Changes in lifestyles, cognitive impairment, quality of life and activity day living after combined use of smartphone and smartband technology: a randomized clinical trial (EVIDENT-Age study)

Effectiveness of Mobile Health Interventions for Reducing Sitting Time in Older Adults: Systematic Review and Meta-Analysis

BACKGROUND

Mobile health (mHealth) provides health information through electronic devices, even at home. The escalating prevalence of sedentary behaviors among older adults, which leads to increased adverse health outcomes, underscores the pressing need for a comprehensive understanding of the effectiveness of mHealth interventions.

OBJECTIVE

This study aims to examine the effectiveness of mHealth interventions in the sitting time of older adults (age 55 years).

METHODS

A systematic review and meta-analysis of randomized controlled trials was conducted to evaluate the effects of mHealth interventions on total sitting time during waking hours, excluding sleep. A literature search was conducted using multiple databases, including PubMed, Embase, Web of Science, and Cochrane, covering articles published from the inception of each database through October 2023. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were explicitly applied to structure this report. Methodological quality was assessed using the Cochrane Risk of Bias (ROB 2) tool for randomized controlled trials and the Methodological Index for Non-Randomized Studies (MINORS) tool for nonrandomized studies. Two independent reviewers screened the studies, extracted data, and assessed methodological quality using established criteria. Meta-analyses were performed using Review Manager (version 5.4; Cochrane Collaboration).

RESULTS

Ten studies were identified, of which 3 were included in the meta-analysis, while the remaining 7 were assessed exclusively in the systematic review. The interventions predominantly took place in community settings (n=3) and home-based settings (n=3). Three studies aimed to decrease sedentary behavior and 7 aimed to increase physical activity. The interventions were primarily conducted once daily (n=7) via mobile devices such as smartphones (n=7) and typically involved a single intervention delivered at different time intervals, such as every 15, 20, or 30 minutes (n=4). The interventions typically lasted 12 weeks (n=4) and used objective assessment tools, such as the ActiGraph GT3X+ (n=8). The included studies applied the habit formation theory (n=1), the self-efficacy theory (n=1), the social cognitive theory (n=1), and the social-ecological theory (n=1) as frameworks. Additionally, behavior change techniques, including "goal setting," "problem-solving," "action planning," and "review behavior goal(s)" (n=6), were used. Meta-analysis of the 3 studies included showed a significant decrease in sedentary behavior with mHealth interventions compared with conventional or no interventions (weighted mean difference [WMD]=59.1 min/d, 95% CI 99.1 to 20.2; P=.003).

CONCLUSIONS

mHealth interventions effectively reduce sitting time in older adults. Strategies using interventions with specific frequencies and durations, dedicated mobile monitoring devices, and behavior change techniques showed the potential to reduce sedentary behavior among older adults. These results also underscore the potential of mHealth as a key tool for promoting the well-being of older adults through technology-driven public health efforts.

TRIAL REGISTRATION

PROSPERO CRD42023443926; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023443926.

Telehealth intervention involving the HEARTS Technical Package and the additional use of an activity monitor to increase physical activity level post-stroke: Protocol for a feasibility randomized controlled trial

BACKGROUND

Low physical activity level is a common risk factor for recurrent stroke. Feasibility studies show behavior change interventions can increase physical activity participation, but face barriers (e.g., home visits or internet access). Low-cost telehealth approaches, like telephone calls, may overcome these challenges. Another low-cost strategy involves motivational tools supporting "Behavioral Regulation," such as physical activity monitors. However, evidence is insufficient to support their use in increasing physical activity levels post-stroke. A systematic review suggests integrating these devices into multifaceted behavior change interventions (e.g., the 5As brief intervention outlined in the HEARTS Technical Package) may enhance their effectiveness. Combined with physical activity monitors and telephone follow-up, this approach has proven feasible for individuals post-stroke. These findings underscore the need to explore combining the 5As brief intervention with physical activity monitors to assess potential added benefits. This feasibility randomized controlled trial (RCT) study will investigate whether the telehealth intervention (by telephone call) combining the 5As brief intervention, as outlined in the HEARTS Technical Package, and physical activity monitoring, compared to a control group receiving only the 5As brief intervention, is feasible and supports a fully powered RCT.

METHODS

A feasibility RCT study, with blinded assessment, will assign 24 individuals post-stroke (diagnosed ≥ 6 months), aged ≥ 18 years, inactive, able to walk 10 meters independently, and medically approved for physical activity, to experimental (n = 12) or control group (n = 12). Both groups will undergo the 5As brief intervention (Ask, Advise, Assess, and Assist delivered face-to-face, and Arrange via telephone call follow-up), for 12 weeks, with the experimental group also using a physical activity monitor. Outcomes include feasibility of recruitment, intervention, measurement, and blinding the outcome assessor, cost and clinical outcomes.

DISCUSSION

The intervention aligns with stroke secondary prevention recommendations and utilizes low-cost telehealth approaches. This study will contribute to defining future RCT phases.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06068036.

The effectiveness of digital technology interventions for cognitive function in older adults: a systematic review and meta-analysis of randomized controlled trials

Digital technology interventions (DTIs) are seen as promising interventions to prevent or delay cognitive decline in older adults, yet evidence from reviews is not conclusive. The aim of this study is to explore the effectiveness of DTIs in improving older adults' cognitive function while taking study design and intervention characteristics as moderators. We searched the PubMed, Embase, CINAHL, PsycINFO, and Scopus databases up to May 26, 2023. Only randomized controlled trials examined the effects of DTIs on cognitive function were included in our study. Standardized mean difference (SMD) and 95% confidence interval for outcomes were applied in meta-analyses and subgroup analyses. A risk of bias assessment was also conducted. Overall, 23 eligible studies with a total sample size of 1454 participants were included. We found that DTIs significantly improved global cognitive function (SMD = 0.479), attention and processing speed (SMD = 0.488), executive function (SMD = 0.287), immediate recall (SMD = 0.266), and working memory (SMD = 0.307). Our subgroup analyses revealed that DTIs were more effective for cognitively impaired subjects, and DTIs with specific intervention characteristics, such as the inclusion of cognitive standard tasks, virtual reality-based interventions, specialized settings, professional guidance, low/medium-density training, > 24 sessions, and sessions lasting > 30 min, were more effective for different cognitive domains. This study supported the effectiveness of DTIs in improving cognitive function in older adults aged 60 years old and over, which may be influenced by study design and intervention characteristics. These findings have important implications for clinical dementia prevention and treatment strategies targeted at specific cognitive domains.

Exploring the Feasibility of a 5-Week mHealth Intervention to Enhance Physical Activity and an Active, Healthy Lifestyle in Community-Dwelling Older Adults: Mixed Methods Study

BACKGROUND

Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA).

OBJECTIVE

The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot.

METHODS

Our study used a mixed methods approach to evaluate the MIA app's acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based.

RESULTS

The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6%. Analysis showed general satisfaction with the app's workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants.

CONCLUSIONS

The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515.

The Internet of Things in the Nutritional Management of Patients with Chronic Neurological Cognitive Impairment: A Scoping Review

BACKGROUND/OBJECTIVES

The Internet of Things (IoT) technology connects objects to the internet, and its applications are increasingly used in healthcare to improve the quality of care. However, the use of IoT for the nutritional management of patients with chronic neurological cognitive impairment is still in development. This scoping review aims to describe the integration of IoT and its applications to support monitoring, interventions, and nutritional education for patients with chronic neurological cognitive impairment.

METHODS

A scoping review was conducted using the Cochrane, PubMed/Medline, CINAHL, Embase, Scopus, and Web of Science databases following the Arksey and O'Malley framework.

RESULTS

Of the 1424 records identified, 10 were included in the review. Most of the articles were peer-reviewed proceedings from technology conferences or publications in scientific and technology journals. IoT-based innovations in nutritional management were discussed in methodological articles, case studies, or project descriptions. Innovations were identified across three key areas: monitoring, intervention, and education.

CONCLUSIONS

IoT technology offers promising innovations for the nutritional management of patients with chronic neurological cognitive impairment. However, IoT capabilities in this field are still in the early stages of development and are not yet highly specific.

Are Mobile Apps Effective at Targeting Physical Activity or Malnutrition in Community-Dwelling Older Adults? A Systematic Review and Meta-Analysis

This systematic review aims to identify the effectiveness of digital health applications (apps) to increase physical activity (PA) or prevent malnutrition in community-dwelling older adults. Searches were conducted in June 2023 across seven electronic databases (MEDLINE, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, Allied and Complementary Medicine Database, and Cochrane Central Register of Controlled Trials), and grey literature were searched via google scholar. Data from studies that met the inclusion criteria were extracted. Risk of bias was assessed, and the quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation. Meta-analyses were undertaken where appropriate using DerSimonian and Laird random-effects model (Stata version 16.1), or data were described narratively. Twenty-seven studies met the eligibility criteria, although 23 of these had low or unclear risk of bias. Twelve studies considered PA outcomes only, two studies considered nutritional outcomes only, and three studies considered both PA and nutritional components. A meta-analysis comprising six studies (818 participants) showed that those using a digital health app had a higher step count compared with participants in the control group (mean difference = 799, 95% CI [48.76, 1550.08]). Studies looking at nutritional outcomes aimed to increase protein intake or adherence to dietary patterns with mixed findings. Digital health apps have the potential to increase PA in community-dwelling older adults. Digital health app interventions that aim to reduce the risk of malnutrition in older adults is a relatively unexplored area with mixed findings, so more high-quality studies should be prioritized.

Effect of Dietary Patterns on Vascular Aging Using the Brachial-Ankle Index

The Mediterranean diet (MD) plays an important role in delaying vascular aging. The main objective of this study was to analyze the association between adherence to the MD and vascular aging estimated with brachial-ankle pulse wave velocity (ba-PWV) in a Spanish population sample and the differences by sex.

METHODS

Cross-sectional descriptive study. A total of 3437 subjects from the EVA, MARK and EVIDENT studies participated. The ba-PWV was assessed with the Vasera VS-1500® device. Vascular aging was classified as healthy vascular aging (HVA), normal vascular aging (NVA) and early vascular aging (EVA) and adherence to the MD was assessed with the Mediterranean Diet Adherence Screener questionnaire.

RESULTS

The mean age was 60.15 ± 9.55 (60.09 ± 9.71 in women; 60.20 ± 9.43 in men). Overall, MD adherence was observed in 48.0% of subjects (40% in women; 54% in men). The mean value of ba-PWV was 14.38 ± 2.71 (women 14.24 ± 2.89; men 14.49 ± 2.56). In multinomial logistic regression a positive association was found overall between HVA and NVA (OR = 1.751, 95% CI: 1.411-2.174, p < 0.001) and between HVA and EVA (OR = 1.501, 95% CI:1.295-1.740, p < 0.001); in women between HVA and NVA (OR = 2. 055, 95% CI:1.456-2.901, p < 0.001) and between HVA and EVA (OR = 1.413, 95% CI:1.124-1.776; p = 0.003); and in men between HVA and NVA (OR = 1.551, 95% CI: 1.175-2.047, p = 0.002) and between HVA and EVA (OR = 1.549, 95% CI: 1.275-1.882; p < 0.001).

CONCLUSIONS

The results of this work indicate that greater adherence to the MD is associated with healthier vascular aging.

Smartphone use by older adult in the healthy ageing process: a theory based on data

BACKGROUND

(1) Older adult are still segregated from young people when it comes to technology.

BACKGROUND

(2) On a daily basis, older people recognize the need, usefulness and applicability of the smartphone.

BACKGROUND

(3) Older adult are gradually moving towards digital skills.

BACKGROUND

(4) Digital tools are means of enhancing healthy ageing.

BACKGROUND

(5) WhatsApp ® groups help older people to engage virtually with peers.

to understand the feelings and recognitions of older adults when they experience the use of smartphones in everyday life, as well as the implications for the healthy aging process.

qualitative research, using the Unified Theory of Acceptance and Use of Technology; the Senior Technology Acceptance & Adoption Model and the methodological framework of Constructivist Grounded Theory. We intentionally recruited people aged 60+; smartphone users; participants for 6 months or more in an extension project, without cognitive impairment, determined by theoretical sampling. A semi-structured script guided data collection. Constant and concomitant comparative analysis followed the steps of initial and focused coding, supported by memos, until theoretical saturation. The Sankey diagram was used to analyze the data, using Atlas.ti software.

37 participants were allocated to two sample groups. We present the category "Experiencing technological evolution during the aging process" and two subcategories: "Experiencing feelings when aging in the face of technological development"; "Using the smartphone and recognizing new experiences".

when experiencing the use of smartphones, older adult understand and recognize the search for digital skills based on their need for usefulness and applicability of information and communication technology in their daily lives, integrating it into the healthy ageing process.

Smartphone applications for nutrition Support: A systematic review of the target outcomes and main functionalities

INTRODUCTION

A proper nutrition is essential for human life. Recently, special attention on this topic has been given in relation to three health statuses: obesity, malnutrition and specific diseases that can be related to food or treated with specific diets. Mobile technology is often used to assist users that wish to regulate their eating habits, and identifying which fields of application have been explored the most by the app developers and which main functionalities have been adopted can be useful in view of future app developments.

METHODS

We selected 322 articles mentioning nutrition support apps through a literature database search, all of which have undergone an initial screening. After the exclusion of papers that were already reviews, not presenting apps or not focused on nutrition, not relevant or not developed for human subjects, 100 papers were selected for subsequent analyses that aimed at identifying the main treated conditions, outcome measures and functionalities implemented in the Apps.

RESULTS

Of the selected studies, 33 focus on specific diseases, 24 on obesity, 2 on malnutrition and 41 on other targets (e.g., weight/diet control). Type 2 diabetes is the most targeted disease, followed by gestational diabetes, hypertension, colorectal cancer and CVDs which all were targeted by more than one app. Most Apps include self-monitoring and coaching functionalities, educational content and artificial intelligence (AI) tools are slightly less common, whereas counseling, gamification and questionnaires are the least implemented. Body weight and calories/nutrients were the most common general outcome measures, while glycated hemoglobin (HbA1c) was the most common clinical outcome. No statistically significant differences in the effectiveness of the different functionalities were found.

CONCLUSION

The use of mobile technology to improve nutrition has been widely explored in the last years, especially for weight control and specific diseases like diabetes; however, other food-related conditions such as Irritable Bowel Diseases appear to be less targeted by newly developed smartphone apps and their related studies. All different kinds of functionalities appear to be equally effective, but further specific studies are needed to confirm the results.

The Effects of ICT-Based Interventions on Physical Mobility of Older Adults: A Systematic Literature Review and Meta-Analysis

Systematic literature review and meta-analysis were conducted to integrate and analyze intervention studies dealing with the effects of information and communications technology- (ICT-) based interventions on the physical mobility of older adults in the community. The PubMed/MEDLINE, Embase, CINAHL, and Cochrane CENTRAL databases were searched for studies published from January 2000 to December 2022. We used the Risk of Bias 2 (RoB 2) tool to evaluate the quality of the randomized controlled studies in the systematic review. The meta-analysis was performed using a random-effects model. The model was used to calculate the standardized mean difference (SMD) and 95% confidence interval (CI) for both effect measures. I2 tests were used to measure the presence of heterogeneity. Thirty-seven randomized controlled trials were included (2,419 intervention participants), of which 23 were included in the meta-analysis. ICT interventions significantly improved Timed Up and Go (TUG) as a marker of physical mobility variable in older adults (SMD = -0.33, 95% CI: -0.57 to -0.10, p=0.005, I2 = 74.7%). A sensitivity analysis was performed on subgroups, and interventions were found to be effective in improving TUG in the exergame group (SMD = -0.40, 95% CI: -0.72 to -0.08, p < 0.001, I2 = 75.0%) and in the exergame with virtual reality (VR) group (SMD = -0.33, 95% CI: -1.01 to 0.35, p < 0.001, I2 = 91.0%) but both groups showed high heterogeneity. A meta-analysis was also performed on Short Physical Performance Battery (SPPB) but statistically significant results were not found (SMD = -0.19, 95% CI: -0.61 to 0.23, p=0.375, I2 = 87.7%). For the Berg Balance Scale (BBS), the post-intervention scores were significantly better than baseline (SMD = 1.52, 95% CI: 0.48 to 2.57, p=0.004, I2 = 93.5%). However, the number of studies included in the meta-analysis was small and heterogeneity was high, so follow-up studies are needed. This study confirmed that exergames, telecommunication, e-health, information applications, and robots were used as effective ICT-based interventions for improving the physical mobility of older adults. It is necessary to develop and apply more diverse ICT-based interventions that will prevent impairments of mobility and encourage older adults to live more independently, with a higher quality of life, based on extensive research on ICT-based interventions.