A Systematic Review of e-Health Interventions for Physical Activity: An Analysis of Study Design, Intervention Characteristics, and Outcomes

Online prevention aimed at lifestyle behaviors: a systematic review of reviews

Background

Interventions aimed at behavior change are increasingly being delivered over the Internet. Although research on intervention effectiveness has been widely conducted, their true public health impact as indicated by reach, effectiveness, and use is unclear.

Objective

The aim of this paper is to (1) review the current literature on online prevention aimed at lifestyle behaviors, and (2) identify research gaps regarding reach, effectiveness, and use.

Methods

A systematic search in PubMed revealed relevant literature published between 2005 and 2012 on Internet-delivered behavior change interventions aimed at dietary behaviors, physical activity, alcohol use, smoking, and condom use. Our search yielded 41 eligible reviews, which were analyzed in terms of reach, effectiveness, and use according to the RE-AIM framework.

Results

According to health priorities, interventions are largely targeted at weight-related behaviors, such as physical activity and dietary behavior. Evaluations are predominantly effect-focused and overall effects are small, variable, and not sustainable. Determinants of effectiveness are unclear; effectiveness cannot yet be unambiguously attributed to isolated elements. Actual reach of interventions is undiversified, mostly reaching participants who are female, highly educated, white, and living in high-income countries. One of the most substantial problems in online prevention is the low use of the interventions, a phenomenon seen across all behavior domains.

Conclusions

More research is needed on effective elements instead of effective interventions, with special attention to long-term effectiveness. The reach and use of interventions need more scientific input to increase the public health impact of Internet-delivered interventions.

What kinds of website and mobile phone-delivered physical activity and nutrition interventions do middle-aged men want?

Within a health context, men in Western societies are a hard-to-reach population who experience higher rates of chronic disease compared with women. Innovative technology-based interventions that specifically target men are needed; however, little is known about how these should be developed for this group. This study aimed to examine opinions and perceptions regarding the use of Internet and mobile phones to improve physical activity and nutrition behaviors for middle-aged men. The authors conducted 6 focus groups (n = 30) in Queensland, Australia. Their analyses identified 6 themes: (a) Internet experience, (b) website characteristics, (c) Web 2.0 applications, (d) website features, (e) self-monitoring, and (f) mobile phones as delivery method. The outcomes indicate that men support the use of the Internet to improve and self-monitor physical activity and dietary behaviors on the condition that the website-delivered interventions are quick and easy to use, because commitment levels to engage in online tasks are low. Participants also indicated that they were reluctant to use normal mobile phones to change health behaviors, although smartphones were perceived to be more acceptable. This pilot study suggests that there are viable avenues to engage middle-aged men in Internet- or in mobile-delivered health interventions. This study also suggests that to be successful, these interventions need to be tailor-made especially for men, with an emphasis on usability and convenience. A wider quantitative study would bring further support to these findings.

Validation of Web-based physical activity measurement systems using doubly labeled water

BACKGROUND

Online or Web-based measurement systems have been proposed as convenient methods for collecting physical activity data. We developed two Web-based physical activity systems-the 24-hour Physical Activity Record Web (24hPAR WEB) and 7 days Recall Web (7daysRecall WEB).

OBJECTIVE

To examine the validity of two Web-based physical activity measurement systems using the doubly labeled water (DLW) method.

METHODS

We assessed the validity of the 24hPAR WEB and 7daysRecall WEB in 20 individuals, aged 25 to 61 years. The order of email distribution and subsequent completion of the two Web-based measurements systems was randomized. Each measurement tool was used for a week. The participants' activity energy expenditure (AEE) and total energy expenditure (TEE) were assessed over each week using the DLW method and compared with the respective energy expenditures estimated using the Web-based systems.

RESULTS

The mean AEE was 3.90 (SD 1.43) MJ estimated using the 24hPAR WEB and 3.67 (SD 1.48) MJ measured by the DLW method. The Pearson correlation for AEE between the two methods was r = .679 (P < .001). The Bland-Altman 95% limits of agreement ranged from -2.10 to 2.57 MJ between the two methods. The Pearson correlation for TEE between the two methods was r = .874 (P < .001). The mean AEE was 4.29 (SD 1.94) MJ using the 7daysRecall WEB and 3.80 (SD 1.36) MJ by the DLW method. The Pearson correlation for AEE between the two methods was r = .144 (P = .54). The Bland-Altman 95% limits of agreement ranged from -3.83 to 4.81 MJ between the two methods. The Pearson correlation for TEE between the two methods was r = .590 (P = .006). The average input times using terminal devices were 8 minutes and 10 seconds for the 24hPAR WEB and 6 minutes and 38 seconds for the 7daysRecall WEB.

CONCLUSIONS

Both Web-based systems were found to be effective methods for collecting physical activity data and are appropriate for use in epidemiological studies. Because the measurement accuracy of the 24hPAR WEB was moderate to high, it could be suitable for evaluating the effect of interventions on individuals as well as for examining physical activity behavior.