational drivers.

METHODS

The electronic databases "Web of Science," "Scopus," and "PubMed" were searched using keywords related to "occupational drivers," "exercise," and "health outcomes." Studies were included if they examined the effects of physical activity and exercise among occupational drivers on the following health outcomes: pain, disability, lifestyle factors (sleep, weight, physical activity, nutrition), fatigue, stress, and cardiometabolic risk factors. The methodological quality of the studies was assessed by the Cochrane Risk of Bias tools for randomized and non-randomized studies.

RESULTS

Fourteen articles were included (three randomized and 11 non-randomized controlled trials). All studies were judged to have an overall risk of bias as "some concerns, low, moderate or serious." Evidence suggests that stretching and isometric exercises have significantly improved pain, disability, and fatigue. In contrast, multicomponent lifestyle interventions have enhanced physical activity levels, cardiometabolic risk factors, anthropometrics (body mass index, weight, waist circumference), sleep, and dietary intake among occupational drivers.

CONCLUSION

The available evidence indicates the potential benefits of exercise interventions and physical activity for health outcomes in occupational drivers. However, high-quality studies are needed in the future to establish stronger evidence supporting the effect of the exercise intervention.

The effect of physical exercise and cognition-orientated interventions on post-stroke cognitive function: Protocol for an overview of reviews

BACKGROUND

Strokes are becoming more common, and with improving survival rates, the prevalence of stroke survivors has increased. Almost half of chronic stroke survivors are cognitively impaired, and healthcare services are struggling to manage these patients, leaving some feeling "abandoned". Several systematic reviews have investigated the effect of physical exercise and cognition-orientated interventions on post-stroke cognitive impairment, and have produced conflicting findings, making it difficult for clinicians and guideline producers to make evidence-based decisions. This overview of reviews aims to provide a comprehensive overview of systematic reviews investigating the effect of physical exercise and cognition-orientated interventions on post-stroke cognitive function, assess methodological quality and certainty of evidence, and identify sources of discordance between these reviews.

METHODS

Eight databases-Embase, Medline, CINAHL, Psycinfo, SPORTDiscus, The Cochrane Database of Systematic reviews, Epistemonikos, and Scopus-plus grey literature sources will be searched. The eligibility criteria include systematic reviews of trials that included an adult stroke population and investigated physical exercise and/or cognition-orientated interventions. Only reviews that assessed at least one of the DSM-5 neurocognitive domains will be included. Screening, data extraction, and quality appraisal will be conducted by two independent reviewers. Methodological quality, certainty of evidence, and primary study overlap will be assessed using the AMSTAR-2, GRADE, and GROOVE tools, respectively. Interventions will be grouped into exercise, cognition-orientated, and combined interventions, and findings will be synthesised narratively. Heterogeneity assessment will be conducted to identify factors causing discordance between reviews.

DISCUSSION

The findings of this overview will allow decision makers to make evidence-based decisions, stratified by methodological quality and certainty of evidence. Heterogeneity assessment may identify factors causing discordance between systematic reviews, which could inform the design of future studies.

TRIAL REGISTRATION

Registration: PROSPERO CRD42024534179.

The Effects of Self-Monitoring Using a Smartwatch and Smartphone App on Stress Awareness, Self-Efficacy, and Well-Being-Related Outcomes in Police Officers: Longitudinal Mixed Design Study

Background

Wearable sensor technologies, often referred to as "wearables," have seen a rapid rise in consumer interest in recent years. Initially often seen as "activity trackers," wearables have gradually expanded to also estimate sleep, stress, and physiological recovery. In occupational settings, there is a growing interest in applying this technology to promote health and well-being, especially in professions with highly demanding working conditions such as first responders. However, it is not clear to what extent self-monitoring with wearables can positively influence stress- and well-being-related outcomes in real-life conditions and how wearable-based interventions should be designed for high-risk professionals.

Objective

The aim of this study was to investigate (1) whether offering a 5-week wearable-based intervention improves stress- and well-being-related outcomes in police officers and (2) whether extending a basic "off-the-shelf" wearable-based intervention with ecological momentary assessment (EMA) questionnaires, weekly personalized feedback reports, and peer support groups improves its effectiveness.

Methods

A total of 95 police officers from 5 offices participated in the study. The data of 79 participants were included for analysis. During the first 5 weeks, participants used no self-monitoring technology (control period). During the following 5 weeks (intervention period), 41 participants used a Garmin Forerunner 255 smartwatch with a custom-built app (comparable to that of the consumer-available wearable), whereas the other 38 participants used the same system, but complemented by daily EMA questionnaires, weekly personalized feedback reports, and access to peer support groups. At baseline (T0) and after the control (T1) and intervention (T2) periods, questionnaires were administered to measure 15 outcomes relating to stress awareness, stress management self-efficacy, and outcomes related to stress and general well-being. Linear mixed models that accounted for repeated measures within subjects, the control and intervention periods, and between-group differences were used to address both research questions.

Results

The results of the first analysis showed that the intervention had a small (absolute Hedges g=0.25-0.46) but consistent effect on 8 of 15 of the stress- and well-being-related outcomes in comparison to the control group. The second analysis provided mixed results; the extended intervention was more effective than the basic intervention at improving recovery after work but less effective at improving self-efficacy in behavior change and sleep issues, and similarly effective in the remaining 12 outcomes.

Conclusions

Offering a 5-week wearable-based intervention to police officers can positively contribute to optimizing their stress-related, self-efficacy, and well-being-related outcomes. Complementing the basic "off-the-shelf" wearable-based intervention with additional EMA questionnaires, weekly personalized feedback reports, and peer support groups did not appear to improve the effectiveness of the intervention. Future work is needed to investigate how different aspects of these interventions can be tailored to specific characteristics and needs of employees to optimize these effects.

Acceptance of Illness and Health-Related Quality of Life in Patients After Myocardial Infarction-Narrative Review

Introduction: Cardiovascular diseases, particularly myocardial infarction (MI), significantly impact patients' lives, causing stress and prompting varied responses to illness. Aim and methods: We conducted a narrative review concerning the acceptance of illness and quality of life in post-MI patients. Based on an extensive search of the available literature, this review consolidates current evidence on the proposed topic. Conclusions and implications: While some patients struggle with acceptance and face emotional distress, others who accept their condition are more likely to engage in treatment and lifestyle changes, leading to an improved health-related quality of life (HRQoL). Following an MI, patients often experience depression, anxiety, and stress, complicating their acceptance of the illness. Risk factors, such as hypertension, diabetes, and smoking, play a significant role in influencing HRQoL in post-MI patients. An accurate assessment of HRQoL is crucial for tailoring effective treatments and support strategies to enhance patient outcomes and identify those most at risk of developing post-MI depression or anxiety. Effective physician-patient and nurse-patient communication and support from family might be helpful in recovery. Cardiac rehabilitation improves patients' outcomes and HRQoL. This review underscores the importance of integrating psychological support with optimal medical care to improve patient prognosis and enhance the HRQoL of individuals recovering from MI. The healthcare system could implement routine psychological assessments for MI patients at admission and discharge to establish a baseline for follow-up. Future research should explore effective psychological interventions, the interplay of CVD risk factors and psychosocial aspects, the emerging role of artificial intelligence in personalized care, and the cost-effectiveness of integrated treatment models.

Changes in Physical Activity Across Cancer Diagnosis and Treatment Based on Smartphone Step Count Data Linked to a Japanese Claims Database: Retrospective Cohort Study

BACKGROUND

Although physical activity (PA) is recommended for patients with cancer, changes in PA across cancer diagnosis and treatment have not been objectively evaluated.

OBJECTIVE

This study aimed to assess the impact of cancer diagnosis and treatment on PA levels.

METHODS

This was a retrospective cohort study using a Japanese claims database provided by DeSC Healthcare Inc, in which daily step count data, derived from smartphone pedometers, are linked to the claims data. In this study, we included patients newly diagnosed with cancer, along with those newly diagnosed with diabetes mellitus for reference. We collected data between April 2014 and September 2021 and analyzed them. The observation period spanned from 6 months before diagnosis to 12 months after diagnosis. We applied a generalized additive mixed model with a cubic spline to describe changes in step counts before and after diagnosis.

RESULTS

We analyzed the step count data of 326 patients with malignant solid tumors and 1388 patients with diabetes. Patients with cancer exhibited a 9.6% (95% CI 7.1%-12.1%; P<.001) reduction in step counts from baseline at the start of the diagnosis month, which further deepened to 12.4% (95% CI 9.5%-15.2%; P<.001) at 3 months and persisted at 7.1% (95% CI 4.2%-10.0%; P<.001) at 12 months, all relative to baseline. Conversely, in patients with diabetes, step counts remained relatively stable after diagnosis, with a slight upward trend, resulting in a change of +0.6% (95% CI -0.6% to 1.9%; P=.31) from baseline at 3 months after diagnosis. At 12 months after diagnosis, step counts remained decreased in the nonendoscopic subdiaphragmatic surgery group, with an 18.0% (95% CI 9.1%-26.2%; P<.001) reduction, whereas step counts returned to baseline in the laparoscopic surgery group (+0.3%, 95% CI -6.3% to 7.5%; P=.93).

CONCLUSIONS

The analysis of objective pre- and postdiagnostic step count data provided fundamental information crucial for understanding changes in PA among patients with cancer. While cancer diagnosis and treatment reduced PA, the decline may have already started before diagnosis. The study findings may help tailor exercise recommendations based on lifelog data for patients with cancer in the future.

Association between Activity Quotient and cause-specific mortality - A prospective cohort study of 0.5 million participants in Asia

BACKGROUND

Regular physical activity (PA) is important for reducing the risk of chronic diseases and improving overall health. Activity Quotient (AQ) is a novel metric that translates heart rate during PA into a weekly score, providing an objective measure of an individual's PA. We prospectively examined the association of AQ with cancer and cardiovascular (CVD) mortality outcomes, the two major causes of death, in a Taiwanese population.

METHODS

A cohort of 515,608 healthy adults (52 % women) enrolled in a standard medical screening program was followed for mortality outcomes. The weekly AQ score of each participant was estimated based on self-reported PA intensity and weekly duration, and placed into six categories (0, ≤50, 51-99,100-149, 150-199, or ≥ 200 AQ per week). We used multivariable Cox proportional hazard models adjusted for potential confounders to estimate the hazard ratios (HR) and 95 % confidence intervals (CI).

RESULTS

Higher weekly AQ scores were associated with lower risks of CVD, cancer, and all-cause mortalities. Compared with inactive individuals, HRs (CI) for the association of AQ scores of ≤50, 50-99, 100-149, 150-199, and ≥ 200 were 0.93 (0.89-0.97), 0.91 (0.85-0.96), 0.84 (0.77-0.91), 0.84 (0.74-0.96), and 0.81 (0.73-0.90) with cancer mortality; and 0.88 (0.83-0.93), 0.86 (0.80-0.93), 0.81 (0.73-0.90), 0.71 (0.60-0.85), and 0.73 (0.64-0.84) with CVD mortality, respectively. Subgroup analyses showed that meeting 50 AQ a week was associated with lower risk of disease specific mortality risk across age groups and among individuals with known risk factors. Higher weekly AQ scores were also associated with longer life expectancy, with the highest gains observed among those achieving 150-199 weekly AQ.

CONCLUSION

Our findings show that AQ may be an objective tool for assessing and tracking PA and predicting mortality risks. Encouraging individuals to achieve ≥50 AQ a week could have substantial public health benefits, including lower mortality from major chronic diseases as well as prolonged health- and life expectancy.

The impact of preschool children's physical fitness evaluation under self organizing maps neural network

To improve the scientific accuracy and precision of children's physical fitness evaluations, this study proposes a model that combines self-organizing maps (SOM) neural networks with cluster analysis. Existing evaluation methods often rely on traditional, single statistical analyses, which struggle to handle the complexity of high-dimensional, nonlinear data, resulting in a lack of precision and personalization. This study uses the SOM neural network to reduce the dimensionality of high-dimensional health data. Moreover, it integrates cluster analysis to categorize and analyze key physical fitness attributes, such as strength, flexibility, and endurance. Experimental results show that the proposed optimized model outperforms comparison models such as T-distributed stochastic neighbor embedding, density peak clustering, and deep embedded clustering in terms of performance. The accuracy for the strength dimension reaches 0.934, the F1 score is 0.862, and the area under the curve of receiver operating characteristic is 0.944. The silhouette coefficients for cluster analysis in strength, flexibility, and endurance dimensions are 0.655, 0.559, and 0.601, respectively, demonstrating good intra-class and inter-class distances. The proposed model enhances the comprehensive analysis of children's physical fitness and provides a scientific basis for personalized health interventions, making an important contribution to research in this field.

Physical activity promotes well-being: medical students' engagement and perspective. A cross-sectional study scoped through innovation and technology

Background

The role of physical activity (PA) in health promotion is further complimented by its disease preventive value. Future doctors' involvement and advocacy in diverse aspects of such significant role is still under evaluation.

Objectives

This study aimed to assess medical students' overall PA engagement and their perspective, and to identify whether their level of engagement affects their advocacy and promotion, while discussing related educational innovations and technological advances.

Methods

Through a cross-sectional observational study design, stratified sampling from third-, fourth-, and fifth-year medical students attending Nile University, Sudan, during the period from February to April 2020, were included. Descriptive data analysis was done using the SPSS software, and presented including, frequencies, cross-tabulation, Chi-square testing with 95% confidence level, and a P value, after data collection via a structured questionnaire adopting parts of the IPAQ. Study has been reported in line with the STROCSS criteria.

Results

Out of 188 students, 43% males and 57% females, less than half (91, 48.40%) participated in planned PA, and majority (156, 82.98%) agreed with its health-related significance. Few (57, 30.32%) considered academic load as a barrier, and only 20 (10.60%) were not actively promoting PA engagement to others. Most PA participants were males (57.14%), leaning toward group-based activity (54, 59.34%), making regular plans (51, 56.04%) and motivated by self-health promotion (86, 94.51%) (P < 0.05). Despite majority of students (82.98%) agreement on PA's benefits, nearly half (51.60%) do not engage, Similarly, overall advocacy for PA promotion in relation to specific people was not statistically significant (P = 0.21). Embedding PA into undergraduate curriculum, use of PA report cards, exercise prescription training and targeted mentoring, in addition to digital bracelets, smart phone applications and internet-based social media, had positive impact on PA participation and promotion.

Conclusion

Medical students' understanding of PA health related significance did not equate to increase engagement, despite active promotion. Curricular integration of PA should accompany recent innovative educational strategies to increase their participation and advocation. Future studies are needed to evaluate the role of technology-based and AI-driven PA in achieving this goal.

Effect of digital monitoring and counselling on self-management ability in patients with rheumatoid arthritis: a randomised controlled trial

OBJECTIVES

To assess a remote physiotherapist (PT) counselling intervention using self-monitoring tools for improving self-management ability, physical activity participation and health outcomes in people with rheumatoid arthritis (RA).

METHODS

Eligible participants were randomly assigned to receive group education, a Fitbit®, a self-monitoring app, and PT counselling phone calls (Immediate Group). The Delayed Group received a monthly e-newsletter until week 26, and then the intervention. The primary outcome was Patient Activation Measure (PAM-13). Participants were assessed at baseline, 27 weeks (the primary end point) and 53 weeks. Secondary outcomes included disease activity, pain, fatigue, depression, sitting/walking habits, daily physical activity time and daily awake sedentary time. Generalized Linear Mixed-effect Models (GLMMs) were used to assess the effect of the intervention on the change of each outcome measure from the initiation to 27 weeks after the intervention.

RESULTS

Analysis included 131 participants (91.6% women; 80.2% completed during the COVID-19 pandemic). The mean change of PAM-13 at 27 weeks was 4.6 (Standard Deviation [SD] = 14.7) in the Immediate Group vs -1.6 (SD = 12.5) in the Delayed Group. The mean change in Delayed Group at 53 weeks (after the 26-week intervention) was 3.6 (SD = 14.6). Overall, the intervention improved PAM-13 at 27 weeks post-intervention from the GLMM analysis (adjusted coefficient: 5.3; 95% CI: 2.0, 8.7; P ≤ 0.001). Favourable intervention effects were also found in disease activity, fatigue, depression and self-reported walking habit.

CONCLUSION

Remote counselling paired with self-monitoring tools improved self-management ability in people with RA. Findings of secondary outcomes indicate that the intervention had a positive effect on symptom management.

Spontaneous walking characteristics of patients with peripheral arterial disease

Background: Walking rehabilitation is the cornerstone of patients with peripheral arterial disease (PAD) treatment. In order to propose a personalised walking rehabilitation program to each patient, it is important to know the PAD-patients walking characteristics. Such data are lacking in the literature. The aim of this study was to analyse the spontaneous walking characteristics of PAD patients. Patients and methods: This study was conducted between May 2016 and March 2018. Walking characteristics (cadence, stride, number of daily walking episodes, duration of an episode, distance covered during an episode, daily total walking duration and distance, walking speed) were recorded by Withings Pulse O2® activity trackers for one week in patients with asymptomatic or symptomatic PAD. Walking intensity was classified as ambling pace (<2 METs), slow walking (2-3 METs) and active walking (>3 METs). Study protocol has been approved by an independent ethics committee. Results: Eighty-seven patients were included (males 87%, mean age 66 ± 9 years, intermittent claudication 86%, right ankle brachial index (ABI) = 0.80 ± 0.19 and left ABI = 0.79 ± 0.15). The mean recording duration was 8 ± 1.2 days. Most of the steps were shuffling pace (shuffling pace 55.7%, active walking 32.8%, slow walking 11.5%). There was no significant difference between weekdays and weekend days nor for cadence, stride, episode duration, distance covered during an episode, number of daily walking episodes, daily total walking duration and distance. The average duration of active walking episodes was 3 minutes. Duration of active walking was less than 3 minutes in 66% of patients with a mean duration of 1 minute and 55 seconds. Conclusion: Analysis of PAD patients spontaneous walking characteristics with an activity tracker can get the maximum active walking duration achieved by each patient and be useful to offer a personalised walking rehabilitation program.

Exploring the Use of Activity Trackers to Support Physical Activity and Reduce Sedentary Behavior in Adults Diagnosed With Type 2 Diabetes: Qualitative Interview Study Using the RE-AIM Framework

Background

The prevalence of type 2 diabetes in adults worldwide is increasing. Low levels of physical activity and sedentary behavior are major risk factors for developing the disease. Physical activity interventions incorporating activity trackers can reduce blood glucose levels in adults diagnosed with type 2 diabetes. The My Diabetes My Way website is a support and educational platform for people diagnosed with diabetes and health care professionals. Users of the My Diabetes My Way website can upload their Fitbit (Google Inc) activity data into the system but this is not presently being analyzed and used routinely within clinical care. Developers of the My Diabetes My Way system are planning to allow different makes of activity trackers to be integrated with the platform.

Objective

This qualitative study aimed to explore (through the RE-AIM [reach, effectiveness, adoption, implementation, and maintenance] framework) views from adults diagnosed with type 2 diabetes and health care professionals on the integration of activity trackers into type 2 diabetes care.

Methods

Overall, 12 adults diagnosed with type 2 diabetes and 9 health care professionals (4 general practitioners, 1 consultant, 2 diabetes nurses, 1 practice nurse, and 1 physical activity advisor) were recruited through social media and professional contacts. Semistructured one-to-one interviews were conducted. Abductive thematic analysis was undertaken, and main themes and subthemes were identified. The RE-AIM framework was used to evaluate the themes with respect to the wider use of activity trackers and the My Diabetes My Way platform within type 2 diabetes clinical care.

Results

Overall, 6 main themes (awareness, access, cost, promotion, support, and technology and data) and 20 subthemes were identified. Evaluation using the 5 RE-AIM dimensions found that reach could be improved by raising awareness of the My Diabetes My Way platform and the ability to upload activity tracker data into the system. Effectiveness could be improved by implementing appropriate personalized measures of health benefits and providing appropriate support for patients and health care staff. Adoption could be improved by better promotion of the intervention among stakeholders and the development of joint procedures. Implementation could be improved through the development of an agreed protocol, staff training, and introducing measurements of costs. Maintenance could be improved by supporting all patients for long-term engagement and measuring improvements to patients' health.

Conclusions

Through this study, we identified how the reach, effectiveness, adoption, implementation, and maintenance of integrating activity trackers into adult type 2 diabetes care could be improved.

Dynamic Prediction of Physical Exertion: Leveraging AI Models and Wearable Sensor Data During Cycling Exercise

Background/Objectives: This study aimed to explore machine learning approaches for predicting physical exertion using physiological signals collected from wearable devices. Methods: Both traditional machine learning and deep learning methods for classification and regression were assessed. The research involved 27 healthy participants engaged in controlled cycling exercises. Physiological data, including ECG, heart rate, oxygen saturation, and pedal speed (RPM), were collected during these sessions, which were divided into eight two-minute segments. Heart rate variability (HRV) was also calculated to serve as a predictive indicator. We employed two feature selection algorithms to identify the most relevant features for model training: Minimum Redundancy Maximum Relevance (MRMR) for both classification and regression, and Univariate Feature Ranking for Classification. A total of 34 traditional models were developed using MATLAB's Classification Learner App, utilizing 20% of the data for testing. In addition, Long Short-Term Memory (LSTM) networks were trained on the top features selected by the MRMR and Univariate Feature Ranking algorithms to enhance model performance. Finally, the MRMR-selected features were used for regression to train the LSTM model for predicting continuous outcomes. Results: The LSTM model for regression demonstrated robust predictive capabilities, achieving a mean squared error (MSE) of 0.8493 and an R-squared value of 0.7757. The classification models also showed promising results, with the highest testing accuracy reaching 89.2% and an F1 score of 91.7%. Conclusions: These results underscore the effectiveness of combining feature selection algorithms with advanced machine learning (ML) and deep learning techniques for predicting physical exertion levels using wearable sensor data.

Causal effects of sedentary breaks on affective and cognitive parameters in daily life: a within-person encouragement design

Understanding the complex relationship between sedentary breaks, affective well-being and cognition in daily life is critical as modern lifestyles are increasingly characterized by sedentary behavior. Consequently, the World Health Organization, with its slogan "every move counts", emphasizes a central public health goal: reducing daily time spent in sedentary behavior. Previous studies have provided evidence that short sedentary breaks are feasible to integrate into daily life and can improve affective and cognitive parameters. However, observational studies do not allow for causal interpretation. To overcome this limitation, we conducted the first empirical study that integrated the within-person encouragement approach to test the causal effects of short 3-min sedentary breaks on affective and cognitive parameters in daily life. The results suggest that brief sedentary breaks may have a beneficial impact on valence and energetic arousal. Moreover, our methodological approach powerfully demonstrated the possibility of moving towards causal effects in everyday life.

From Wristbands to Implants: The Transformative Role of Wearables in Heart Failure Care

BACKGROUND

Heart failure (HF) management increasingly relies on innovative solutions to enhance monitoring and care. Wearable devices, originally popularized for fitness tracking, show promise in clinical decision-making for HF. This study explores the application and potential for the broader integration of wearable technology in HF management, emphasizing remote monitoring and personalized care.

METHODS

A comprehensive literature review was performed to assess the role of wearables in HF management, focusing on functionalities like vital sign tracking, patient engagement, and clinical decision support. Clinical outcomes and barriers to adopting wearable technology in HF care were critically analyzed.

RESULTS

Wearable devices increasingly track physiological parameters relevant to HF, such as heart rate, physical activity, and sleep. They can identify at-risk patients, promote lifestyle changes, facilitate early diagnosis, and accurately detect arrhythmias that lead to decompensation. Additionally, wearables may assess fluid status, identifying early signs of decompensation to prevent hospitalization and supporting therapeutic adjustments. They also enhance physical activity and optimize cardiac rehabilitation programs, improving patient outcomes. Both wearable and implanted cardiac devices enable continuous, non-invasive monitoring through small devices. However, challenges like data integration, regulatory approval, and reimbursement impede their widespread adoption.

CONCLUSIONS

Wearable technology can transform HF management through continuous monitoring and early interventions. Collaboration among involved parties is essential to overcome integration challenges and validate most of these devices in clinical practice.

Effects of physical exercise on cardio-respiratory health of young adults during short-term exposure to varying air pollution levels

BACKGROUND

Air pollution (AP) has become a substantial environmental issue affecting human cardiorespiratory health. Physical exercise (PE) is widely accepted to promote cardiorespiratory health. There is a paucity of research on the point at which the level of polluted environment engaged in PE could be used as a preventive approach to compensate for the damages of AP.

OBJECTIVES

To assess the effects of acute moderate-intensity PE on the cardio-respiratory and inflammatory responses of young adults in varying levels of AP, and to determine the pollution level at which engaging in short-term PE is considered safe.

METHODS

We constructed a real-world crossover study of 30 healthy young adults with repeated measures. Participants participated in 90 min of moderate-intensity PE in different (low, medium, high) AP exposure scenarios. Cardiorespiratory health was measured by assessing systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), mean forced expiratory flow between 25% and 75% of FVC (FEF25-75%), and fractional exhaled nitric oxide (FeNO) before and after the intervention. Blood samples were also collected simultaneously. The percentage changes in cardiorespiratory health markers after exercise in the three AP levels environments were compared using linear mixed-effects models.

RESULTS

Compared to the changes observed post-exercise in the low-level AP environment, only PEF (-9.36, P = 0.018) showed a significant decrease, and eosinophils showed a significant increase in the medium-level environment (25.64, P = 0.022), with no significant differences in other indicators. Conversely, post-exercise in the high-level AP environment resulted in a significant increase in DBP (6.5, P = 0.05), lung inflammation (FeNO: 13.3, p < 0.001), inflammatory cell counts (WBC: 27.0, p < 0.001; neutrophils: 26.8, p < 0.001; lymphocytes: 32.2, p < 0.001; monocytes: 28.2, p < 0.001; and eosinophils: 48.9, p < 0.001), and inflammatory factors (IL-1β: 0.76, P = 0.003; IL-10: 0.17, P = 0.02; IL-6: 0.1, P = 0.17; TNF-α: 0.97, P = 0.011; CRP: 0.17, P = 0.003). Additionally, there were significant declines in lung function parameters, including FVC (-6.84, P = 0.04), FEV1 (-8.97, P = 0.009), and PEF (-9.50, P = 0.013).

CONCLUSIONS

Acute PE in low and medium-level AP environments is generally secure concerning short-term effects on cardiorespiratory health among healthy young adults. However, acute PE in high-level AP environments can be detrimental to cardiorespiratory health, significantly increasing the body's inflammatory response.

TRIAL REGISTRATION

ChiCTR2000031851; Registered 12.04.2020.