Using an electronic activity monitor system as an intervention modality: A systematic review

Wearable Devices Beyond Activity Trackers in Youth With Obesity: Summary of Options

Background: Current treatment protocols to prevent and treat pediatric obesity focus on prescriptive lifestyle interventions. However, treatment outcomes are modest due to poor adherence and heterogeneity in responses. Wearable technologies offer a unique solution as they provide real-time biofeedback that could improve adherence to and sustainability of lifestyle interventions. To date, all reviews on wearable devices in pediatric obesity cohorts have only explored biofeedback from physical activity trackers. Hence, we conducted a scoping review to (1) catalog other biofeedback wearable devices available in this cohort, (2) document various metrics collected from these devices, and (3) assess safety and adherence to these devices. Methods: This scoping review was conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Fifteen eligible studies examined the use of biofeedback wearable devices beyond activity trackers in pediatric cohorts, with an emphasis on feasibility of these devices. Results: Included studies varied in sample sizes (15-203) and in ages 6-21 years. Wearable devices are being used to capture various metrics of multicomponent weight loss interventions to provide more insights about glycemic variability, cardiometabolic function, sleep, nutrition, and body fat percentage. High safety and adherence rates were reported among these devices. Conclusions: Available evidence suggests that wearable devices have several applications aside from activity tracking, which could modify health behaviors through real-time biofeedback. Overall, these devices appear to be safe and feasible so as to be employed in various settings in the pediatric age group to prevent and treat obesity.

Wearable Devices to Improve Physical Activity and Reduce Sedentary Behaviour: An Umbrella Review

BACKGROUND

Several systematic reviews (SRs), with and without meta-analyses, have investigated the use of wearable devices to improve physical activity, and there is a need for frequent and updated syntheses on the topic.

OBJECTIVE

We aimed to evaluate whether using wearable devices increased physical activity and reduced sedentary behaviour in adults.

METHODS

We conducted an umbrella review searching PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, MedRxiv, Rxiv and bioRxiv databases up to February 5th, 2023. We included all SRs that evaluated the efficacy of interventions when wearable devices were used to measure physical activity in adults aged over 18 years. The primary outcomes were physical activity and sedentary behaviour measured as the number of steps per day, minutes of moderate to vigorous physical activity (MVPA) per week, and minutes of sedentary behaviour (SB) per day. We assessed the methodological quality of each SR using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR 2) and the certainty of evidence of each outcome measure using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). We interpreted the results using a decision-making framework examining the clinical relevance and the concordances or discordances of the SR effect size.

RESULTS

Fifty-one SRs were included, of which 38 included meta-analyses (302 unique primary studies). Of the included SRs, 72.5% were rated as 'critically low methodological quality'. Overall, with a slight overlap of primary studies (corrected cover area: 3.87% for steps per day, 3.12% for MVPA, 4.06% for SB) and low-to-moderate certainty of the evidence, the use of WDs may increase PA by a median of 1,312.23 (IQR 627-1854) steps per day and 57.8 (IQR 37.7 to 107.3) minutes per week of MVPA. Uncertainty is present for PA in pathologies and older adults subgroups and for SB in mixed and older adults subgroups (large confidence intervals).

CONCLUSIONS

Our findings suggest that the use of WDs may increase physical activity in middle-aged adults. Further studies are needed to investigate the effects of using WDs on specific subgroups (such as pathologies and older adults) in different follow-up lengths, and the role of other intervention components.

Sleep behavior and daily activity levels in people with metabolic syndrome: effect of 1 year of metformin treatment

Impaired sleep and low daily activity levels increase the risk of developing metabolic syndrome (MS). Metformin (MET), an insulin sensitizer drug, is effective in regressing MS and has been recently studied as an adjuvant agent for managing sleep disorders. The present study aimed to assess whether 1,700 mg/day of MET treatment modifies sleep and daily activity levels in people with MS evaluated by Rest-Activity circadian Rhythm (RAR), which is the expression of 24 h of spontaneous activity parameters. A total of 133 subjects with MS, randomized into the MET (n = 65) or placebo (PLA, n = 68) group, underwent a clinical/anthropometric examination and carried out a continuous 7-day actigraphic monitoring to investigate sleep and RAR parameters at baseline and after 1 year of intervention. After 1 year of intervention, 105 subjects were analyzed. The MET group showed greater anthropometric and metabolic improvements compared with placebo, with a significant reduction in weight (p = 0.01), body mass index (p = 0.01), waist circumference (p = 0.03), and glucose (p < 0.001). With regard to sleep parameters, the MET group showed a significant increase in actual sleep time (p = 0.01) and sleep efficiency (p = 0.04) compared with placebo. There were no significant changes reported in the RAR parameters. Our study suggests that MET might be used as an adjuvant treatment for sleep disorders in people with MS.

Health Wearables, Gamification, and Healthful Activity

Health wearables in combination with gamification enable interventions that have the potential to increase physical activity-a key determinant of health. However, the extant literature does not provide conclusive evidence on the benefits of gamification and there are persistent concerns that competition-based gamification approaches will only benefit those who are highly active at the expense of those who are sedentary. We investigate the effect of Fitbit leaderboards on the number of steps taken by the user. Using a unique dataset of Fitbit wearable users, some of whom participate in a leaderboard, we find that leaderboards lead to a 370 (3.5%) step increase in the users' daily physical activity. However, we find that the benefits of leaderboards are highly heterogeneous. Surprisingly, we find that those who were highly active prior to adoption are hurt by leaderboards and walk 630 fewer steps daily post adoption (a 5% relative decrease). In contrast, those who were sedentary prior to adoption benefited substantially from leaderboards and walked an additional 1,300 steps daily after adoption (a 15% relative increase). We find that these effects emerge because sedentary individuals benefit even when leaderboards are small and when they do not rank first on them. In contrast, highly active individuals are harmed by smaller leaderboards and only see benefit when they rank highly on large leaderboards. We posit that this unexpected divergence in effects could be due to the underappreciated potential of non-competition dynamics (e.g., changes in expectations for exercise) to benefit sedentary users, but harm more active ones.

How digital health technologies promote healthy life in the Post-COVID-19 Era: evidences from national survey on Chinese adolescents and youngsters

The rapid development of intelligent technologies coupled with the stay-at-home trends in the Post-COVID-19 Era has significantly changed youth's health behavior as well as reshaped their lifestyles. Digital health technologies (DHTs) have been more and more used for health management among youngsters. However, little was known about the use of DHTs among youths and its consequences on their health, especially in developing countries like China. Inspired by behavior intervention technology (BIT) model, this study examined the underlying mechanisms of use and social interactions of DHTs on Chinese adolescents' and youngsters' healthy lifestyles and mental health, using a representatively national survey among high school and freshman students in China (N = 2,297). It found that use of DHTs had a significantly positive effect on Chinese youths' healthy lifestyles and mental health, with behavioral regulation as a mediator. However, social interactions of DHTs were negatively associated with their mental health. The findings contribute to a better guidance on health promotion, as well as the enhanced design of DHTs' products.

Use of Wearable Activity-Monitoring Technologies to Promote Physical Activity in Cancer Survivors: Challenges and Opportunities for Improved Cancer Care

The aim of this review was to explore the acceptability, opportunities, and challenges associated with wearable activity-monitoring technology to increase physical activity (PA) behavior in cancer survivors. A search of Medline, Embase, CINAHL, and SportDiscus was conducted from 1 January 2011 through 3 October 2022. The search was limited to English language, and peer-reviewed original research. Studies were included if they reported the use of an activity monitor in adults (+18 years) with a history of cancer with the intent to motivate PA behavior. Our search identified 1832 published articles, of which 28 met inclusion/exclusion criteria. Eighteen of these studies included post-treatment cancer survivors, eight were on active cancer treatment, and two were long-term cancer survivor studies. ActiGraph accelerometers were the primary technology used to monitor PA behaviors, with Fitbit as the most commonly utilized self-monitoring wearable technology. Overall, wearable activity monitors were found to be an acceptable and useful tool in improving self-awareness, motivating behavioral change, and increasing PA levels. Self-monitoring wearable activity devices have a positive impact on short-term PA behaviors in cancer survivors, but the increase in PA gradually attenuated through the maintenance phase. Further study is needed to evaluate and increase the sustainability of the use of wearable technologies to support PA in cancer survivors.

The effectiveness of wearable activity trackers for increasing physical activity and reducing sedentary time in older adults: A systematic review and meta-analysis

Background

Traditional interventions such as education and counseling are successful in increasing physical activity (PA) participation, but are usually labor and resource intensive. Wearable activity trackers can objectively record PA and provide feedback to help users to achieve activity goals and are an increasingly popular tool among adults used to facilitate self-monitoring of PA. However, no reviews systematically explored the roles of wearable activity trackers in older populations.

Methods

We searched PubMed, Web of Science, Google Scholar, Embase, Cochrane Library, and Scopus from inception to September 10, 2022. Randomized controlled trials were included. Two reviewers independently conducted study selection, data extraction, risk of bias, and certainty of evidence assessment. A random-effects model was used to evaluate the effect size.

Results

A total of 45 studies with 7144 participants were included. A wearable activity tracker was effective in increasing daily steps (standard mean differences (SMD) = 0.59, 95% confidence interval (CI) (0.44, 0.75)), weekly moderate-to-vigorous PA (MVPA) (SMD = 0.54, 95% CI (0.36, 0.72)), and total daily PA (SMD = 0.21, 95% CI (0.01, 0.40)) and reducing sedentary time (SMD = -0.10, 95% CI (-0.19, -0.01)). Subgroup analysis showed that the effectiveness of wearable activity trackers for daily steps was not influenced by participants and intervention features. However, wearable activity trackers seemed more effective in promoting MVPA of participant's age <70 than participant's age ≥70. In addition, wearable activity trackers incorporated with traditional intervention components (e.g. telephone counseling, goal setting, and self-monitoring) could better promote MVPA than alone use. Short-term interventions potentially achieve better MVPA increase than long-term.

Conclusion

This review showed that wearable activity trackers are an effective tool to increase PA for the old population and also favor reducing sedentary time. When used together with other interventions, wearable activity trackers can achieve better MVPA increase, especially in the short term. However, how to more effectively improve the effectiveness of wearable activity trackers is an important direction of future research.

Effectiveness of pedometer- and accelerometer-based interventions in improving physical activity and health-related outcomes among college students: A systematic review and meta-analysis

Background

Although the pedometer- and accelerometer-based interventions (PABI) have demonstrated efficacy in improving physical activity (PA) and health-related outcomes, the dearth of empirical evidence in college students warrants further investigation.

Objective

This systematic review and meta-analysis aim to examine the effects of PABI on improving PA and health-related outcomes among college students.

Methods

PubMed, Web of Science, Embase, Cochrane Library, and PsycINFO were searched for relevant literature from inception to 20 February 2022. Randomized controlled trials (RCTs) conducted among college students with PABI to increase objectively measured PA as the primary outcome were included in this study.

Results

A total of nine RCTs with 527 participants were included in this study. The combined results showed that PABI significantly improved PA (standardized mean difference = 0.41, 95% confidence interval (CI): 0.08, 0.74, P = 0.016) and significantly contributed to weight loss (mean differences (MD) = -1.56 kg, 95% CI: -2.40 kg, -0.73 kg, P < 0.01), and lower body mass index (MD = -0.33 kg/m2, 95% CI: -0.66 kg/m2, 0.00 kg/m2, P = 0.05) compared to the control group, but no significant effects were observed on improvements of body fat (%) and exercise self-efficacy. Interventions in the group of step, general students, pedometer-based intervention, theory, and developed region were significantly more effective in subgroup analyses.

Conclusions

PABI was found to be effective in promoting PA and weight loss among college students. Future research is needed to further explore the long-term effects of PABI and the characteristics of multiple intervention models.

Nature-Based Feasibility Intervention to Influence Mitigation Strategies for Perceived Stress

Burnout, compassion fatigue, and perceived stress among undergraduate nursing students are significant factors leading to a poorer quality of life, decreased job satisfaction, and adversely impact patient outcomes. Burnout among undergraduate nursing students is a critical individual and workforce issue with contributing factors including a relentless schedule, academically challenging and rigorous programs, pressure to perform, and the completion of clinical hours caring for patients. This paper describes our feasibility study of a nature-based intervention (NBI) to reduce perceived stress and quality of life as it relates to burnout, and compassion fatigue. Quantitative data was collected through demographics, surveys, and electronic sensor data. The project's aim was to determine the feasibility of NBI monitored by NatureDose^TM to decrease perceived stress burnout and compassion fatigue among undergraduate nursing students.

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

Wearable activity trackers offer an appealing, low-cost tool to address physical inactivity. This systematic review of systematic reviews and meta-analyses (umbrella review) aimed to examine the effectiveness of activity trackers for improving physical activity and related physiological and psychosocial outcomes in clinical and non-clinical populations. Seven databases (Embase, MEDLINE, Ovid Emcare, Scopus, SPORTDiscus, the Cochrane Library, and Web of Science) were searched from database inception to April 8, 2021. Systematic reviews of primary studies using activity trackers as interventions and reporting physical activity, physiological, or psychosocial outcomes were eligible for inclusion. In total, 39 systematic reviews and meta-analyses were identified, reporting results from 163 992 participants spanning all age groups, from both healthy and clinical populations. Taken together, the meta-analyses suggested activity trackers improved physical activity (standardised mean difference [SMD] 0·3-0·6), body composition (SMD 0·7-2·0), and fitness (SMD 0·3), equating to approximately 1800 extra steps per day, 40 min per day more walking, and reductions of approximately 1 kg in bodyweight. Effects for other physiological (blood pressure, cholesterol, and glycosylated haemoglobin) and psychosocial (quality of life and pain) outcomes were typically small and often non-significant. Activity trackers appear to be effective at increasing physical activity in a variety of age groups and clinical and non-clinical populations. The benefit is clinically important and is sustained over time. Based on the studies evaluated, there is sufficient evidence to recommend the use of activity trackers.

Fitbit Use and Activity Levels From Intervention to 2 Years After: Secondary Analysis of a Randomized Controlled Trial

Background

There has been a rapid increase in the use of commercially available activity trackers, such as Fitbit, in physical activity intervention research. However, little is known about the long-term sustained use of trackers and behavior change after short-term interventions.

Objective

This study aims to use minute-level data collected from a Fitbit tracker for up to 2 years after the end of a randomized controlled trial to examine patterns of Fitbit use and activity over time.

Methods

Participants in this secondary data analysis were 75 female breast cancer survivors who had been enrolled in a 12-week physical activity randomized controlled trial. Participants randomized to the exercise intervention (full intervention arm) received a Fitbit One, which was worn daily throughout the 12-week intervention, and then were followed for 2 years after the intervention. Participants randomized to the waitlist arm, after completing the randomized controlled trial, received a Fitbit One and a minimal version of the exercise intervention (light intervention arm), and then were followed for 2 years after the intervention. Average and daily adherence and MVPA were compared between the 2 groups in the interventional and postinterventional periods using both linear and generalized additive mixed effects models.

Results

Adherence to wearing the Fitbit during the 12-week intervention period was significantly higher in the full intervention arm than in the light intervention arm (85% vs 60%; P<.001). Average adherence was significantly lower for both study arms during the follow-up period than in the intervention period; however, there were statistically different patterns of adherence during the follow-up period, with the light intervention arm having steeper declines than the full intervention arm over time (P<.001). Similar to the adherence results, mean minutes of Fitbit-measured MVPA was higher for the full intervention arm than for the light intervention arm during the 12-week intervention period (mean MVPA 27.89 minutes/day, SD 16.38 minutes/day vs 18.35 minutes/day, SD 12.64 minutes/day; P<.001). During the follow-up period, average MVPA was significantly lower than the 12-week intervention period for both the full intervention arm (21.74 minutes/day, SD 24.65 minutes/day; P=.002) and the light intervention arm (15.03 minutes/day, SD 13.27 minutes/day; P=.004). Although the mean MVPA in each arm was similar across the follow-up period (P=.33), the pattern of daily MVPA was significantly different between the 2 groups (P<.001).

Conclusions

While adherence to wearing activity trackers and maintaining physical activities declined after completion of a 12-week exercise intervention, a more active interventional strategy resulted in greater wear time and activity levels during the intervention and more stable patterns of adherence and activity in the long term. An improved understanding of long-term maintenance patterns may inform improved exercise interventions that result in sustained increases in physical activity.

Trial Registration

ClinicalTrials.gov NCT02332876; https://clinicaltrials.gov/ct2/show/NCT02332876

Examining the Dose-Response Relationship between Outdoor Jogging and Physical Health of Youths: A Long-Term Experimental Study in Campus Green Space

Many studies have demonstrated that outdoor physical activity positively affects the physical health of young people. Here, we aimed to examine the extent to which outdoor jogging was associated with the physical health of youths, and then to decipher whether a dose–response relationship exists between them. A total of 2852 youths from a Chinese university were enrolled in a long-term experimental study between September 2018 and September 2019. We conducted two waves of physical health tests for 2852 youths (before and after the jogging interventions in 2018 and 2019, respectively) using China’s National Student Physical Health Standard (NSPHS). Paired t-tests were used to examine statistical differences. A multiple regression model was used to evaluate the associations between jogging and physical health. The results showed that: statistically significant changes in the two waves of physical health outcomes were suggested after jogging interventions; outdoor jogging in campus green space was associated with participants’ physical health after controlling for covariates; and a dose–response relationship between jogging and physical health outcomes was revealed, with 120–140 km/year (approximately 3.43–4 km/week) being the most effective intervention dose. Our findings have implications for promoting physical health in youth groups by encouraging outdoor physical activity.

What Factors Predict the Adoption of Type 2 Diabetes Patients to Wearable Activity Trackers-Application of Diffusion of Innovation Theory

Background: Globally, diabetes has brought an enormous burden to public health resources, and the situation of disease burden caused by diabetes in China is especially severe. China is currently facing the dual threat of aging and diabetes, and wearable activity trackers could promote elderly diabetic patients' physical activity levels and help them to manage blood glucose control. Therefore, examining the influencing factors of elderly patients' adoption intention is critical as wearing adoption determines actual wearing behaviors. Objective: This study aims to explore the predicting factors of Chinese elderly type 2 diabetic patients' adoption intention to wearable activity trackers and their actual wearing behavior, using diffusion of innovation theory as the theoretical framework. We hope to provide insights into future interventions using wearable activity trackers as tools to improve the outcome of patients. Methods: Wearable activity trackers were freely distributed to type 2 diabetic patients in Beijing, China. A questionnaire survey was conducted to examine predicting factors of adoption intention after a week's try-on. Actual wearing behavior for 3-month was obtained from the exclusive cloud. Data were analyzed with structural equation modeling. Results: A total of 725 patients completed the questionnaire. Patients had a mean age of 60.3 ± 7.6 years old and the educational level was generally lower. The results indicated that observability was the primary influencing factor of patients' adoption intention (β = 0.775, P < 0.001). Relative advantage (β = 0.182, P = 0.014) and perceived social image (β = 0.080, P = 0.039) also had a positive influence while perceived risk (β = -0.148, P < 0.001) exerted a negative influence. In addition, results showed that the more intention led to the better actual wearing behavior (β = 0.127, P = 0.003). Observability (β = 0.103, P = 0.005), perceived ease (β = 0.085, P = 0.004), and relative advantage (β = 0.041, P = 0.009) also indirectly influenced the wearing behavior. Conclusion: The intentions of Chinese elderly type 2 diabetic patients to wearable activity trackers directly influenced the actual wearing behavior. In addition, their adoption intention to wearable activity trackers was mainly influenced by observability, perceived ease to use, relative advantage, perceived risk, and social image.

What Are We Measuring When We Evaluate Digital Interventions for Improving Lifestyle? A Scoping Meta-Review

Background: Lifestyle Medicine (LM) aims to address six main behavioral domains: diet/nutrition, substance use (SU), physical activity (PA), social relationships, stress management, and sleep. Digital Health Interventions (DHIs) have been used to improve these domains. However, there is no consensus on how to measure lifestyle and its intermediate outcomes aside from measuring each behavior separately. We aimed to describe (1) the most frequent lifestyle domains addressed by DHIs, (2) the most frequent outcomes used to measure lifestyle changes, and (3) the most frequent DHI delivery methods. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) Extension for Scoping Reviews. A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Web of Science for publications since 2010. We included systematic reviews and meta-analyses of clinical trials using DHI to promote health, behavioral, or lifestyle change. Results: Overall, 954 records were identified, and 72 systematic reviews were included. Of those, 35 conducted meta-analyses, 58 addressed diet/nutrition, and 60 focused on PA. Only one systematic review evaluated all six lifestyle domains simultaneously; 1 systematic review evaluated five lifestyle domains; 5 systematic reviews evaluated 4 lifestyle domains; 14 systematic reviews evaluated 3 lifestyle domains; and the remaining 52 systematic reviews evaluated only one or two domains. The most frequently evaluated domains were diet/nutrition and PA. The most frequent DHI delivery methods were smartphone apps and websites. Discussion: The concept of lifestyle is still unclear and fragmented, making it hard to evaluate the complex interconnections of unhealthy behaviors, and their impact on health. Clarifying this concept, refining its operationalization, and defining the reporting guidelines should be considered as the current research priorities. DHIs have the potential to improve lifestyle at primary, secondary, and tertiary levels of prevention-but most of them are targeting clinical populations. Although important advances have been made to evaluate DHIs, some of their characteristics, such as the rate at which they become obsolete, will require innovative research designs to evaluate long-term outcomes in health.

Effect and feasibility of wearable physical activity trackers and pedometers for increasing physical activity and improving health outcomes in cancer survivors: A systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aimed to evaluate the effect of wearable devices for improving physical activity and health-related outcomes in cancer survivors.

METHODS

CINAHL, Cochrane, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing and Allied Health Source, ScienceDirect, and SPORTDiscus databases were searched for randomized controlled trials published before September 1, 2020, that evaluated interventions involving wearable devices in cancer survivors. Standardized mean differences (SMDs) were calculated to assess effects on physical activity and health-related outcomes. Subgroup analyses were conducted to assess whether the effects differed by interventions and cancer characteristics. Risk of bias was assessed using the Cochrane risk of bias tool.

RESULTS

Thirty-five trials were included (breast cancer, n = 15, 43%). Intervention durations ranged between 4 weeks and 1 year. Most trials (n = 25, 71%) involved pedometer-based physical activity interventions. Seven (20%) involved Fitbit-based interventions, and 3 (9%) involved other wearable physical activity trackers (e.g., Polar, Garmin). Compared to usual care, wearable devices had moderate-to-large effects (SMD range 0.54-0.87, p < 0.001) on moderate-intensity physical activity, moderate-to-vigorous-intensity physical activity, total physical activity, and daily steps. Compared to usual care, those in the intervention had higher quality of life, aerobic fitness, physical function, and reduced fatigue (SMD range = 0.18-0.66, all p < 0.05).

CONCLUSION

Wearable physical activity trackers and pedometers are effective tools that increase physical activity and improve health-related outcomes in individuals with cancer. Identifying how these devices can be implemented for longer-term use with other intervention components remains an area for future research.

A multiple technology-based physical activity intervention for Latina adolescents in the USA: randomized controlled trial study protocol for Chicas Fuertes

Background

Latina adolescents in the USA report some of the lowest rates of physical activity of any demographic subgroup; this is paralleled by a markedly higher lifetime risk of obesity, type 2 diabetes, and other conditions related to inactivity. Despite this, to date, no fully powered clinical trials have tested physical activity interventions specifically for this population. High use of mobile technologies (including text messages, smartphone apps, and social media) suggests this could be an appropriate intervention channel, while also having potential for broad reach. This paper describes the protocol for Chicas Fuertes, a fully powered randomized trial of a mobile technology-based physical activity intervention for Latina adolescents.

Methods

We plan to recruit 200 Latina teens (age 13–18) in San Diego, CA, currently engaging in ≤ 150 min/week of moderate-to-vigorous physical activity (MVPA) to be assigned 1:1 to the intervention or control groups. Those randomly assigned to the intervention group receive a one-on-one goal setting session followed by 6 months of mobile technology-based intervention, including a personalized website, Fitbit activity tracker and app, individually tailored text messages based on Fitbit data, and daily intervention content on Instagram. Those randomized to the control group receive only a Fitbit activity tracker. The main outcome is change in weekly minutes of MVPA from baseline to 6 months, measured both objectively (ActiGraph accelerometers and Fitbit Inspire HR) and subjectively (7-Day Physical Activity Recall Interview). Additional outcomes are maintenance of activity change at 12 months and changes in psychosocial constructs, including social support and self-efficacy, engagement with mobile technology channels, and costs of intervention delivery. We are also examining the potential mediators and moderators of the intervention. The efficacy of the intervention is analyzed using a mixed effects regression model, adjusting for any potential confounders not balanced by randomization. All analyses of accelerometer measured MVPA are also adjusted for wear time.

Discussion

The Chicas Fuertes trial uses widely available mobile technologies to target critical health behavior, physical activity, in Latina teens, a population with a high lifetime risk of lifestyle-related diseases. The results will speak to the efficacy and acceptability of the intervention, which has the potential for broad dissemination.

Trial registration

ClinicalTrials.govNCT04190225. Registered on November 20, 2019

Effectiveness of physical activity monitors in adults: systematic review and meta-analysis

OBJECTIVE

To estimate the effectiveness of physical activity monitor (PAM) based interventions among adults and explore reasons for the heterogeneity.

DESIGN

Systematic review and meta-analysis.

STUDY SELECTION

The electronic databases MEDLINE, Embase, SPORTDiscus, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on 4 June 2021. Eligible randomised controlled trials compared interventions in which adults received feedback from PAMs with control interventions in which no feedback was provided. No restrictions on type of outcome measurement, publication date, or language were applied.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data and assessed risk of bias. Random effects meta-analyses were used to synthesise the results. The certainty of evidence was rated by the Grading of Recommendations Assessment and Evaluation (GRADE) approach.

MAIN OUTCOME MEASURES

The three primary outcomes of interest were physical activity, moderate to vigorous physical activity, and sedentary time.

RESULTS

121 randomised controlled trials with 141 study comparisons, including 16 743 participants, were included. The PAM based interventions showed a moderate effect (standardised mean difference 0.42, 95% confidence interval 0.28 to 0.55) on physical activity, equivalent to 1235 daily steps; a small effect (0.23, 0.16 to 0.30) on moderate to vigorous physical activity, equivalent to 48.5 weekly minutes; and a small insignificant effect (-0.12, -0.25 to 0.01) on sedentary time, equal to 9.9 daily minutes. All outcomes favoured the PAM interventions.

CONCLUSIONS

The certainty of evidence was low for the effect of PAM based interventions on physical activity and moderate for moderate to vigorous physical activity and sedentary time. PAM based interventions are safe and effectively increase physical activity and moderate to vigorous physical activity. The effect on physical activity and moderate to vigorous physical activity is well established but might be overestimated owing to publication bias.

STUDY REGISTRATION

PROSPERO CRD42018102719.

Accuracy of wrist-worn wearable devices for determining exercise intensity

Objective

As an indicator of exercise intensity, heart rate can be measured in a timely manner using wrist-worn devices. No study has attempted to estimate a target exercise intensity using wearable devices. The objective of the study was to evaluate the validity of prescribing exercise intensity using wrist-worn devices.

Methods

Thirty healthy subjects completed a maximal cardiopulmonary exercise test. Their heart rates were recorded using an electrocardiogram and two devices—Apple Watch Series 6 and Garmin Forerunner 945. Exercise intensity with the target heart rate was defined as resting heart rate + (maximal heart rate − resting heart rate) * n% ( n%: 40–60% for moderate-intensity exercise and 60–89% for vigorous-intensity exercise). Heart rate was analyzed at the lower and upper limits of each exercise intensity (HR40, HR60, and HR89). The mean absolute percentage error and concordance correlation coefficient were calculated, and Bland–Altman plots and scatterplots were constructed.

Results

Both devices showed a low mean absolute error (1.16–1.48 bpm for Apple and 1.35–2.25 for Garmin) and mean absolute percentage error (<1% for Apple and 1.16–1.39% for Garmin) in all intensities. A substantial correlation with electrocardiogram-measured heart rate was observed for moderate to vigorous intensity with concordance correlation coefficient > 0.95 for both devices, except that Garmin showed moderate correlation at the upper limit of vigorous activity with concordance correlation coefficient = 0.936. Moreover, Bland–Altman plots and scatterplots demonstrated a strong correlation without systematic error when the values obtained via the two devices were compared with electrocardiogram measurements.

Conclusions

Our findings indicate the high validity of exercise prescriptions based on the heart rate measured by the two devices. Additional research should explore other populations to confirm these findings.

Exploring the effect of an eHealth intervention on women's physical activity: Design and rationale for a randomized controlled trial

Objective

This manuscript reports on the protocol for a three-arm randomized controlled trial aiming to assess the effect a self-determination theory-based eHealth intervention on physical activity among insufficiently active women who are overweight or obese.

Methods

The intervention-of-interest provided (A) six weekly behavioural support emails, (B) a wearable activity tracker, and (C) a copy and verbal explanation of the Canadian physical activity guidelines, and was compared to an intervention that provided (B + C) and another that provided (C). Women from a local community were invited to participate in this study. Participants were recruited between September 2018 and March 2019. Data were collected using self-report and direct measures three times: at baseline (week 0), post-intervention (week 7), and at follow-up (week 21). The primary outcome was self-reported total metabolic equivalent minutes of physical activity per week (MET-m/week); exploratory outcomes included number of days of strength training per week, self-determination theory constructs (i.e. motivational regulations, basic psychological needs satisfaction and thwarting), and well-being indicators (i.e. affect, vitality, depression).

Conclusion

Findings will provide insight into which combination of intervention components may be more effective at promoting physical activity among insufficiently active women who are overweight or obese, and thus inform the design of future interventions aiming to promote physical activity.

Effectiveness of Wearable Device-based Intervention on Glycemic Control in Patients with Type 2 Diabetes: A System Review and Meta-Analysis

With the development of flexible electronics and chip technology, the application value of wearable devices in lifelong treatment of chronic diseases is increasing. In view of its rapid development and diversified forms, wearable device-based intervention seems to provide a promising option to solve the problems of long-term glycemic control in type 2 diabetes (T2D). However, to date, it is unclear whether the intervention based on wearable device is effective on glycemic control in patients with T2D. In order to explore whether this choice is effective in glycemic control in patients with T2D, after database search and study screening, 6 studies and 1001 patients were selected from 181studies for this meta-analysis. The results guided that the wearable device-based intervention may be more effective than usual care on glycemic control in patients with T2D. Subgroup analysis showed that when the duration of intervention was equal to or less than 12 weeks, the effect of wearable device-based intervention was significantly different from that of usual care, but when the intervention duration greater than 12 weeks, the effect was not significantly different. The intervention effect of wearable devices with goal-setting or encouragement functions was significantly better than that of usual care, and there was no significant difference between automatic drug delivery wearable devices and usual care. In conclusion, the wearable device-based intervention is effective on glycemic control in patients with T2D. In general, this choice of wearable devices for patients with T2D may be effective to some extent.

A Wearable Activity Tracker Intervention With and Without Weekly Behavioral Support Emails to Promote Physical Activity Among Women Who Are Overweight or Obese: Randomized Controlled Trial

Background

Physical activity (PA) plays a fundamental role in combating the current obesity epidemic; however, most women who are overweight or obese are generally physically inactive. Wearable activity tracker interventions can help increase the PA levels in this population. Supplementing such interventions with behavioral support emails may further improve their effectiveness, but this remains to be confirmed.

Objective

This study aims to determine if adding behavioral support emails to a wearable activity tracker intervention can further increase PA levels among women who are overweight or obese in comparison to a wearable activity tracker–only intervention and a control condition.

Methods

Women with a BMI ≥25 kg/m² who were not meeting the Canadian PA guidelines for aerobic and strength training were randomized into 1 of 3 groups. Group 1 received 6 weekly behavioral support emails, a wearable activity tracker, and a copy of the Canadian PA guidelines. Group 2 received a wearable activity tracker and a copy of the Canadian PA guidelines, and group 3 (control condition) received a copy of the Canadian PA guidelines. Self-reported data for walking and moderate to vigorous intensity PA were collected preintervention (week 0; prerandomization), postintervention (7 weeks postrandomization), and at follow-up (21 weeks postrandomization) and analyzed as metabolic equivalent of task minutes per week. In addition, potential mechanisms of behavior change (ie, basic psychological needs satisfaction and motivational regulations) were assessed for within- and between-group differences at all 3 time points. Data were analyzed using nonparametric statistical tests.

Results

A total of 49 women were recruited; data from 47 women (mean age 37.57 years, SD 11.78 years; mean BMI 31.69 kg/m², SD 5.97 kg/m²) were available for analysis. Group 1 reported a significant increase in walking from preintervention to postintervention (χ²₂=7.5; P=.02) but not in moderate to vigorous intensity PA (P=.24). Group 1 also reported significant increases in perceptions of competence from preintervention to follow-up (χ²₂=7.6; P=.02) and relatedness from preintervention to follow-up (χ²₂=8.7; P=.005). Increases in perceived autonomy were observed for group 2 (χ²₂=7.0) and group 3 (χ²₂=10.6). There were no significant changes in the motivational regulations within the groups. The difference between the groups was not significant for any outcome variable.

Conclusions

The results suggest that adding behavioral support emails to a wearable activity tracker intervention may help to increase time spent walking and perceptions of competence and relatedness for PA among women who are overweight or obese.

Trial Registration

ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663

Effects of Non-Contact Corrective Exercise Continuum for 12 Weeks on Postural Imbalance in Adults

OBJECTIVES This study was to examine the effect of the 12-week video-based non-contact corrective exercise continuum (CEC) program on the forward head posture, central asymmetry, varus and valgus knees for men and women with postural imbalance.METHODS Subjects were recruited openly by the Internet community and measured their posture with a 3D whole body scanner (Medicube WS-210, Korea), and then classified into exercise group (n=32, EG) and control group (n=32, CG). Total subjects were classified into forward head posture exercise group (n=8), central asymmetry exercise group (n=8), varus exercise group (n=8), valgus exercise group and each control group (n=8). For the non-contact home training, 12 weeks of 30 minutes/day, 3 times/week, corrective exercise continuum were conducted. The CEC program is an effective treatment to correct the anatomical alignment of the extremities as suggested by the National Academy of Sports Medicine.RESULTS As a result, the distance between the centers according to the forward head posture CEC program in EG, the angle of spinal inclination of the cervical and thoracic vertebrae, and central asymmetry were lowered (p<.05). Body shape distribution balance and shoulder tilt angle were lowered in EG according to the central asymmetry CEC program (p <.05). According to the varus CEC program in EG, the distance between the center of the knee, the tilt angle of the femur and tibia, and body shape distribution were lowered (p <.05). According to the valgus CEC program in EG, the distance between the center of the knee increased, and the tilt angle of the femur and tibia decreased (p<.05).CONCLUSIONS The effect of improving the anterior head posture, central asymmetry, varus and valgus knees of postural imbalance according to the CEC program was confirmed. It is thought that the CEC program can restore optimal neuromuscular control by restoring proper joint kinematics and restore posture and balance by reducing the observed muscle tension.

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

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

Smartphone-Based Interventions for Physical Activity Promotion: Scoping Review of the Evidence Over the Last 10 Years

Background

Several reviews of mobile health (mHealth) physical activity (PA) interventions suggest their beneficial effects on behavior change in adolescents and adults. Owing to the ubiquitous presence of smartphones, their use in mHealth PA interventions seems obvious; nevertheless, there are gaps in the literature on the evaluation reporting processes and best practices of such interventions.

Objective

The primary objective of this review is to analyze the development and evaluation trajectory of smartphone-based mHealth PA interventions and to review systematic theory- and evidence-based practices and methods that are implemented along this trajectory. The secondary objective is to identify the range of evidence (both quantitative and qualitative) available on smartphone-based mHealth PA interventions to provide a comprehensive tabular and narrative review of the available literature in terms of its nature, features, and volume.

Methods

We conducted a scoping review of qualitative and quantitative studies examining smartphone-based PA interventions published between 2008 and 2018. In line with scoping review guidelines, studies were not rejected based on their research design or quality. This review, therefore, includes experimental and descriptive studies, as well as reviews addressing smartphone-based mHealth interventions aimed at promoting PA in all age groups (with a subanalysis conducted for adolescents). Two groups of studies were additionally included: reviews or content analyses of PA trackers and meta-analyses exploring behavior change techniques and their efficacy.

Results

Included articles (N=148) were categorized into 10 groups: commercial smartphone app content analyses, smartphone-based intervention review studies, activity tracker content analyses, activity tracker review studies, meta-analyses of PA intervention studies, smartphone-based intervention studies, qualitative formative studies, app development descriptive studies, qualitative follow-up studies, and other related articles. Only 24 articles targeted children or adolescents (age range: 5-19 years). There is no agreed evaluation framework or taxonomy to code or report smartphone-based PA interventions. Researchers did not state the coding method, used various evaluation frameworks, or used different versions of behavior change technique taxonomies. In addition, there is no consensus on the best behavior change theory or model that should be used in smartphone-based interventions for PA promotion. Commonly reported systematic practices and methods have been successfully identified. They include PA recommendations, trial designs (randomized controlled trials, experimental trials, and rapid design trials), mixed methods data collection (surveys, questionnaires, interviews, and focus group discussions), scales to assess app quality, and industry-recognized reporting guidelines.

Conclusions

Smartphone-based mHealth interventions aimed at promoting PA showed promising results for behavior change. Although there is a plethora of published studies on the adult target group, the number of studies and consequently the evidence base for adolescents is limited. Overall, the efficacy of smartphone-based mHealth PA interventions can be considerably improved through a more systematic approach of developing, reporting, and coding of the interventions.

The Acceptability, Feasibility, and Effectiveness of Wearable Activity Trackers for Increasing Physical Activity in Children and Adolescents: A Systematic Review

Wearable activity trackers (wearables) embed numerous behaviour change techniques (BCTs) that have previously been shown to increase adult physical activity (PA). With few children and adolescents achieving PA guidelines, it is crucial to explore ways to increase their PA. This systematic review examined the acceptability, feasibility, and effectiveness of wearables and their potential mechanisms of action for increasing PA in 5 to 19-year-olds. A systematic search of six databases was conducted, including data from the start date of each database to December 2019 (PROSPERO registration: CRD42020164506). Thirty-three studies were included. Most studies (70%) included only adolescents (10 to 19 years). There was some-but largely mixed-evidence that wearables increase steps and moderate-to-vigorous-intensity PA and reduce sedentary behaviour. There were no apparent differences in effectiveness based on the number of BCTs used and between studies using a wearable alone or as part of a multi-component intervention. Qualitative findings suggested wearables increased motivation to be physically active via self-monitoring, goal setting, feedback, and competition. However, children and adolescents reported technical difficulties and a novelty effect when using wearables, which may impact wearables' long-term use. More rigorous and long-term studies investigating the acceptability, feasibility, and effectiveness of wearables in 5 to 19-year-olds are warranted.

Effect of commercial wearables and digital behaviour change resources on the physical activity of adolescents attending schools in socio-economically disadvantaged areas: the RAW-PA cluster-randomised controlled trial

Background

There has been increasing interest in using wearable activity trackers to promote physical activity in youth. This study examined the short- and longer-term effects of a wearable activity tracker combined with digital behaviour change resources on the physical activity of adolescents attending schools in socio-economically disadvantaged areas.

Methods

The Raising Awareness of Physical Activity (RAW-PA) Study was a 12-week, multicomponent intervention that combined a Fitbit Flex (and accompanying app), and online digital behaviour change resources and weekly challenges delivered via Facebook. RAW-PA was evaluated using a cluster-randomised controlled trial with 275 adolescents (50.2% female; 13.7 ± 0.4 years) from 18 Melbourne secondary schools (intervention n = 9; wait-list control group n = 9). The primary outcome was moderate- to vigorous-intensity physical activity (MVPA), measured using hip-worn ActiGraph accelerometers. The secondary outcome was self-reported physical activity. Data were collected at baseline, 12-weeks (immediately post-intervention), and 6-months post-intervention (follow-up). Multilevel models were used to determine the effects of the intervention on daily MVPA over time, adjusting for covariates.

Results

No significant differences were observed between intervention and wait-list control adolescents’ device-assessed MVPA immediately post-intervention. At 6-months post-intervention, adolescents in the intervention group engaged in 5 min (95% CI: − 9.1 to − 1.0) less MVPA per day than those in the wait-list control group. Males in the intervention group engaged in 11 min (95% CI: − 17.6 to − 4.5) less MVPA than males in the wait-list control group at 6-months post-intervention. No significant differences were observed for females at either time point. For self-reported physical activity, no significant effects were found at 12-weeks and 6-months post-intervention.

Conclusions

Combining a wearable activity tracker with digital behaviour change resources and weekly challenges did not increase inactive adolescents’ accelerometer-derived and self-reported physical activity levels immediately post-intervention. This contrasts previous research that has suggested wearable activity tracker may increase youth physical activity levels in the short-term. Lower engagement in MVPA 6-months post-intervention was observed for males but not for females, though it is unclear why this finding was observed. The results suggest wearable activity trackers, in combination with supporting materials, may not be effective for increasing physical activity levels in adolescents.

Trial registration

ACTRN12616000899448. Australian and New Zealand Clinical Trials Registry. Registered 7 July 2016.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01110-1.

Patterns of self-monitoring technology use and weight loss in people with overweight or obesity

Mobile applications and paired devices allow individuals to self-monitor physical activity, dietary intake, and weight fluctuation concurrently. However, little is known regarding patterns of use of these self-monitoring technologies over time and their implications for weight loss. The objectives of this study were to identify distinct patterns of self-monitoring technology use and to investigate the associations between these patterns and weight change. We analyzed data from a 6-month weight loss intervention for school district employees with overweight or obesity (N = 225). We performed repeated measures latent profile analysis (RMLPA) to identify common patterns of self-monitoring technology use and used multiple linear regression to evaluate the relationship between self-monitoring technology use and weight change. RMLPA revealed four distinct profiles: minimal users (n = 65, 29% of sample), activity trackers (n = 124, 55%), dedicated all-around users (n = 25, 11%), and dedicated all-around users with exceptional food logging (n = 11, 5%). The dedicated all-around users with exceptional food logging lost the most weight (X2[1,225] = 5.27, p = .0217). Multiple linear regression revealed that, adjusting for covariates, only percentage of days of wireless weight scale use (B = -0.05, t(212) = -3.79, p < .001) was independently associated with weight loss. We identified distinct patterns in mHealth self-monitoring technology use for tracking weight loss behaviors. Self-monitoring of weight was most consistently linked to weight loss, while exceptional food logging characterized the group with the greatest weight loss. Weight loss interventions should promote self-monitoring of weight and consider encouraging food logging to individuals who have demonstrated consistent use of self-monitoring technologies.

Evaluation of the FitBark Activity Monitor for Measuring Physical Activity in Dogs

Accelerometers track changes in physical activity which can indicate health and welfare concerns in dogs. The FitBark 2 (FitBark) is an accelerometer for use with dogs; however, no studies have externally validated this tool. The objective of this study was to evaluate FitBark criterion validity by correlating FitBark activity data to dog step count. Dogs (n = 26) were fitted with a collar-mounted FitBark and individually recorded for 30 min using a three-phase approach: (1) off-leash room explore; (2) human-dog interaction; and (3) on-leash walk. Video analysis was used to count the number of times the front right paw touched the ground (step count). Dog step count and FitBark activity were moderately correlated across all phases (r = 0.65, p < 0.001). High correlations between step count and FitBark activity were observed during phases 1 (r = 0.795, p < 0.001) and 2 (r = 0.758, p < 0.001), and a low correlation was observed during phase 3 (r = 0.498, p < 0.001). In conclusion, the FitBark is a valid tool for tracking physical activity in off-leash dogs; however, more work should be done to identify the best method of tracking on-leash activity.

Effectiveness of Minimal Contact Interventions: An RCT

INTRODUCTION

Around 23% of adults worldwide are insufficiently active. Wearable devices paired with virtual coaching software could increase physical activity. The effectiveness of 3 minimal contact interventions (paper-based physical activity diaries, activity trackers, and activity trackers coupled with virtual coaching) in increasing physical activity energy expenditure and cardiorespiratory fitness were compared over 12 weeks among inactive adults.

METHODS

This was an open label, parallel-group RCT. Inactive adults (aged ≥18 years, N=488) were randomized to no intervention (Control; n=121), paper-based diary (Diary; n=124), activity tracker (Activity Band; n=122), or activity tracker plus virtual coaching (Activity Band PLUS; n=121) groups. Coprimary outcomes included 12-week changes in physical activity energy expenditure and fitness (May 2012-January 2014). Analyses were conducted in 2019-2020.

RESULTS

There were no differences between groups overall (physical activity energy expenditure: p=0.114, fitness: p=0.417). However, there was a greater increase in physical activity energy expenditure (4.21 kJ/kg/day, 95% CI=0.42, 8.00) in the Activity Band PLUS group than in the Diary group. There were also greater decreases in BMI and body fat percentage in the Activity Band PLUS group than in the Control group (BMI= -0.24 kg/m2, 95% CI= -0.45, -0.03; body fat= -0.48%, 95% CI= -0.88, -0.08) and in theActivity Band PLUS group than in the Diary group (BMI= -0.30 kg/m2, 95% CI= -0.50, -0.09; body fat= -0.57%, 95% CI= -0.97, -0.17).

CONCLUSIONS

Coupling activity trackers with virtual coaching may facilitate increases in physical activity energy expenditure compared with a traditional paper‒based physical activity diary intervention and improve some secondary outcomes compared with a traditional paper‒based physical activity diary intervention or no intervention.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov ISRCTN31844443.

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

OBJECTIVE

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

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed and seven additional databases, from 2007 to 2020.

STUDY SELECTION

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

DATA EXTRACTION AND SYNTHESIS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

Multilevel mobile health approach to improve cardiovascular health in resource-limited communities with Step It Up: a randomised controlled trial protocol targeting physical activity

INTRODUCTION

Although physical activity (PA) reduces cardiovascular disease (CVD) risk, physical inactivity remains a pressing public health concern, especially among African American (AA) women in the USA. PA interventions focused on AA women living in resource-limited communities with scarce PA infrastructure are needed. Mobile health (mHealth) technology can increase access to PA interventions. We describe the development of a clinical protocol for a multilevel, community-based, mHealth PA intervention for AA women.

METHODS AND ANALYSIS

An mHealth intervention targeting AA women living in resource-limited Washington, DC communities was developed based on the socioecological framework for PA. Over 6 months, we will use a Sequential Multi-Assignment, Randomized Trial approach to compare the effects on PA of location-based remote messaging (named 'tailored-to-place') to standard remote messaging in an mHealth intervention. Participants will be randomised to a remote messaging intervention for 3 months, at which point the intervention strategy will adapt based on individuals' PA levels. Those who do not meet the PA goal will be rerandomised to more intensive treatment. Participants will be followed for another 3 months to determine the contribution of each mHealth intervention to PA level. This protocol will use novel statistical approaches to account for the adaptive strategy. Finally, effects of PA changes on CVD risk biomarkers will be characterised.

ETHICS AND DISSEMINATION

This protocol has been developed in partnership with a Washington, DC-area community advisory board to ensure feasibility and acceptability to community members. The National Institutes of Health Intramural IRB approved this research and the National Heart, Lung, and Blood Institute provided funding. Once published, results of this work will be disseminated to community members through presentations at community advisory board meetings and our quarterly newsletter.

TRIAL REGISTRATION NUMBER

NCT03288207.

Analysis of the Behavioral Change and Utility Features of Electronic Activity Monitors

The aim of this study was to perform a content analysis of electronic activity monitors that also evaluates utility features, code behavior change techniques included in the monitoring systems, and align the results with intervention functions of the Behaviour Change Wheel program planning model to facilitate informed device selection. Devices were coded for the implemented behavior change techniques and device features. Three trained coders each wore a monitor for at least 1 week from December 2019–April 2020. Apple Watch Nike, Fitbit Versa 2, Fitbit Charge 3, Fitbit Ionic—Adidas Edition, Garmin Vivomove HR, Garmin Vivosmart 4, Amazfit Bip, Galaxy Watch Active, and Withings Steel HR were reviewed. The monitors all paired with a phone/tablet, tracked exercise sessions, and were wrist-worn. On average, the monitors implemented 27 behavior change techniques each. Fitbit devices implemented the most behavior change techniques, including techniques related to the intervention functions: education, enablement, environmental restructuring, coercion, incentivization, modeling, and persuasion. Garmin devices implemented the second highest number of behavior change techniques, including techniques related to enablement, environmental restructuring, and training. Researchers can use these results to guide selection of electronic activity monitors based on their research needs.

Validity and Reliability of Physiological Data in Applied Settings Measured by Wearable Technology: A Rapid Systematic Review

The purpose of this review was to evaluate the current state of the literature and to identify the types of study designs, wearable devices, statistical tests, and exercise modes used in validation and reliability studies conducted in applied settings/outdoor environments. This was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We identified nine articles that fit our inclusion criteria, eight of which tested for validity and one tested for reliability. The studies tested 28 different devices with exercise modalities of running, walking, cycling, and hiking. While there were no universally common analytical techniques used to measure accuracy or validity, correlative measures were used in 88% of studies, mean absolute percentage error (MAPE) in 75%, and Bland–Altman plots in 63%. Intra-class correlation was used to determine reliability. There were not any universally common thresholds to determine validity, however, of the studies that used MAPE and correlation, there were only five devices that had a MAPE of < 10% and a correlation value of > 0.7. Overall, the current review establishes the need for greater testing in applied settings when validating wearables. Researchers should seek to incorporate multiple intensities, populations, and modalities into their study designs while utilizing appropriate analytical techniques to measure and determine validity and reliability.

Fitbit-Based Interventions for Healthy Lifestyle Outcomes: Systematic Review and Meta-Analysis

BACKGROUND

Unhealthy behaviors, such as physical inactivity, sedentary lifestyle, and unhealthful eating, remain highly prevalent, posing formidable challenges in efforts to improve cardiovascular health. While traditional interventions to promote healthy lifestyles are both costly and effective, wearable trackers, especially Fitbit devices, can provide a low-cost alternative that may effectively help large numbers of individuals become more physically fit and thereby maintain a good health status.

OBJECTIVE

The objectives of this meta-analysis are (1) to assess the effectiveness of interventions that incorporate a Fitbit device for healthy lifestyle outcomes (eg, steps, moderate-to-vigorous physical activity, and weight) and (2) to identify which additional intervention components or study characteristics are the most effective at improving healthy lifestyle outcomes.

METHODS

A systematic review was conducted, searching the following databases from 2007 to 2019: MEDLINE, EMBASE, CINAHL, and CENTRAL (Cochrane). Studies were included if (1) they were randomized controlled trials, (2) the intervention involved the use of a Fitbit device, and (3) the reported outcomes were related to healthy lifestyles. The main outcome measures were related to physical activity, sedentary behavior, and weight. All the studies were assessed for risk of bias using Cochrane criteria. A random-effects meta-analysis was conducted to estimate the treatment effect of interventions that included a Fitbit device compared with a control group. We also conducted subgroup analysis and fuzzy-set qualitative comparative analysis (fsQCA) to further disentangle the effects of intervention components.

RESULTS

Our final sample comprised 41 articles reporting the results of 37 studies. For Fitbit-based interventions, we found a statistically significant increase in daily step count (mean difference [MD] 950.54, 95% CI 475.89-1425.18; P<.001) and moderate-to-vigorous physical activity (MD 6.16, 95% CI 2.80-9.51; P<.001), a significant decrease in weight (MD -1.48, 95% CI -2.81 to -0.14; P=.03), and a nonsignificant decrease in objectively assessed and self-reported sedentary behavior (MD -10.62, 95% CI -35.50 to 14.27; P=.40 and standardized MD -0.11, 95% CI -0.48 to 0.26; P=.56, respectively). In general, the included studies were at low risk for bias, except for performance bias. Subgroup analysis and fsQCA demonstrated that, in addition to the effects of the Fitbit devices, setting activity goals was the most important intervention component.

CONCLUSIONS

The use of Fitbit devices in interventions has the potential to promote healthy lifestyles in terms of physical activity and weight. Fitbit devices may be useful to health professionals for patient monitoring and support.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42019145450; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019145450.

Effect of Electronic Activity Monitors and Pedometers on Health: Results from the TAME Health Pilot Randomized Pragmatic Trial

Background: Brief counseling and self-monitoring with a pedometer are common practice within primary care for physical activity promotion. It is unknown how high-tech electronic activity monitors compare to pedometers within this setting. This study aimed to investigate the outcomes, through effect size estimation, of an electronic activity monitor-based intervention to increase physical activity and decrease cardiovascular disease risk. Method: The pilot randomized controlled trial was pre-registered online at clinicaltrials.gov (NCT02554435). Forty overweight, sedentary participants 55–74 years of age were randomized to wear a pedometer or an electronic activity monitor for 12 weeks. Physical activity was measured objectively for 7 days at baseline and follow-up by a SenseWear monitor and cardiovascular disease risk was estimated by the Framingham risk calculator. Results: Effect sizes for behavioral and health outcomes ranged from small to medium. While these effect sizes were favorable to the intervention group for physical activity (PA) (d = 0.78) and general health (d = 0.39), they were not favorable for measures. Conclusion: The results of this pilot trial show promise for this low-intensity intervention strategy, but large-scale trials are needed to test its efficacy.

Succeeding with prolonged usage of consumer-based activity trackers in clinical studies: a mixed methods approach

BACKGROUND

Lack of physical activity (PA) is a risk factor for death and non-communicable disease. Despite this, more than one fourth of adults worldwide do not follow PA guidelines. As part of a feasibility study to test a complex intervention for increasing PA, we included a consumer-based activity tracker (AT) as a tool to measure PA outcomes and to track heart rate during exercise sessions. The aim of the present study was to identify factors that increase wear time when using a consumer-based AT for monitoring of participants in clinical research.

METHODS

Sixteen participants aged 55-74 years, with obesity, sedentary lifestyle, and elevated cardiovascular risk were recruited to a 12-month feasibility study. Participants wore a Polar M430 AT to collect continuous PA data during a six-month intervention followed by 6 months of follow-up. We performed quantitative wear time analysis, tested the validity of the AT, and completed two rounds of qualitative interviews to investigate how individual wear-time was linked to participant responses.

RESULTS

From 1 year of tracking, mean number of valid wear days were 292 (SD = 86), i.e. 80%. The Polar M430 provides acceptable measurements for total energy expenditure. Motivations for increased wear time were that participants were asked to wear it and the ability to track PA progress. Perceived usefulness included time keeping, heart rate- and sleep tracking, becoming more conscious about day-to-day activity, and improved understanding of which activity types were more effective for energy expenditure. Sources of AT annoyance were measurement inaccuracies and limited instruction for use. Suggestions for improvement were that the AT was big, unattractive, and complicated to use.

CONCLUSIONS

Adherence to wearing a consumer-based AT was high. Results indicate that it is feasible to use a consumer-based AT to measure PA over a longer period. Potential success factors for increased wear time includes adequate instruction for AT use, allowing participants to choose different AT designs, and using trackers with accurate measurements. To identify accurate trackers, AT validation studies in the target cohort may be needed.

TRIAL REGISTRATION

U.S. National Library of Medicine, Clinical Trial registry: NCT03807323 ; Registered 16 September 2019 - Retrospectively registered.

Wearable Activity Trackers in the Management of Rheumatic Diseases: Where Are We in 2020?

In healthcare, physical activity can be monitored in two ways: self-monitoring by the patient himself or external monitoring by health professionals. Regarding self-monitoring, wearable activity trackers allow automated passive data collection that educate and motivate patients. Wearing an activity tracker can improve walking time by around 1500 steps per day. However, there are concerns about measurement accuracy (e.g., lack of a common validation protocol or measurement discrepancies between different devices). For external monitoring, many innovative electronic tools are currently used in rheumatology to help support physician time management, to reduce the burden on clinic time, and to prioritize patients who may need further attention. In inflammatory arthritis, such as rheumatoid arthritis, regular monitoring of patients to detect disease flares improves outcomes. In a pilot study applying machine learning to activity tracker steps, we showed that physical activity was strongly linked to disease flares and that patterns of physical activity could be used to predict flares with great accuracy, with a sensitivity and specificity above 95%. Thus, automatic monitoring of steps may lead to improved disease control through potential early identification of disease flares. However, activity trackers have some limitations when applied to rheumatic patients, such as tracker adherence, lack of clarity on long-term effectiveness, or the potential multiplicity of trackers.

Translatability of a Wearable Technology Intervention to Increase Adolescent Physical Activity: Mixed Methods Implementation Evaluation

Background

Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts.

Objective

This paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up.

Methods

A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically.

Results

Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years; 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120; 93.3%). Half of the adolescents perceived the text messages to be useful (61/120; 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time; only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out.

Conclusions

RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.

The effectiveness of a wearable activity tracker (WAT)-based intervention to improve physical activity levels in sedentary older adults: A systematic review and meta-analysis

BACKGROUND

The evidence shows that WAT-based interventions enhance the physical activity (PA) levels of young people by sustainably delivering behavior change techniques (BCTs). These results may not be replicable among older adults. This paper aims to evaluate the effectiveness of WAT-based interventions in improving PA levels in sedentary older adults.

METHODS

Eight electronic databases were searched for randomized controlled trials published January 2008 to December 2018. BCTs delivered by WAT aimed at increasing PA levels using step counts or time spent on moderate-to-vigorous (MVPA) exercise as an outcome were eligible for inclusion.

RESULTS

In nine out of the ten included studies, higher PA levels were seen in the intervention group than in the control group. One study where the participants' mean age was 80+ showed no significant increase in PA levels. Significant effects were also demonstrated from the meta-analysis, which included four studies using a passive control (i.e., the usual care or health information) on step counts (n = 207, Hedges g = 1.27, 95 % CI = 0.51-2.04, p = 0.001) and two studies on MVPA (n = 83, Hedge's g = 1.23, 95 % CI = 0.75-1.70, p < 0.001). A non-significant effect was found on step counts (n = 201, Hedge's g = 0.22, 95 % CI = -0.62 to 1.06, p = 0.61) in three studies that used an active control comparison group (i.e., traditional pedometer).

CONCLUSIONS

A WAT-based intervention is effective at improving PA levels among older adults over the short term when compared with the usual care or health information. However, when compared with a traditional pedometer or when used among old-old adults, the results were inconclusive.

Acceptability and feasibility of the mHealth intervention 'MyDayPlan' to increase physical activity in a general adult population

Background

Electronic health (eHealth) and mobile health (mHealth) interventions have the potential to tackle the worldwide problem of physical inactivity. However, they often suffer from large attrition rates. Consequently, feasibility and acceptability of interventions have become important matters in the creation of e- and mHealth interventions. The aim of this study was to evaluate participants’ opinions regarding acceptability and feasibility of a self-regulation, app-based intervention called ‘MyDayPlan’. ‘MyDayPlan’ provides an innovative daily cycle providing several self-regulation techniques throughout the day that guide users towards an active lifestyle via various self-regulation techniques.

Methods

Semi-structured interviews were conducted with 20 adults after using the app for 2 weeks. A directed content analysis was performed using NVivo Software.

Results

‘MyDayPlan’ was well-received and seems to be feasible and acceptable with inactive adults. The straightforward lay out and ease of use of the app were appreciated. Furthermore, the incorporation of the techniques ‘action planning’, and ‘prompting review of behavioral goals’ was positively evaluated. However, the users gave some recommendations: implementation of activity trackers to self-monitor physical activity could be of added value. Furthermore, increasing intuitiveness by minimizing text input and providing more preprogrammed options could further increase the ease of use. Finally, users indicated that they would benefit from more guidance during the “coping planning” component (barrier identification/problem solving), for example by receiving more tailored examples.

Conclusions

Based on these findings, adaptations will be made to the ‘MyDayPlan’ app before evaluating its effectiveness. Furthermore, involving potential end users and evaluating acceptability and feasibility during the development of an e- and mHealth intervention is key. Also, creating interventions with a large ease of use and straightforward layout that provides tailored support during action and coping planning is key.

Telephone health coaching with exercise monitoring using wearable activity trackers (TeGeCoach) for improving walking impairment in peripheral artery disease: study protocol for a randomised controlled trial and economic evaluation

INTRODUCTION

Peripheral artery disease (PAD) is the third most prevalent cardiovascular disease worldwide, with smoking and diabetes being the strongest risk factors. The most prominent symptom is leg pain while walking, known as intermittent claudication. To improve mobility, first-line treatment for intermittent claudication is supervised exercise programmes, but these remain largely unavailable and economically impractical, which has led to the development of structured home-based exercise programmes. This trial aims to determine the effectiveness and cost advantage of TeGeCoach, a 12-month long home-based exercise programme, compared with usual care of PAD. It is hypothesised that TeGeCoach improves walking impairment and lowers the need of health care resources that are spent on patients with PAD.

METHODS AND ANALYSIS

The investigators conduct a prospective, pragmatic randomised controlled clinical trial in a health insurance setting. 1760 patients diagnosed with PAD at Fontaine stage II are randomly assigned to either TeGeCoach or care-as-usual. TeGeCoach consists of telemonitored intermittent walking exercise with medical supervision by a physician and telephone health coaching. Participants allocated to the usual care group receive information leaflets and can access supervised exercise programmes, physical therapy and a variety of programmes for promoting a healthy lifestyle. The primary outcome is patient reported walking ability based on the Walking Impairment Questionnaire. Secondary outcome measures include quality of life, health literacy and health behaviour. Claims data are used to collect total health care costs, healthcare resource use and (severe) adverse events. Outcomes are measured at baseline, 12 and 24 months.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Medical Association Hamburg. Findings are disseminated through peer-reviewed journals, reports to the funding body, conference presentations and media press releases. Data from this trial are made available to the public and researchers upon reasonable request.NCT03496948 (www.clinicaltrials.gov), Pre-results.

Older adults' experiences of using a wearable activity tracker with health professional feedback over a 12-month randomised controlled trial

Objective

Wearable activity trackers can help older adults remain physically active. However, knowledge of the user experience during long-term use is scarce. Therefore, this study examined older adults' experiences with, and perceptions of, wearable activity trackers combined with health professional feedback after a year's use as part of a randomised controlled trial.

Methods

Twenty older adults (73.6 ± 5.5 years) who had used a Jawbone UP24 activity tracker for 12 months during a randomised controlled trial were recruited for this study. All participants had at least one chronic condition. Acceptability data relating to activity tracker wear time was combined with focus group data to explore participants experiences of long-term activity tracker use. Data was analysed using thematic analysis.

Results

The activity tracker was well-accepted with the device worn on an average of 86% of possible days and participants reported an overall positive experience. Four themes were identified: (a) increased sense of awareness of activity levels is related to motivation; (b) the level of engagement with the activity tracker influences the user experience; (c) the role of feedback from a health professional in providing ongoing support; d) the role of habits in supporting long-term behaviour change.

Conclusions

The use of an activity tracker combined with health professional support can assist older adults to maintain their activity levels over 12 months. Consideration should be given to the previous technology experience of users and the design and accuracy of an activity tracker when recommending their use in a research or clinical setting.

The Feasibility and Acceptability of Using a Wearable UV Radiation Exposure Monitoring Device in Adults and Children: Cross-Sectional Questionnaire Study

BACKGROUND

In the United States, melanoma is the 5th most common cancer. Reducing ultraviolet radiation (UVR) exposure is essential for the prevention of melanoma. Objectively assessing individual-level UVR exposure with the use of wearable technology offers a promising tool for reducing UVR exposure. However, the feasibility and acceptability of using UVR monitoring wearable devices have not been assessed.

OBJECTIVE

The aim of this study was to assess the feasibility and acceptability of a commercially available UVR monitoring wearable device among adults and children.

METHODS

The study recruited families (one parent and one child) to test a new, commercially-available UVR monitoring device (Shade). Participants wore the Shade device for two weeks and completed questionnaires assessing the feasibility and acceptability of wearing the device. Qualitative analyses were conducted to summarize participants' open-ended responses regarding device feasibility.

RESULTS

A total of 194 individuals (97 adults and 97 children) participated. Participating children were on average 12.7 years old. Overall, adults and children reported moderate satisfaction with wearing the Shade device. Feasibility of use of the Shade device was adequate with 73% of adults and 61% of children reporting that they wore the device "all of the time they were outside." Through open-ended responses, participants reported appreciating the device's ease of use, compact size, and that it increased their awareness about their UVR exposure.

CONCLUSIONS

A new, wearable UVR monitoring device can be feasibly used by adults and children and use of the device was acceptable to participants. The device could be integrated into melanoma preventive interventions to increase individual's and families' awareness of their UVR exposure and to facilitate the use of recommended melanoma preventive strategies.

Pilot test of an interactive obesity treatment approach among employed adults in a university medical billing office

Background

There is a need for workplace programs promoting healthy eating and activity that reach low-wage employees and are scalable beyond the study site. Interventions designed with dissemination in mind aim to utilize minimal resources and to fit within existing systems. Technology-based interventions have the potential to promote healthy behaviors and to be sustainable as well as scalable. We developed an interactive obesity treatment approach (iOTA), to be delivered by SMS text messaging, and therefore accessible to a broad population. The aim of this pilot study was to evaluate participant engagement with, and acceptability of, this iOTA to promote healthy eating and activity behaviors among low-wage workers with obesity.

Methods

Twenty participants (self-reporting body mass index ≥ 30 kg/m²) of a single workgroup employed by a university medical practice billing office had access to the full intervention and study measures and provided feedback on the experience. Height and weight were measured by trained research staff at baseline. Each participant was offered a quarterly session with a health coach. Measured weight and a self-administered survey, including dietary and activity behaviors, were also collected at baseline, 3, 6, 12, 18, and 24 months. Participant engagement was assessed through responsiveness to iOTA SMS text messages throughout the 24-month pilot. A survey measure was used to assess satisfaction with iOTA at 3 months. Due to the small sample size and pilot nature of the current study, we conducted descriptive analyses. Engagement, weight change, and duration remaining in coaching are presented individually for each study participant.

Results

The pilot was originally intended to last 3 months, but nearly all participants requested to continue; we thus continued for 24 months. Most (14/20) participants remained in coaching for 24 months. At the 3-month follow-up, eight (47%) of the remaining 17 participants had lost weight; by 24 months, five (36%) of the remaining 14 participants had lost weight (one had bariatric surgery). Participants reported very high satisfaction.

Conclusions

This pilot provides important preliminary results on acceptability and participant engagement with iOTA, which has significant potential for dissemination and sustainability.

The utility of wearable fitness trackers and implications for increased engagement: An exploratory, mixed methods observational study

Objective

To explore which features of wearable fitness trackers are used and deemed helpful.

Methods

Forty-seven participants took part in an online survey. All participants were over 18 years of age and owned a wearable device that objectively measured physical activity and provided feedback. The survey included questions related to the acceptance of different features of wearables, and exercise information, self-efficacy, exercise identity, motivation, and general demographics of the wearer. Seven participants took part in focus groups in an effort to gain further insight into the acceptability and utilization of wearables. Data were examined using means and frequencies.

Results

Participants were mostly young adults (18–24 years, 48.9%), White (63.8%), female (80.9%), overweight (body mass index 26.0±6.2), students (42.6%) and generally healthy. Fitbit was the most commonly owned wearable device (42.6%). Most participants had owned their device for 6–12 months (27.7%) and they wore their device daily (80.9%). The most commonly used features were rewards/badges (59.6%), notifications (52.2%), and challenges (42.6%). The features that were reportedly the most helpful, however, were motivational cues (83.3%), general health information (82.4%), and challenges (75.0%).

Conclusions

The reported use and helpfulness ratings of various features of wearables appeared to vary based on the wearer’s gender, race/ethnicity, exercise goal, exercise proficiency, preferred type of exercise, and psychosocial metrics but the results are inconclusive. Future research should evaluate whether engagement with certain features is strongly associated with improved outcomes and whether the use of these features is significantly associated with wearer characteristics.

Changing the Physical Activity Behavior of Adults With Fitness Trackers: A Systematic Review and Meta-Analysis

OBJECTIVE

To examine whether a fitness tracker (FT) intervention changes physical activity (PA) behavior compared to a control condition or compared to an alternative intervention.

DATA SOURCE

Searches between January 01, 2010, and January 01, 2019, were conducted in PubMed, CINAHL, Cochrane CENTRAL, EMBASE, and PsycINFO.

INCLUSION/EXCLUSION CRITERIA

Randomized clinical trials of adults using an FT to change PA behavior were included. Nonclinical trials, studies that included the delivery of structured exercise, and/or studies that only used the FT to assess PA were excluded.

DATA EXTRACTION

Extracted features included characteristics of the study population, intervention components, PA outcomes, and results.

DATA SYNTHESIS

Papers were pooled in a statistical meta-analysis using a fixed effects model. Where statistical pooling was not possible, standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated. Findings were presented in a narrative form and tables.

RESULTS

Of 2076 articles found, 21 were included in the review. A small yet significant positive effect (SMD = 0.25, 95% CI = 0.17-0.32; P < .01; I² = 56.9%; P = .03) was found in step count for interventions compared to control. A small yet significant negative effect (SMD = -0.11, 95% CI = -0.20 to -0.02; P = .02; I² = 58.2%; P = 0.03) was found in moderate-to-vigorous PA for interventions compared to an alternative intervention.

CONCLUSION

Trackers may enhance PA interventions, as a general positive effect is found in step count compared to a control. However, there is no evidence of a positive effect when interventions are compared to an alternative intervention. It is unknown whether results are due to other intervention components and/or clinical heterogeneity.