Engaging Overweight Adolescents in a Health and Fitness Program Using Wearable Activity Trackers

Use of activity trackers to improve blood pressure in young people at risk for cardiovascular disease: a pilot randomized controlled trial

BACKGROUND

Promoting physical activity among young individuals with cardiovascular disease (CVD) risk factors such as hypertension, diabetes, or chronic kidney disease can lower systolic blood pressure (BP). We sought to determine whether a 6-month intervention using a physical activity tracker was feasible and effective, compared with usual care.

METHODS

Participants were recruited at a single academic medical center. Those aged 8-30 years were randomized in a 2:1 ratio to either the intervention (use of a Fitbit physical activity tracker coupled with feedback regarding the participant's step count) or usual care. The primary feasibility outcomes were screening-to-enrollment ratio and 6-month retention rates; the primary clinical outcome was a change in systolic BP from 0-6 months.

RESULTS

Sixty-three participants were enrolled (57% male; mean age: 18 ± 4 years). The screening-to-enrollment ratio was 1.8:1. Six-month retention was 62% in the intervention group and 86% in the control group (p = 0.08). Mean change in systolic BP in the intervention group was not significantly different from the control group at 6 months (- 2.3 mmHg; 95% CI - 6.5, 1.8 vs. 3.0 mmHg; 95% CI - 2.5, 8.4, respectively, p = 0.12).

CONCLUSIONS

Among children and young adults at elevated CVD risk, the use of a physical activity tracker coupled with tailored feedback regarding their step count progress was feasible but not sustained over time. Physical activity tracker use did not have a statistically significant effect on BP after 6 months. Augmented strategies to mitigate risk in young patients at high risk for early-onset CVD should be explored. This trial is registered at ClinicalTrials.gov (NCT03325426).

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

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

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.

How shoulder immobilization after surgery influences daily activity - a prospective pedometer-based study

PURPOSE

Immobilization, especially of the lower extremity, after orthopaedic surgery has been associated with reduced physical activity. Previous interventions from our study group showed even in young, healthy people reduced activity levels after immobilization of the shoulder. Therefore, this study investigates the change in physical activity due to shoulder immobilization after a reconstructive surgery.

METHODS

This prospective study includes 40 patients undergoing surgery from May 2019 to December 2020. Daily activity was measured before surgery, after discharge and three weeks postoperatively each time for six days. Activity including step counts and active time were measured by Fitbit™ inspire. Range of motion before and after surgery as well as Pain (VAS) were documented.

RESULTS

Steps became significantly less immediately postoperatively with an immobilized shoulder joint than before surgery (9728.8 vs. 6022.6, p < 0.05). At follow-up, the number of steps increased again, but still showed a significantly lower number of steps (mean 8833.2) compared to preoperative. Patients preoperatively showed mostly an "active" activity pattern, whereas postoperatively a "low active" behaviour predominated. The proportion of sedentary behaviour ("basal activity" and "limited activity") was almost three times higher postoperatively (12.5% vs. 30%).

CONCLUSION

General physical activity is restricted during upper limb immobilization in adults. Therefore, activity-enhancing measures should be implemented in the early phase of rehabilitation after upper extremity surgery.

Wearable-Technology-Assisted Interventions for Breast-Cancer Survivors: A Meta-Analysis and Meta-Regression

OBJECTIVES

This review, meta-analysis, and meta-regression aimed to (1) evaluate the effect of wearable-technology-assisted interventions on the physical activity and weight of breast cancer survivors, (2) identify the essential features of wearable-technology-assisted interventions, and (3) explore the covariates of the treatment effect.

DATA SOURCES

Randomized controlled trials were obtained from 10 databases and trial registries from inception until December 21, 2021. Trials that examined the effects of wearable-technology-assisted interventions for individuals with breast cancer were included. The mean and standard deviation scores were used to compute the effect sizes.

CONCLUSION

The meta-analyses revealed significantly improved in moderate-to-vigorous activity, total physical activity, and weight control. The findings from this review suggest that wearable-technology-assisted interventions may be a potential solution to improve physical activity and weight in breast cancer survivors. Future studies should include high-quality trials with large sample sizes.

IMPLICATIONS FOR NURSING PRACTICE

Wearable technology has promising effects on physical activity and could be incorporated into routine care for breast cancer survivors.

Use of the Self- and Family Management Framework in quantitative studies

BACKGROUND

The Self- and Family Management Framework (SFMF) identifies factors and outcomes of patient and family management of chronic illness. In a previous citation analysis, we reported the frequency and nature of use of the SFMF.

PURPOSE

We conducted a sub-analysis of quantitative articles in the citation analysis to examine testing of relationships depicted in the SFMF.

METHODS

We analyzed study purposes, independent and dependent variables, study implications, and text that referred to the SFMF in 40 articles.

FINDINGS

The SFMF has been used largely to explore factors affecting SFM behaviors, focusing on patient versus family self-management. Independent variables included all categories of facilitators/barriers specified in the SFMF. Dependent variables included all SFMF components (Facilitators/Barriers, Processes, Proximal and Distal Outcomes). Racial/ethnic diversity was limited among study participants. Study implications pertained mostly to psychosocial outcomes. Most studies referred to the SFMF generally.

DISCUSSION

Findings will contribute to revision of the SFMF.

The Effectiveness of Web-Based Interventions to Promote Health Behaviour Change in Adolescents: A Systematic Review

Although web-based interventions are attractive to researchers and users, the evidence about their effectiveness in the promotion of health behaviour change is still limited. Our aim was to review the effectiveness of web-based interventions used in health behavioural change in adolescents regarding physical activity, eating habits, tobacco and alcohol use, sexual behaviour, and quality of sleep. Studies published from 2016 till the search was run (May-to-June 2021) were included if they were experimental or quasi-experimental studies, pre-post-test studies, clinical trials, or randomized controlled trials evaluating the effectiveness of web-based intervention in promoting behaviour change in adolescents regarding those health behaviours. The risk of bias assessment was performed by using the Effective Public Health Practice Project (EPHPP)-Quality Assessment Tool for Quantitative Studies. Fourteen studies were included. Most were in a school setting, non-probabilistic and relatively small samples. All had a short length of follow-up and were theory driven. Thirteen showed significant positive findings to support web-based interventions' effectiveness in promoting health behaviour change among adolescents but were classified as low evidence quality. Although this review shows that web-based interventions may contribute to health behaviour change among adolescents, these findings rely on low-quality evidence, so it is urgent to test these interventions in larger controlled trials with long-term maintenance.

Studying wearable health technology in the workplace using the Behavior Change Wheel: a systematic literature review and content analysis

Wearable Health Technology (WHT) is considered to be fast, feasible, and effective in workplace health promotion programs. This study aims to analyze behavior change strategies applied to WHT products used by employees in health promotion programs. A systematic literature review of WHT in workplace health promotion between 2006 and 2020 was conducted. The Behavior Change Wheel (BCW) was used to undertake the content analysis. We identified 14 articles of WHT in the workplace. First, physical activity and weight management were the most common health issue. Second, using the BCW, we found guidelines, regulation and communication were the most frequently applied policy categories. Third, education, enablement and training were the most common intervention functions. For example, the promoter could provide health education information by WHT. Moreover, encouraging online would motivate employees to improve health behavior. There has been a growing interest in WHT with increasing complexity in research designs and specifications. While using WHT can be an appropriate strategy to adopt as employee health projects, other interventions should be considered, for incentivization and modeling, etc. The results of this study suggest using WHT should take related health behavior theories or variables into consideration to form a comprehensive health promotion programs.

Is health consciousness and perceived privacy protection critical to use wearable health devices? Extending the model of goal-directed behavior

Purpose

The present study is an attempt to extend the Model of Goal-directed Behavior (MGB) to consider health consciousness and perceived privacy protection as two critical factors to predict desire and intention by individuals to adopt and use wearable health devices (WHDs).

Design/methodology/approach

Based on the literature review hypotheses were framed and tested using data collected through a questionnaire survey. A total of 418 self-reported complete responses were considered to analyze the hypotheses proposed in the study. Structural equation modeling, effects analysis and model comparison (MGB and extended MGB) were performed to understand the predictability of the suggested model.

Findings

The results of the study corroborate that along with MGB, health consciousness and perceived privacy protection also induces the intention of users toward using WHDs. Health-consciousness is found to have a positive and significant direct and indirect impact on intention to use WHDs. Further, the model comparison exhibits that the proposed extended MGB is a better predictor of intention to use WHDs.

Practical implications

Apart from the conventional framework of MGB, health consciousness and perceived privacy protection promote desire and intention to use WHDs. This research provides a framework for marketers to promote health consciousness among consumers by motivating them to adopt WHDs. Further, privacy protection features should be showcased in order to induce trust in consumers which in turn will trigger their intention to use WHDs to lead a healthy lifestyle.

Originality/value

The current study incorporates health consciousness and perceived privacy protection in MGB to fit into the context of healthcare intention study, which enhances the predictability of intention behavior of consumers and adds to the existing body of MGB and healthcare literature.

Use of the self- and family management framework and implications for further development

BACKGROUND

The Self- and Family Management Framework (SFMF) was created in 2006 and revised in 2015 to guide research on self- and family management of chronic conditions. There has been no review of use of the SFMF.

PURPOSE

We reviewed articles citing the SFMF to identify the frequency and nature of use.

METHOD

We conducted a citation analysis, searching Web of Science, Scopus, and Google Scholar databases and extracted key data from identified articles.

FINDINGS

Of 126 articles, 84(66%) cited the 2006 SFMF, 37(29%) cited the 2015 SFMF, and 6(5%) cited both. The SFMF was used most to inform study design. Users noted strengths (e.g., considers family context) and limitations (e.g., non-specification of patient- family caregiver synergies) of the framework.

DISCUSSION

The SFMF has been used broadly to guide research on self- and family management of chronic conditions. Findings will inform development of a third version of the SFMF.

Objective Measurement of Physical Activity Attributed to a Park-Based Afterschool Program

BACKGROUND

Only 24% of US youth meet physical activity recommendations set by the Centers for Disease Control and Prevention. Research demonstrates that community-based programs provide underresourced minority youth with opportunities for routine physical activity, although limited work draws from accelerometry data. This study objectively assessed youth physical activity attributable to participation (vs nonparticipation) days in a park-based afterschool program in Miami-Dade County, Miami, FL.

METHODS

Participants' (n = 66; 60% male; 57% white Hispanic, 25% non-Hispanic black, 14% Black Hispanic, mean age = 10.2 y) physical activity was assessed April to May 2019 over 10 days across 7 park sites using Fitbit (Charge 2) devices. Separate repeated-measures multilevel models were developed to assess the relationship between program daily attendance and total (1) moderate to vigorous physical activity minutes and (2) step counts per day.

RESULTS

Models adjusted for individual-level age, sex, race/ethnicity, poverty, and clustering by park showed significantly higher moderate to vigorous physical activity minutes (β = 25.33 more minutes per day; 95% confidence interval, 7.0 to 43.7, P < .01) and step counts (β = 4067.8 more steps per day; 95% confidence interval, 3171.8 to 4963.8, P < .001) on days when youth did versus did not attend the program.

CONCLUSIONS

Study findings suggest that park-based programs may support underserved youth in achieving daily physical activity recommendations.

Development and Implementation of a "Music Beeps" Program to Promote Physical Fitness in Adolescents

This study aimed to develop a physical education fitness program for adolescents to counteract the declining physical activity levels caused by the COVID-19 pandemic, as well as to investigate the program's effect. This mixed-methods study developed and implemented a five-component "Music Beeps" (MB) program to promote adolescents' physical fitness. A total of 240 students from two high schools in South Korea-divided into experimental and control groups-participated in 32 sessions over 16 weeks. The changes in students' fitness were analyzed, and the educational effects were examined via inductive analysis of the observation logs and group and in-depth interviews. The results demonstrated that, whereas the comparison group demonstrated no statistically significant changes in power, muscular strength and endurance, or cardiopulmonary endurance, the experimental group showed changes in all these variables, along with changes in flexibility. Further, the MB program had significant educational effects. First, students reported that musical cues enhanced their fitness motivation and sense of responsibility. Second, record-keeping and active participation contributed to self-led fitness management. Third, activity in a small space with few pieces of equipment led to the positive perception that the program was efficient and enabled regular exercise regardless of climate conditions.

Effects of Motivational Interviewing and Wearable Fitness Trackers on Motivation and Physical Activity: A Systematic Review

OBJECTIVE

To systematically review the impacts of Wearable Fitness Trackers (WFTs), Motivational Interviewing (MI), and Self Determination Theory (SDT)-based interventions on physical activity (PA) and motivation for PA.

DATA SOURCE

Manuscripts published between 2008 and 2018 in PubMed, Web of Science, CABAbstracts, and SPORTDiscus database were reviewed.

STUDY INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria were original pilot studies, randomized controlled trials (RCT), cross-sectional studies, qualitative assessments, prospective cohort studies, longitudinal observational studies, and pretest posttest designs published in peer-reviewed journals.

DATA EXTRACTION

Studies were evaluated by 2 independent researchers for inclusion.

DATA SYNTHESIS

Extracted data were synthesized in a tabular format and narrative summary.

RESULTS

Twenty-six studies met final inclusion criteria, 10 addressed WFT use and PA behavior, 4 investigated WFT use and its association with motivation for PA, and 10 examined SDT and/or MI and their effect on motivation for PA and/or PA behavior. Finally, 2 studies addressed SDT-based MI, WFT use, and the combined effect on PA behavior.

CONCLUSIONS

While SDT-based interventions and MI positively impact motivation for PA and PA behavior, WFTs revealed mixed results. Wearable Fitness Trackers prove effective among individuals not currently meeting PA guidelines but have little impact on other populations. Self Determination Theory, MI, and WFTs use provides a promising combination of interventions to increase PA among sedentary individuals, though research is limited.

Review of Wearable Device Technology and Its Applications to the Mining Industry

This paper reviews current trends in wearable device technology, and provides an overview of its prevalent and potential deployments in the mining industry. This review includes the classification of wearable devices with some examples of their utilization in various industrial fields as well as the features of sensors used in wearable devices. Existing applications of wearable device technology to the mining industry are reviewed. In addition, a wearable safety management system for miners and other possible applications are proposed. The findings of this review show that by introducing wearable device technology to mining sites, the safety of mining operations can be enhanced. Therefore, wearable devices should be further used in the mining industry.

Pediatric Obesity Algorithm: A Practical Approach to Obesity Diagnosis and Management

Childhood obesity is a growing global health problem. Despite the highest rates of childhood obesity in the United States and other developed countries over the last 30 years, there is still no clear treatment strategy. Practitioners often do not know where to turn to find guidance on managing the nearly one third of their population who present for medical care either with obesity that coexists with other medical problems or because of obesity. The Pediatric Obesity Algorithm is an evidence based roadmap for the diagnosis and management of children with obesity. In this article, we summarize topics from the Pediatric Obesity Algorithm pertaining to pediatric obesity diagnosis, evaluation, and management including assessment, differential diagnosis, review of systems, diagnostic work up, physical exam, age specific management, comorbidities, use of medications and surgery, and medication associated weight gain. Identifying and treating children with obesity as early as possible is important, as is identifying comorbid conditions. Earlier and more comprehensive management through resources such as the Pediatric Obesity Algorithm serve to help guide health care practitioners with a practical and evidence based approach to the diagnosis and management of children with obesity, and provide families with the tools needed for a healthy future.