1
|
Wong EML, Leung DYP, Wang Q, Leung AYM, Cheung ASP. The effect of a lifestyle intervention program using a mobile application versus the effect of a program using a booklet for adults with metabolic syndrome: A three-arm randomized controlled trial. J Nurs Scholarsh 2023; 55:936-948. [PMID: 36896916 DOI: 10.1111/jnu.12883] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE The research aimed to examine the effect of a lifestyle intervention program using mobile application versus booklet for adults with metabolic syndrome in Hong Kong. The outcomes comprised body weight (primary outcome), exercise amount, improvement of cardiometabolic risk factors, cardiovascular endurance, perceived stress scale, and exercise self-efficacy. DESIGN A three-arm randomized controlled trial namely App group, Booklet group, and control group was adopted. METHODS Two hundred sixty-four adults with metabolic syndrome were recruited from community centers from 2019 to December 2021. Inclusion criteria are those adults with metabolic syndrome, able to use a smart phone. All participants received a 30-min health talk. App group additionally received a mobile application, while Booklet group received a booklet, and the control group received a placebo booklet. Data were collected at baseline, Weeks 4, 12, and 24. SPSS and generalized estimating equations (GEE) model were employed for data analysis. FINDINGS Attrition rates were minimal, ranged from 2.65% to 6.44%. Both app and booklet group showed significant improvement in outcomes (exercise amount, waist circumference) when compared to control group. However, statistically significant and superior results were observed in app group, including body weight, exercise amount, waist circumference, body mass index, and systolic blood pressure when compared to booklet group. CONCLUSION The lifestyle intervention supported with app was found to be superior to the booklet support for reducing body weight and maintaining exercise. CLINICAL RELEVANCE The lifestyle intervention program using mobile application support could be used widely for adults with metabolic syndrome in the community. Suggest nurses may incorporate this program in their health promotion strategies focusing on a healthy lifestyle to reduce the risk of progression to metabolic syndrome.
Collapse
Affiliation(s)
| | | | - Qun Wang
- School of Nursing, Shenzhen University, Shenzhen, China
| | | | | |
Collapse
|
2
|
Lee S, Patel P, Myers ND, Pfeiffer KA, Smith AL, Kelly KS. A Systematic Review of eHealth Interventions to Promote Physical Activity in Adults with Obesity or Overweight. Behav Med 2023; 49:213-230. [PMID: 35465851 DOI: 10.1080/08964289.2022.2065239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 11/02/2022]
Abstract
Use of information and communication technology to improve health, known as eHealth, is an emerging concept in healthcare that may present opportunities to promote physical activity in adults with obesity. The purpose of this research was to systematically review eHealth intervention studies to promote physical activity in adults with obesity. Five electronic databases were used. Two authors screened articles, assessed risk of bias, and extracted data independently. A qualitative data synthesis for summarizing the findings was performed using harvest plots. In the search, 2276 articles were identified, and 18 studies met all inclusion criteria. Study quality ranged from poor to good. The included studies varied in intervention technology (e.g., web-based), physical activity assessment (e.g., device-based), and control group (e.g., wait-list). Behavioral change techniques used in the included studies were consistent with some techniques (e.g., self-monitoring) known as effective in face-to-face interventions, but more efficiently employed in eHealth using information and communication technology. Overall, this systematic review showed that a web-based or physical activity monitor-based eHealth intervention had the potential to effectively promote physical activity in adults with obesity. Some recommendations for future eHealth interventions to promote physical activity in adults with obesity were provided (e.g., use of theory, accelerometers).
Collapse
Affiliation(s)
- Seungmin Lee
- Department of Health and Wellness Studies, Binghamton University
| | - Priya Patel
- Department of Kinesiology, Michigan State University
| | | | | | - Alan L Smith
- The Emma Eccles Jones College of Education and Human Services, Utah State University
| | - Kimberly S Kelly
- Department of Counseling, Educational Psychology and Special Education, Michigan State University
| |
Collapse
|
3
|
Peng S, Yuan F, Othman AT, Zhou X, Shen G, Liang J. The Effectiveness of E-Health Interventions Promoting Physical Activity and Reducing Sedentary Behavior in College Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:318. [PMID: 36612643 PMCID: PMC9819541 DOI: 10.3390/ijerph20010318] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Insufficient physical activity (PA) and excessive sedentary behavior (SB) are detrimental to physical and mental health. This systematic review and meta-analysis aimed to identify whether e-health interventions are effective for improving PA and SB in college students. Five electronic databases, including Medline, Web of Science, Embase, Cochrane Library, and ProQuest, were searched to collect relevant randomized controlled trials up to 22 June 2022. In total, 22 trials (including 31 effects) with 8333 samples were included in this meta-analysis. The results showed that e-health interventions significantly improved PA at post-intervention (SMD = 0.32, 95% CI: 0.19, 0.45, p < 0.001) compared with the control group, especially for total PA (SMD = 0.34, 95% CI: 0.10, 0.58, p = 0.005), moderate to vigorous PA (SMD = 0.17, 95% CI: 0.01, 0.32, p = 0.036), and steps (SMD = 0.75, 95% CI: 0.23, 1.28, p < 0.001. There were no significant effects for both PA at follow-up (SMD = 0.24, 95% CI: − 0.01, 0.49, p = 0.057) and SB (MD = −29.11, 95% CI: −70.55, 12.32, p = 0.17). The findings of subgroup analyses indicated that compared to the control group, interventions in the group of general participants (SMD = 0.45, 95% CI: 0.27, 0.63, p < 0.001), smartphone apps (SMD = 0.46, 95% CI: 0.19, 0.73, p = 0.001), and online (SMD = 0.23, 95% CI: 0.04, 0.43, p < 0.001) can significantly improve PA at post-intervention. Moreover, the intervention effects were significant across all groups of theory, region, instrument, duration, and female ratio. At follow-up, interventions in groups of developing region (SMD = 1.17, 95% CI: 0.73, 1.62, p < 0.001), objective instrument (SMD = 0.83, 95% CI: 0.23, 1.42, p = 0.007), duration ≤ 3-month (SMD = 1.06, 95% CI: 0.72, 1.39, p < 0.001), and all female (SMD = 0.79, 95% CI: 0.02, 1.56, p = 0.044) can significantly improve PA. The evidence of this meta-analysis shows that e-health interventions can be taken as promising strategies for promoting PA. The maintenance of PA improvement and the effect of interventions in reducing SB remain to be further studied. Educators and health practitioners should focus on creating multiple e-health interventions with individualized components.
Collapse
Affiliation(s)
- Sanying Peng
- Physical Education Department, Hohai University, Nanjing 210024, China
- School of Educational Studies, University Sains Malaysia, Penang 11800, Malaysia
| | - Fang Yuan
- College of International Languages and Cultures, Hohai University, Nanjing 210024, China
| | | | - Xiaogang Zhou
- School of Educational Studies, University Sains Malaysia, Penang 11800, Malaysia
| | - Gang Shen
- School of Physical Education, Changzhou University, Changzhou 213164, China
| | - Jinghong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| |
Collapse
|
4
|
Wu QL, Brannon GE. Factors related to moderate exercise during COVID-19 for overweight and obese individuals: A secondary analysis of HINTS data. PEC INNOVATION 2022; 1:100058. [PMID: 35765668 PMCID: PMC9222089 DOI: 10.1016/j.pecinn.2022.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022]
Abstract
Objective COVID-19 has exacerbated pre-existing rates of overweight and obesity in the United States. mHealth technologies are gaining in popularity for its potential to reduce obesity, if facilitated by patient-centered communication. This study explores predictors of overweight and obese individuals' exercise levels during COVID-19. Methods 2191 respondents who visited a doctor in the past year and self-reported being overweight were selected from the 2020 Health Information National Trends Survey (HINTS). Respondents reported their physical activity, beliefs about obesity, health tracking behaviors, and communication with providers during the pandemic. Structural equation modeling was used to explore connections among the variables. Results Patient-provider (e-)communication was significantly associated with changes in people's obesity-related beliefs and mHealth tracking usage, predicting moderate exercise during the pandemic. Conclusion The findings illustrate the need for patient-centered communication encounters to include discussions on mHealth technologies and accessible methods of engaging in physical activity.Innovation: This study examined secondary data provided by overweight and obese individuals from the early days of the COVID-19 pandemic; this population may benefit from targeted health interventions using mHealth technologies. Our findings suggest that healthcare providers should engage patients through mHealth technology and seek to improve digital health literacy to progress physical activity nationwide.
Collapse
Affiliation(s)
- Qiwei Luna Wu
- School of Communication, College of Liberal Arts and Social Sciences, Cleveland State University, 2121 Euclid Ave., MU 233, Cleveland, OH 44115, USA
| | - Grace Ellen Brannon
- Department of Communication, College of Liberal Arts, University of Texas at Arlington, 700 West Nedderman Drive, FAB 118, Arlington, TX 76019, USA
| |
Collapse
|
5
|
Wong EML, Tam HL, Leung AYM, Cheung ASP, Cheung KC, Leung DYP. Impacts of Educational Interventions with Support of Mobile App versus Booklet for Patients with Hypertension and Metabolic Syndrome: A Secondary Data Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12591. [PMID: 36231891 PMCID: PMC9565212 DOI: 10.3390/ijerph191912591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Hypertension comorbid with metabolic syndrome could increase the development of adverse cardiovascular events. Educational interventions were effective to improve outcomes in patients. METHODS This was a secondary data analysis of participants with hypertension. The original randomized controlled trial aimed to examine the effect of app and booklet versus control among individuals diagnosed with metabolic syndrome living in the community. A 30-min health education was provided to each participant. In addition to the education, the app group received a mobile app while the booklet group received a booklet. Data were collected at baseline, week 4, week 12, and week 24. Intention-to-treat principle was followed, and generalized estimating equations was employed for data analysis. RESULTS A total of 118 participants with hypertension and metabolic syndrome were extracted from the three-arm trial data. The sample size was 36, 42, and 40 in the app group, booklet group, and control group, respectively. Compared to the control group, the app group showed a significant reduction on body weight and waist circumference at week 24, while the total exercise and self-efficacy for exercise were increased at week 12 and week 24 but no significant findings were observed in the booklet group. CONCLUSIONS The educational intervention supported with app was superior to the booklet support on the outcomes of body weight, waist circumference, total exercise, and self-efficacy for exercise among patients with hypertension and metabolic syndrome in the community.
Collapse
Affiliation(s)
| | - Hon Lon Tam
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | - Ka Ching Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | |
Collapse
|
6
|
Rodríguez-González P, Hassan MA, Gao Z. Effects of Family-Based Interventions Using Mobile Apps on Youth’s Physical Activity: A Systematic Review. J Clin Med 2022; 11:jcm11164798. [PMID: 36013037 PMCID: PMC9410395 DOI: 10.3390/jcm11164798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Objective. This review synthesized the currently available literature on the effects of family-based interventions using smartphone apps on youth physical activity. Design. Systematic review. Data Sources. 1037 studies from eight databases were retrieved. Eligibility Criteria for Selecting Studies. The seven articles included in this review met the following inclusion criteria: (1) experimental studies, (2) using smartphone apps, and (3) involving families with healthy children/adolescents. Results. Studies were stratified according to whether they used smartphone apps only or the combination of sports wearables and their associated companion app. The smartphone app interventions showed significant improvements in youth’s PA levels. All but one of the studies reported no significant improvement in PA levels after the intervention. However, positive PA-related outcomes were found, and the combination of sports wearables and their associated companion app showed inconclusive results due to the small number of studies. A trend of the relevance of families in improving the PA levels of youths was found. Conclusions. The findings of this review indicate that more research is needed on the effects of family-based interventions using mobile apps on youth’s physical activity. Mixed results were found for variables related to the PA of the youth involved in these programs. Although strong evidence was found that youth’s physical activity levels do not always improve with the implementation of these programs, promising results were found for a positive impact on different variables related to physical activity. Therefore, more experimental studies using only a mobile app to promote PA as the main outcome are needed to understand the real effect of mobile apps on youth’s PA levels. Future studies need to further explore this topic by developing programs based on designs of high methodological quality.
Collapse
Affiliation(s)
- Pablo Rodríguez-González
- School of Kinesiology, The University of Minnesota, Cooke Hall 208, 1900 University Ave. SE, Minneapolis, MN 55455, USA
- Faculty of Teacher Training and Education, University of Oviedo, 33006 Asturias, Spain
| | - Mohamed A. Hassan
- School of Kinesiology, The University of Minnesota, Cooke Hall 208, 1900 University Ave. SE, Minneapolis, MN 55455, USA
- Department of Methods and Curriculum, Physical Education College for Men, Helwan University, Cairo 12552, Egypt
| | - Zan Gao
- School of Kinesiology, The University of Minnesota, Cooke Hall 208, 1900 University Ave. SE, Minneapolis, MN 55455, USA
- Correspondence:
| |
Collapse
|
7
|
Lee YS, Chia M, Komar J. A Systematic Review of Physical Activity Intervention Programs in ASEAN Countries: Efficacy and Future Directions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095357. [PMID: 35564751 PMCID: PMC9103551 DOI: 10.3390/ijerph19095357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 12/10/2022]
Abstract
A systematic review was conducted on the efficacy of interventions to improve physical activity. PubMed, Scopus and Web of Science were scanned for eligible studies published from 1978 to August 2021, resulting in a total of 52 relevant studies for review. The Downs and Black checklist was used as a quality assessment ool for a risk of bias assessment. The 52 studies were then broadly categorised into three major approach types: informational, behavioural and/or social, as well as direct. Within each major approach, studies were further sub-categorised into more specific intervention types before being assessed for their efficacy and applicability. Overall, the intervention types that seemed to be the most efficacious in increasing physical activity levels were those that involved home-based information provision, community-wide campaigns, incentivised change, individually adapted health behaviour programs, family-based social support interventions and the provision of self-monitoring tools. However, the results must be interpreted holistically, as many of the successful interventions included more than one approach type and success is likely contingent on effectively addressing several concurrent facets. The systematic review is registered on PROSPERO. Registration number: 282752.
Collapse
|
8
|
Wong EML, Leung DYP, Tam HL, Ko SY, Leung AYM, Lam SC, Cheung KC, Cheung ASP. Effectiveness of a Nurse-Led Support Programme Using a Mobile Application versus Phone Advice on Patients at Risk of Coronary Heart Disease – A Pilot Randomized Controlled Trial. Risk Manag Healthc Policy 2022; 15:597-610. [PMID: 35422666 PMCID: PMC9005123 DOI: 10.2147/rmhp.s355554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/27/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally. This study aimed to examine the preliminary effect of a nurse-led support programme using a mobile application versus nursing telephone advice on patients at risk of CHD living in the community. Patients and Methods A prospective randomized controlled trial was adopted. Sixty eligible CHD participants were randomized into the app group (App) or the nursing telephone advice (NTA) group to support their own health care and exercise. Data were collected at baseline (T0), 1 month (T1), and 3 months (T2). Outcomes were total amount of exercise, self-efficacy of chronic disease management, total time of exercise, blood pressure, and lipid concentrations. Data were analyzed using the generalized estimating equation models. Results Ninety-two individuals were screened for eligibility and 60 were randomized into the app group (n = 30) or NTA group (n = 30). The mean age of the participants was 60.92. The total attrition rate at T2 was 1.66%. The app group showed a moderate effect (Cohen’s d =0.43) in significant increase in exercise amount, and reduction of lipid concentration (total cholesterol d=−0.43, triglyceride d=−0.39) respectively. Other outcomes showed improvement trend but non-significant between group. Conclusion The CHD app is effective to motivate CHD patients for maintaining exercise amount which will be beneficial to their lipid control.
Collapse
Affiliation(s)
- Eliza Mi Ling Wong
- School of Nursing, Tung Wah College, Hong Kong SAR, People’s Republic of China
- Correspondence: Eliza Mi Ling Wong, School of Nursing, Tung Wah College, 16/F, Ma Kam Chan Memorial Building, 31 Wylie Road, Homantin, Kowloon, Hong Kong SAR, People’s Republic of China, Tel +852 3468 6803, Fax +852 2782 1566, Email
| | - Doris Yin Ping Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China
| | - Hon Lon Tam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China
| | - Shuk Yee Ko
- Accident and Emergency Department, Tuen Mun Hospital, Hong Kong SAR, People’s Republic of China
| | - Angela Yee Man Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China
| | - Simon Ching Lam
- School of Nursing, Tung Wah College, Hong Kong SAR, People’s Republic of China
| | - Ka Ching Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China
| | - Alice Siu Ping Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China
| |
Collapse
|
9
|
Beinema T, op den Akker H, Hurmuz M, Jansen-Kosterink S, Hermens H. Automatic topic selection for long-term interaction with embodied conversational agents in health coaching: A micro-randomized trial. Internet Interv 2022; 27:100502. [PMID: 35198412 PMCID: PMC8842031 DOI: 10.1016/j.invent.2022.100502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Embodied Conversational Agents (ECAs) can be included in health coaching applications as virtual coaches. The engagement with these virtual coaches could be improved by presenting users with tailored coaching dialogues. In this article, we investigate if the suggestion of an automatically tailored topic by an ECA leads to higher engagement by the user and thus longer sessions of interaction. METHODS A Micro-Randomized Trial (MRT) was conducted in which two types of interaction with an ECA were compared: (a) the coach suggests a relevant topic to discuss, and (b) the coach asks the user to select a topic from a set of options. Every time the user would interact with the ECA, one of those conditions would be randomly selected. Participants interacted in their daily life with the ECA that was part of a multi-agent health coaching application for 4-8 weeks. RESULTS In two rounds, 82 participants interacted with the micro-randomized coach a total of 1011 times. Interactions in which the coach took the initiative were found to be of equal length as interactions in which the user was allowed to choose the topic, and the acceptance of topic suggestions was high (71.1% overall, 75.8% for coaching topics). CONCLUSION Tailoring coaching conversations with ECAs by letting the coach automatically suggest a topic that is tailored to the user is perceived as a natural variation in the flow of interaction. Future research could focus on improving the novel coaching engine component that supports the topic selection process for these suggestions or on investigating how the amount of initiative and coaching approach by the ECA could be tailored.
Collapse
Affiliation(s)
- Tessa Beinema
- eHealth Group, Roessingh Research and Development, Enschede, the Netherlands,Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands,Corresponding author at: Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands.
| | - Harm op den Akker
- eHealth Group, Roessingh Research and Development, Enschede, the Netherlands,Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands,Innovation Sprint, Brussels, Belgium
| | - Marian Hurmuz
- eHealth Group, Roessingh Research and Development, Enschede, the Netherlands,Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands
| | - Stephanie Jansen-Kosterink
- eHealth Group, Roessingh Research and Development, Enschede, the Netherlands,Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands
| | - Hermie Hermens
- eHealth Group, Roessingh Research and Development, Enschede, the Netherlands,Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands
| |
Collapse
|
10
|
Jansen-Kosterink S, Broekhuis M, van Velsen L. Time to act mature—Gearing eHealth evaluations towards technology readiness levels. Digit Health 2022; 8:20552076221113396. [PMID: 35847525 PMCID: PMC9280845 DOI: 10.1177/20552076221113396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
It is challenging to design a proper eHealth evaluation. In our opinion, the evaluation of eHealth should be a continuous process, wherein increasingly mature versions of the technology are put to the test. In this article, we present a model for continuous eHealth evaluation, geared towards technology maturity. Technology maturity can be determined best via Technology Readiness Levels, of which there are nine, divided into three phases: the research, development, and deployment phases. For each phase, we list and discuss applicable activities and outcomes on the end-user, clinical, and societal front. Instead of focusing on a single perspective, we recommend to blend the end-user, health and societal perspective. With this article we aim to contribute to the methodological debate on how to create the optimal eHealth evaluation design.
Collapse
Affiliation(s)
- Stephanie Jansen-Kosterink
- eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, The Netherlands
| | - Marijke Broekhuis
- eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, The Netherlands
| | - Lex van Velsen
- eHealth Group, Roessingh Research and Development, Enschede, The Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, The Netherlands
| |
Collapse
|
11
|
Kracht CL, Hutchesson M, Ahmed M, Müller AM, Ashton LM, Brown HM, DeSmet A, Maher CA, Mauch CE, Vandelanotte C, Yin Z, Whatnall M, Short CE, Staiano AE. E-&mHealth interventions targeting nutrition, physical activity, sedentary behavior, and/or obesity among children: A scoping review of systematic reviews and meta-analyses. Obes Rev 2021; 22:e13331. [PMID: 34476890 PMCID: PMC8865754 DOI: 10.1111/obr.13331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/02/2021] [Accepted: 07/21/2021] [Indexed: 12/16/2022]
Abstract
Childhood obesity is a public health concern. Electronic and mobile health (e-&mHealth) approaches can facilitate the delivery of interventions for obesity prevention and treatment. Synthesizing reviews of e-&mHealth interventions to improve weight and weight-related behaviors (physical activity, sedentary behavior, and diet) is useful to characterize the current scope of the literature and identify opportunities for future reviews and studies. Using a scoping review methodology, we aimed to evaluate the breadth and methodological quality of systematic reviews and meta-analyses of e-&mHealth interventions targeting weight and weight-related behaviors in children and adolescents aged <19 years. A systematic search of seven databases was conducted, including reviews published between 2000 and 2019. Review characteristics were extracted, and methodological quality was assessed using the AMSTAR 2 tool. Forty-five systematic reviews and meta-analyses were included. All reviews evaluated intervention efficacy (100%), but few assessed other aspects (20% in total) such as cost-effectiveness. Smartphone applications (47%), text messages (44%), and websites (35%) were the main modalities. Weight (60%), physical activity (51%), and diet (44%) were frequently assessed, unlike sedentary behavior (8%). Most reviews were rated as having critically low or low methodological quality (97%). Reviews that identify the effective active ingredients of interventions and explore metrics beyond efficacy are recommended.
Collapse
Affiliation(s)
- Chelsea L Kracht
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Melinda Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Mavra Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Canada
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Lee M Ashton
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia.,School of Education, Faculty of Education and Arts, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Hannah M Brown
- Hunter New England Population Health, Newcastle, Australia.,Everymind, Newcastle, Australia
| | - Ann DeSmet
- Faculty of Psychology and Educational Sciences, Université Libre de Bruxelles, Brussels, Belgium.,Department of Communication Studies, University of Antwerp, Antwerp, Belgium
| | - Carol A Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Chelsea E Mauch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.,Nutrition and Health Program, Health & Biosecurity Business Unit, CSIRO, Adelaide, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Zenong Yin
- Department of Public Health, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Megan Whatnall
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Camille E Short
- Melbourne School of Psychological Sciences and Melbourne School of Health Sciences, University of Melbourne, Parkville, Australia
| | - Amanda E Staiano
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| |
Collapse
|
12
|
Feasibility of a yoga, aerobic and stretching-toning exercise program for adult cancer survivors: the STAYFit trial. J Cancer Surviv 2021; 16:1107-1116. [PMID: 34455545 PMCID: PMC8402960 DOI: 10.1007/s11764-021-01101-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/17/2021] [Indexed: 11/04/2022]
Abstract
Background The use of yoga as a mind–body practice has become increasingly popular among clinical populations and older adults who use this practice to manage age and chronic disease-related symptoms. Although yoga continues to gain popularity among practitioners and researchers, pilot studies that examine its feasibility and acceptability, especially among cancer survivors, are limited. Feasibility studies play a critical role in determining whether the target population is likely to engage with larger scale efficacy and effectiveness trials. In this paper we present feasibility and acceptability data from a 12-week randomized controlled trial (RCT) conducted with adult cancer survivors. Methods Participants n = 78 (Mean age: 55 years) were randomized to one of three groups: a Hatha yoga, aerobic exercise, or stretching-toning control group with group exercise classes held for 150 min/week for 12 weeks. Herein we report feasibility and acceptability, including enrollment rates, attendance, attrition and adverse events, and participant feedback and satisfaction data. Results Of the 233 adults screened, 109 were eligible and 78 randomized to one of the three intervention arms. Session attendance was high for all groups (75.5–89.5%) and 17 participants dropped out during the 12-week intervention. Program satisfaction was high (4.8 or higher out of 5) and no adverse events were reported. One cohort (n = 15) of the intervention transitioned to remote intervention delivery due to the COVID-19 pandemic. Feasibility data from these participants suggested that synchronized group exercise classes via Zoom with a live instructor were acceptable and enjoyable. Participant feedback regarding most and least helpful aspects of the program as well as suggestions for future yoga interventions are summarized. Conclusions Overall, the yoga intervention was highly feasible and acceptable. The feasibility parameters from this trial can aid researchers in estimating recruitment rates for desired sample sizes to successfully randomize and retain cancer survivors in short- and long-term yoga-based efficacy and effectiveness trials. The findings also provide evidence to clinicians who can recommend up to 150 min of a combination of exercises—aerobic, yoga, or stretching-toning to their cancer patients in order to improve health and wellbeing during cancer survivorship.
Collapse
|
13
|
Krämer LV, Eschrig N, Keinhorst L, Schöchlin L, Stephan L, Stiene M, Bengel J. Effectiveness of a psychological online training to promote physical activity among students: protocol of a randomized-controlled trial. Trials 2021; 22:409. [PMID: 34154637 PMCID: PMC8218437 DOI: 10.1186/s13063-021-05333-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background Many students in Germany do not meet recommended amounts of physical activity. In order to promote physical activity in students, web-based interventions are increasingly implemented. Yet, data on effectiveness of web-based interventions in university students is low. Our study aims at investigating a web-based intervention for students. The intervention is based on the Health Action Process Approach (HAPA), which discriminates between processes of intention formation (motivational processes) and processes of intention implementation (volitional processes). Primary outcome is change in physical activity; secondary outcomes are motivational and volitional variables as proposed by the HAPA as well as quality of life and depressive symptoms. Methods A two-armed randomized controlled trial (RCT) of parallel design is conducted. Participants are recruited via the internet platform StudiCare (www.studicare.com). After the baseline assessment (t1), participants are randomized to either intervention group (immediate access to web-based intervention) or control group (access only after follow-up assessment). Four weeks later, post-assessment (t2) is performed in both groups followed by a follow-up assessment (t3) 3 months later. Assessments take place online. Main outcome analyses will follow an intention-to-treat principle by including all randomized participants into the analyses. Outcomes will be analysed using a linear mixed model, assuming data are missing at random. The mixed model will include group, time, and the interaction of group and time as fixed effects and participant and university as random effect. Discussion This study is a high-quality RCT with three assessment points and intention-to-treat analysis meeting the state-of-the-art of effectiveness studies. Recruitment covers almost 20 universities in three countries, leading to high external validity. The results of this study will be of great relevance for student health campaigns, as they reflect the effectiveness of self-help interventions for young adults with regard to behaviour change as well as motivational and volitional determinants. From a lifespan perspective, it is important to help students find their way into regular physical activity. Trial registration The German clinical trials register (DRKS) DRKS00016889. Registered on 28 February 2019
Collapse
Affiliation(s)
- Lena Violetta Krämer
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany.
| | - Nadine Eschrig
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| | - Lena Keinhorst
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| | - Luisa Schöchlin
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| | - Lisa Stephan
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| | - Malin Stiene
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany
| |
Collapse
|
14
|
Wong EML, Leung DYP, Tam HL, Wang Q, Yeung KW, Leung AYM. The Effect of a Lifestyle Intervention Program Using a Mobile Application for Adults with Metabolic Syndrome, versus the Effect of a Program Using a Booklet: A Pilot Randomized Controlled Trial. Clin Interv Aging 2021; 16:633-644. [PMID: 33888981 PMCID: PMC8057802 DOI: 10.2147/cia.s303920] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/27/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to examine the preliminary effect, feasibility, and acceptability of a lifestyle intervention program using a mobile application (app) versus the effect of a program using a booklet for adults with metabolic syndrome (MetS). Patients and Methods This trial was conducted in two community centers of Hong Kong. Participants were included if they were adults with MetS, aged over 50, and able to use a smartphone. Eligible subjects were randomly assigned to either the app group or booklet group. Those in the booklet group received a health talk and a booklet, whereas those in the app group received a health talk and a MetS app to support their exercise maintenance and health records for 3 months. Both groups received similar educational content related to healthcare for MetS clients. Data were collected at baseline (T1) and at 1- (T2) and 3-month (T3) intervals. Outcomes were body weight (primary outcome), total amount of exercise, blood pressure, and lipid concentrations. Data were analyzed using the generalized estimating equation models. Feasibility and acceptability were assessed in process evaluation. Results Ninety-eight individuals were screened for eligibility and 77 were randomized into the app group (n = 38) or booklet group (n = 39). The attrition rate at T3 was 11.690%. The app group showed a significant reduction in body weight (β = −1.069, p = 0.012) and body mass index (β = −0.371, p = 0.026), a greater amount of exercise (β = 8.454, p = 0.032), and improved exercise self-efficacy (β = 10.62, p = 0.001) within 3 months. There were no significant differences between groups for other outcomes. The participants appreciated the proposed intervention of the programme. Conclusion The MetS app may be incorporated in the health promotion programme to support exercise maintenance and a healthy lifestyle in the community.
Collapse
Affiliation(s)
- Eliza Mi Ling Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, People's Republic of China
| | - Doris Y P Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, People's Republic of China
| | - Hon Lon Tam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, People's Republic of China
| | - Qun Wang
- School of Nursing, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Kai Wang Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, People's Republic of China
| | - Angela Y M Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, People's Republic of China
| |
Collapse
|
15
|
Boudreau F, Dagenais GR, de Vries H, Walthouwer MJL, Côté J, Turbide G, Bourlaud AS, Poirier P. Effectiveness of a web-based computer-tailored intervention promoting physical activity for adults from Quebec City: a randomized controlled trial. Health Psychol Behav Med 2020; 8:601-622. [PMID: 34040888 PMCID: PMC8114390 DOI: 10.1080/21642850.2020.1850287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background The primary objective of this study was to determine the effectiveness of a 3-month web-based computer-tailored intervention on moderate-to-vigorous physical activity (MVPA) in adults. Methods A total of 242 Canadian adults aged between 35 and 70 years were randomized to an experimental group receiving the intervention or a waiting list control group. The fully automated web-based computer-tailored physical activity intervention consists of seven 10- to 15-min sessions over an 8-week period. The theoretical underpinning of the intervention is based on the I-Change Model. Results A repeated-measures ANOVA using a linear mixed model showed a significant 'group-by-time' interaction favoring the intervention group in self-reported MVPA (p = .02). The MVPA was similar in both groups at baseline (mean ± SD; 176 ± 13 vs. 172 ± 15 min/week, p = .72) and higher in the intervention than in the control group at a 3-month follow-up (259 ± 21 vs. 201 ± 22 min/week, p = .04). This finding was comparable across women and men (group-by-sex, p = .57) and across participants meeting or not physical activity guidelines at baseline (group-by-baseline physical activity, p = .43). Although engagement to the web-based sessions declined over time, participants completing more web sessions achieved higher self-reported MVPA (p < .05). Conclusion These findings suggest that this intervention is effective in enhancing self-reported MVPA in this adult population in the short term; however, this needs to be confirmed in a larger trial with better engagement to the web-based sessions.
Collapse
Affiliation(s)
- François Boudreau
- Département des sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Département de médecine, Faculté de médecine, Université Laval, Québec, Canada
| | - Hein de Vries
- School for Public Health and Primary Care (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Michel Jean Louis Walthouwer
- School for Public Health and Primary Care (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - José Côté
- Faculté des sciences infirmières, Centre de recherche du Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | - Ginette Turbide
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Anne-Sophie Bourlaud
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculté de Pharmacie, Université Laval, Québec, Canada
| |
Collapse
|
16
|
Wong EML, Leung DYP, Chair SY, Sit JWH. Effects of a Web-Based Educational Support Intervention on Total Exercise and Cardiovascular Risk Markers in Adults With Coronary Heart Disease. Worldviews Evid Based Nurs 2020; 17:283-292. [PMID: 32772509 DOI: 10.1111/wvn.12456] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/30/2019] [Accepted: 01/01/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND eHealth educational programs have proven to be an effective means for health promotion, yet limited studies have been conducted for coronary heart disease (CHD) patients to improve their total physical exercise, self-efficacy for exercise, and cardiovascular risk factor profile. METHOD A prospective randomized controlled trial (RCT) was conducted in two cardiac clinics in Hong Kong. Four hundred thirty-eight eligible CHD clients were randomly assigned to either the control or the intervention group. All of the participants received standard care, which consisted of regular medical and nursing care in the cardiac clinic. The intervention group received an additional web-based educational support intervention (eHES), which consisted of a 20-minute individual educational session on the use of the eHES web link. The eHES web link contains a health information platform related to CHD care and an individual member area with records of health measures and physical exercise data for six months. Data were collected at baseline, at three-month and six-month intervals at the cardiac clinic. The primary outcome was the total amount of physical exercise, measured by the Godin-Shephard Leisure-Time Physical Activity Questionnaire. The secondary outcomes were self-efficacy for exercise and cardiovascular disease (CVD) risk markers (body weight, blood pressure, lipid profile). The data were analyzed using a generalized estimating equations model. RESULTS The intervention group reported a statistically higher amount of physical exercise and a higher HDL-C at 3 and 6 months, respectively. There were no statistical differences between the groups in self-efficacy for exercise and other CVD risk markers. LINKING EVIDENCE TO ACTION The study demonstrated the effectiveness of the eHES in meeting the challenge of boosting the amount of physical exercise and increase HDL-C among CHD patients who engaged for over three months. The results provide insight for eHealth development to support and promote exercise among CHD patients in the community.
Collapse
Affiliation(s)
- Eliza Mi-Ling Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Doris Y P Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Sek-Ying Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Janet W H Sit
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
17
|
Hurmuz MZM, Jansen-Kosterink SM, Op den Akker H, Hermens HJ. User Experience and Potential Health Effects of a Conversational Agent-Based Electronic Health Intervention: Protocol for an Observational Cohort Study. JMIR Res Protoc 2020; 9:e16641. [PMID: 32242517 PMCID: PMC7165305 DOI: 10.2196/16641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/23/2020] [Accepted: 02/07/2020] [Indexed: 01/23/2023] Open
Abstract
Background While the average human life expectancy has increased remarkably, the length of life with chronic conditions has also increased. To limit the occurrence of chronic conditions and comorbidities, it is important to adopt a healthy lifestyle. Within the European project “Council of Coaches,” a personalized coaching platform was developed that supports developing and maintaining a healthy lifestyle. Objective The primary aim of this study is to assess the user experience with and the use and potential health effects of a fully working Council of Coaches system implemented in a real-world setting among the target population, specifically older adults or adults with type 2 diabetes mellitus or chronic pain. Methods An observational cohort study with a pretest-posttest design will be conducted. The study population will be a dynamic cohort consisting of older adults, aged ≥55 years, as well as adults aged ≥18 years with type 2 diabetes mellitus or chronic pain. Each participant will interact in a fully automated manner with Council of Coaches for 5 to 9 weeks. The primary outcomes are user experience, use of the program, and potential effects (health-related factors). Secondary outcomes include demographics, applicability of the virtual coaches, and user interaction with the virtual coaches. Results Recruitment started in December 2019 and is conducted through mass mailing, snowball sampling, and advertisements in newspapers and social media. This study is expected to conclude in August 2020. Conclusions The results of this study will either confirm or reject the hypothesis that a group of virtual embodied conversational coaches can keep users engaged over several weeks of interaction and contribute to positive health outcomes. Trial Registration The Netherlands Trial Register: NL7911; https://www.trialregister.nl/trial/7911 International Registered Report Identifier (IRRID) PRR1-10.2196/16641
Collapse
Affiliation(s)
- Marian Z M Hurmuz
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Stephanie M Jansen-Kosterink
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Harm Op den Akker
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Hermie J Hermens
- eHealth Group, Roessingh Research and Development, Enschede, Netherlands.,Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| |
Collapse
|
18
|
Patient acceptance of a telemedicine service for rehabilitation care: A focus group study. Int J Med Inform 2019; 125:22-29. [DOI: 10.1016/j.ijmedinf.2019.01.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 12/17/2018] [Accepted: 01/21/2019] [Indexed: 11/22/2022]
|
19
|
A Systematic Review of Electronic and Mobile Health (e- and mHealth) Physical Activity Interventions for African American and Hispanic Women. J Phys Act Health 2019; 16:230-239. [PMID: 30782040 DOI: 10.1123/jpah.2018-0103] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The purpose of this systematic review was to evaluate the existing scientific literature on e- and mHealth interventions promoting physical activity (PA) among African American (AA) and Hispanic women. METHODS Using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, 5 electronic databases and gray literature sources were searched in August 2017. Inclusion criteria are published in English language peer-reviewed journals between 2000 and 2017, use of an e- or mHealth delivery strategy to promote PA, primary focus on AA or Hispanic women, and reported PA outcome data. RESULTS Ten articles met inclusion criteria for review, 6 studies focused on AA women and 4 studies on Hispanic women. The majority (n = 8) were pilot studies; only 2 studies were full-scale randomized controlled trials and both focused on Hispanic women. Six studies (60%) used websites as the primary method of intervention delivery, 3 studies (30%) used text messaging, and 1 study (10%) used the social networking website Facebook. In total, 70% of the studies (n = 7) reported significant within- or between-group differences for at least 1 PA outcome. CONCLUSIONS Findings provide preliminary support for e- and mHealth PA interventions among AA and Hispanic women. However, future large-scale, rigorously designed, randomized controlled trials are needed to further explore their effectiveness among AA and Hispanic women.
Collapse
|
20
|
Cotie LM, Prince SA, Elliott CG, Ziss MC, McDonnell LA, Mullen KA, Hiremath S, Pipe AL, Reid RD, Reed JL. The effectiveness of eHealth interventions on physical activity and measures of obesity among working-age women: a systematic review and meta-analysis. Obes Rev 2018; 19:1340-1358. [PMID: 30156044 DOI: 10.1111/obr.12700] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 12/25/2022]
Abstract
Physical inactivity and obesity are modifiable risk factors for cardiovascular disease, particularly in women. eHealth interventions may increase physical activity and improve obesity-related outcomes among women. The objective of this study was to review the evidence of the effectiveness of eHealth interventions to increase moderate-to-vigorous physical activity among working-age women. The secondary objective was to examine their effectiveness on improving obesity-related outcomes. A comprehensive search strategy was developed for eight electronic databases; through July 2016. All studies consisting of >80% women of working-age (18-65 years) in high income countries were included. Multiple unblinded reviewers determined study eligibility and extracted data. Risk of bias was evaluated using the Cochrane Risk of Bias Tool and data quality using the Grading of Recommendations Assessment, Development and Evaluation approach. Data were pooled using a random-effects model. Sixty studies were included in the review of which 20 were in the meta-analysis. The meta-analysis demonstrated eHealth interventions improved moderate-to-vigorous physical activity (standard mean difference = 1.13, 95% confidence interval: 0.58, 1.68, P < 0.0001); an increase of ~25 min week-1 . No changes were observed in obesity-related outcomes; waist circumference (P = 0.06), body mass (P = 0.05) and body mass index (P = 0.35). eHealth interventions are effective at increasing min week-1 of moderate-to-vigorous physical activity among working-age women from high income countries.
Collapse
Affiliation(s)
- L M Cotie
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - S A Prince
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada
| | - C G Elliott
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - M C Ziss
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - L A McDonnell
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - K A Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - S Hiremath
- Faculty of Medicine, Roger Guindon Hall, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Division of Nephrology, Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, Canada
| | - A L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, Roger Guindon Hall, University of Ottawa, Ottawa, Canada
| | - R D Reid
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, Roger Guindon Hall, University of Ottawa, Ottawa, Canada
| | - J L Reed
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| |
Collapse
|
21
|
Adamse C, Dekker-Van Weering MG, van Etten-Jamaludin FS, Stuiver MM. The effectiveness of exercise-based telemedicine on pain, physical activity and quality of life in the treatment of chronic pain: A systematic review. J Telemed Telecare 2018; 24:511-526. [PMID: 28696152 DOI: 10.1177/1357633x17716576] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Introduction The aim of this study was to systematically review the evidence on the effectiveness of exercise-based telemedicine in chronic pain. Methods We searched the Cochrane, PubMed, MEDLINE, EMBASE, CINAHL and PEDRO databases from 2000 to 2015 for randomised controlled trials, comparing exercise-based telemedicine intervention to no intervention or usual care in adults with chronic pain. Primary outcome data were pooled using random effect meta-analysis. Primary outcomes were pain, physical activity (PA), limitations in activities of daily living (ADL) and quality of life (QoL). Secondary outcomes were barriers, facilitators and usability of telemedicine. Results Sixteen studies were included. Meta-analyses were performed in three subgroups of studies with comparable control conditions. Telemedicine versus no intervention showed significantly lower pain scores (MD -0.57, 95% CI -0.81; -0.34), but not for telemedicine versus usual care (MD -0.08, 95% CI -0.41; 0.26) or in addition to usual care (MD -0.25, 95% CI -1.50; 1.00). Telemedicine compared to no intervention showed non-significant effects for PA (MD 19.93 min/week, 95% CI -5.20; 45.06) and significantly diminished ADL limitations (SMD -0.20, 95% CI -0.29; -0.12). No differences were found for telemedicine in addition to usual care for PA or for ADL (SMD 0.16, 95% CI -0.66; 0.34). Telemedicine versus usual care showed no differences for ADL (SMD 0.08, 95% CI -0.37; 0.53). No differences were found for telemedicine compared to the three control groups for QoL. Limited information was found on the secondary outcomes. Conclusions Exercise-based telemedicine interventions do not seem to have added value to usual care. As substitution of usual care, telemedicine might be applicable but due to limited quality of the evidence, further exploration is needed for the rapidly developing field of telemedicine.
Collapse
Affiliation(s)
- Corine Adamse
- 1 Physiotherapy Department, Antonius Hospital, Sneek, The Netherlands
| | | | | | - Martijn M Stuiver
- 4 Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, The Netherlands
| |
Collapse
|
22
|
Favorable Outcomes Using an eHealth Approach to Promote Physical Activity and Nutrition Among Young African American Women. J Cardiovasc Nurs 2018; 33:62-71. [PMID: 28481823 DOI: 10.1097/jcn.0000000000000409] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Internet and mobile devices are widely used and provide alternative approaches for promoting healthy lifestyles, yet less information is available describing outcomes of these approaches when used with young African American (AA) women at risk for developing hypertension. OBJECTIVE In this study, we evaluated a Web-based, culturally relevant lifestyle change intervention targeting AA women (referred to as the eHealth study). METHODS African American women, aged 18 to 45 years, with untreated prehypertension and Internet access were eligible for a 12-week study that incorporated social cognitive theory strategies. Participants were randomized to (1) lifestyle physical activity (PA) or (2) Dietary Approaches to Stop Hypertension (DASH) online education modules. RESULTS The 14 DASH and 12 PA participant attributes were similar at baseline. The DASH participants had a significant change in total DASH score (P = .001) and large effect sizes for DASH components (vegetables, 0.84; nonfat dairy, 0.71; fruit, 0.62). The PA participants had a favorable change (+39%) in pedometer steps (P = .055). With respect to weight change, a large effect size was observed for PA (0.84) and smaller for DASH participants (0.18). Seventy-one percent of DASH and 48% of PA participants completed program activities, corresponding to a moderate difference in program engagement between groups (d = 0.58). CONCLUSION Our eHealth platform provides an alternative approach for reaching young AA women and was successful with respect to improving PA and dietary behaviors. Furthermore, the eHealth approach has the potential as a powerful program for changing health behaviors for other at-risk populations.
Collapse
|
23
|
Internet-Delivered Self-management Support for Improving Coronary Heart Disease and Self-management-Related Outcomes: A Systematic Review. J Cardiovasc Nurs 2018; 32:E9-E23. [PMID: 28107251 PMCID: PMC5469565 DOI: 10.1097/jcn.0000000000000392] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Coronary heart disease (CHD) is associated with significant morbidity and mortality, including mental health comorbidity, which is associated with poor outcomes. Self-management is key, but there is limited access to self-management support. Internet-delivered interventions may increase access. OBJECTIVE The aim of this study was to conduct a systematic review to (1) determine the effectiveness of Internet-delivered CHD self-management support for improving CHD, mood, and self-management related outcomes and (2) identify and describe essential components for effectiveness. METHOD Randomized controlled trials that met prespecified eligibility criteria were identified using a systematic search of 3 healthcare databases (Medline, PsychINFO, and Embase). RESULTS Seven trials, which included 1321 CHD patients, were eligible for inclusion. There was considerable heterogeneity between studies in terms of the intervention content, outcomes measured, and study quality. All 7 of the studies reported significant positive between-group effects, in particular for lifestyle-related outcomes. Personalization of interventions and provision of support to promote engagement may be associated with improved outcomes, although more data are required to confirm this. The theoretical basis of interventions was poorly developed though evidence-based behavior change interventions were used. CONCLUSION More well-designed randomized controlled trials are needed. These should also explore how interventions work and how to improve participant retention and satisfaction and examine the role of personalization and support within interventions.
Collapse
|
24
|
The Feasibility of Using Facebook, Craigslist, and Other Online Strategies to Recruit Young African American Women for a Web-Based Healthy Lifestyle Behavior Change Intervention. J Cardiovasc Nurs 2018; 32:365-371. [PMID: 27428356 DOI: 10.1097/jcn.0000000000000360] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reports describing successful recruiting of minority participants are available; however, they focus largely on traditional strategies. Internet and mobile devices are widely used, providing alternative approaches, yet less information is available describing the success of these approaches. OBJECTIVE This article (1) evaluates the feasibility of using online advertising as a recruiting modality for a healthy lifestyle behavior change intervention targeting young African American women and (2) describes lessons learned to better inform researchers for future directions. METHODS African American women, aged 18 to 45 years, with untreated prehypertension and Internet access were eligible for a 12-week randomized study providing physical activity or nutrition behavior change education delivered via online modules. Traditional strategies included flyers, tabletop cards, blood pressure screenings, health fairs, and clinics. Online-related strategies included posting ads on Facebook, Craigslist, and on the university Web site, intranet, and "on-hold" telephone line. Descriptive statistics were used to identify frequency of recruitment strategies. χ Analysis was used to assess differences between enrolled and nonenrolled inquiries. RESULTS Among all 176 inquiries, the most frequented strategies were the university Web site (44%), blood pressure screenings (15%), Facebook/Craigslist (13%), and clinics (12%). Enrollment rates differed across recruitment strategies (χ P = .046). The 3 highest enrollment rates were (1) employee in-services (100%), (2) flyers/tabletop cards (31.6%), and (3) word of mouth/physician referral (25%). CONCLUSION Online-related strategies are convenient and have great potential for reaching large numbers of people. However, the actual rate of participants successfully enrolled online was proportionally smaller when compared with traditional recruiting strategies.
Collapse
|
25
|
Lee S, Kim W, Park T, Peng W. The Psychological Effects of Playing Exergames: A Systematic Review. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2017; 20:513-532. [PMID: 28837353 DOI: 10.1089/cyber.2017.0183] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Successful exergames should lead players not only to achieve enough level of energy expenditure but also to engage in the play itself. The aim of this study is to review studies that explored the psychological effects of playing exergames, from the viewpoint of player engagement. Peer-reviewed journal articles in English collected via database search (Science Direct, Web of Science, ACM Digital Library) from 2011 to 2015 were considered, and 45 experimental studies were selected out of 911 studies. The results show that a variety of psychological effects of engagement including enjoyment, immersion, and flow were measured in the exergame studies. In addition, physiological variables (e.g., energy expenditure), feedback modality (e.g., auditory and tactile), and play modes (e.g., solitary or group play mode) are related to psychological effects of playing exergames. Finally, salient methodological issues (e.g., validated measurement, sample size calculation) in the studies are identified and discussed.
Collapse
Affiliation(s)
- Seungmin Lee
- 1 Department of Kinesiology, Michigan State University , East Lansing, Michigan
| | - Wonkyung Kim
- 2 Department of Advertising and Public Relations, Michigan State University , East Lansing, Michigan
| | - Taiwoo Park
- 3 Department of Media and Information, Michigan State University , East Lansing, Michigan
| | - Wei Peng
- 3 Department of Media and Information, Michigan State University , East Lansing, Michigan
| |
Collapse
|
26
|
Lindqvist AK. Physiotherapists enabling school children's physical activity using social cognitive theory, empowerment and technology. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2017.1322141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
27
|
McIntosh J, Jay S, Hadden N, Whittaker P. Do E-health interventions improve physical activity in young people: a systematic review. Public Health 2017; 148:140-148. [DOI: 10.1016/j.puhe.2017.04.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/30/2017] [Accepted: 04/01/2017] [Indexed: 11/29/2022]
|
28
|
Hartman SJ, Dunsiger SI, Marinac CR, Marcus BH, Rosen RK, Gans KM. Internet-based physical activity intervention for women with a family history of breast cancer. Health Psychol 2016; 34S:1296-304. [PMID: 26651471 DOI: 10.1037/hea0000307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Physical inactivity is a modifiable risk factor for breast cancer. Physical activity interventions that can be delivered through the Internet have the potential to increase participant reach. The efficacy of an Internet-based physical activity intervention was tested in a sample of women at an elevated risk for breast cancer. METHOD A total of 55 women with at least 1 first-degree relative with breast cancer (but no personal history of breast cancer) were randomized to a 3-month theoretically grounded Internet-based physical activity intervention or an active control arm. Minutes of moderate to vigorous physical activity, psychosocial mediators of physical activity adoption and maintenance, as well as worry and perceived risk of developing breast cancer were assessed at baseline, 3-month, and 5-month follow up. RESULTS Participants were on average 46.2 (SD = 11.4) years old with a body mass index of 27.3 (SD = 4.8) kg/m2. The intervention arm significantly increased minutes of moderate to vigorous physical activity compared to the active control arm at 3 months (213 vs. 129 min/week) and 5 months (208 vs. 119 min/week; both ps < .001). Regression models indicated that participants in the intervention had significantly higher self-efficacy for physical activity at 3 months (p < .01) and borderline significantly higher self-efficacy at 5 months (p = .05). Baseline breast cancer worry and perceived risk were not associated with physical activity. CONCLUSION Findings from this study suggest that an Internet-based physical activity intervention may substantially increase physical activity in women with a family history of breast cancer.
Collapse
Affiliation(s)
- Sheri J Hartman
- Department of Family Medicine and Public Health and Moores Cancer Center, University of California, San Diego
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Miriam Hospital, Brown University
| | | | - Bess H Marcus
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, Miriam Hospital, Brown University
| | - Kim M Gans
- Department of Human Development and Family Studies, University of Connecticut
| |
Collapse
|
29
|
Gregoski MJ, Newton J, Ling CG, Blaylock K, Smith SA, Paguntalan J, Treiber FA. Effective weight-loss using an e-health delivered physical activity and dietary intervention: A federal credit union pilot study. Work 2016; 54:127-34. [DOI: 10.3233/wor-162282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mathew J. Gregoski
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Janis Newton
- Wellness Center, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine G. Ling
- Graduate School of Nursing, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Kathleen Blaylock
- Wellness Center, Medical University of South Carolina, Charleston, SC, USA
| | - Sheila A.O. Smith
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - John Paguntalan
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Frank A. Treiber
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
30
|
Friederichs SA, Bolman C, Oenema A, Verboon P, Lechner L. Exploring the working mechanisms of a web-based physical activity intervention, based on self-determination theory and motivational interviewing. Internet Interv 2015; 3:8-17. [PMID: 30135784 PMCID: PMC6096131 DOI: 10.1016/j.invent.2015.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 11/12/2015] [Accepted: 11/18/2015] [Indexed: 01/21/2023] Open
Abstract
The aim of this study was to compare a web-based computer tailored physical activity intervention based on self-determination theory and motivational interviewing (I Move) to a traditional web-based computer tailored physical activity intervention (Active Plus) with regard to their basic psychological need supporting capabilities. We also aimed to assess the extent to whether self-determination constructs played a stronger mediating role in the effects of I Move than in the effects of Active Plus. A randomized controlled trial was conducted among 3089 participants (age 44.9 ± 12.9, 69.1% women), comparing 1) I Move, 2) Active Plus, and 3) a waiting list control condition. Physical activity behavior (measured at baseline, and at six months after baseline), potential mediators (intrinsic motivation, identified regulation, perceived competence and perceived choice, measured at baseline, and at three months after baseline) and basic psychological need support (measured six weeks and six months after baseline) were assessed through self-report, using web-based questionnaires. I Move was found to be more effective in supporting participants' basic psychological needs (sessions 1 and 2; p = .001; sessions 3 and 4; p = .004). The results of the mediation analyses show that the effects of both interventions were (equally) mediated by perceived competence, but not by intrinsic motivation, identified regulation or perceived choice.
Collapse
Affiliation(s)
- Stijn A.H. Friederichs
- Open University of the Netherlands, Faculty of Psychology and Educational Sciences, P.O. Box 2960, 6401 DL Heerlen, The Netherlands,Corresponding author.
| | - Catherine Bolman
- Open University of the Netherlands, Faculty of Psychology and Educational Sciences, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
| | - Anke Oenema
- Maastricht University, Department of Health Promotion, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Peter Verboon
- Open University of the Netherlands, Faculty of Psychology and Educational Sciences, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
| | - Lilian Lechner
- Open University of the Netherlands, Faculty of Psychology and Educational Sciences, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
| |
Collapse
|
31
|
|
32
|
Marsaux CF, Celis-Morales C, Fallaize R, Macready AL, Kolossa S, Woolhead C, O'Donovan CB, Forster H, Navas-Carretero S, San-Cristobal R, Lambrinou CP, Moschonis G, Surwillo A, Godlewska M, Goris A, Hoonhout J, Drevon CA, Manios Y, Traczyk I, Walsh MC, Gibney ER, Brennan L, Martinez JA, Lovegrove JA, Gibney MJ, Daniel H, Mathers JC, Saris WH. Effects of a Web-Based Personalized Intervention on Physical Activity in European Adults: A Randomized Controlled Trial. J Med Internet Res 2015; 17:e231. [PMID: 26467573 PMCID: PMC4642412 DOI: 10.2196/jmir.4660] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/20/2015] [Accepted: 09/22/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The high prevalence of physical inactivity worldwide calls for innovative and more effective ways to promote physical activity (PA). There are limited objective data on the effectiveness of Web-based personalized feedback on increasing PA in adults. OBJECTIVE It is hypothesized that providing personalized advice based on PA measured objectively alongside diet, phenotype, or genotype information would lead to larger and more sustained changes in PA, compared with nonpersonalized advice. METHODS A total of 1607 adults in seven European countries were randomized to either a control group (nonpersonalized advice, Level 0, L0) or to one of three personalized groups receiving personalized advice via the Internet based on current PA plus diet (Level 1, L1), PA plus diet and phenotype (Level 2, L2), or PA plus diet, phenotype, and genotype (Level 3, L3). PA was measured for 6 months using triaxial accelerometers, and self-reported using the Baecke questionnaire. Outcomes were objective and self-reported PA after 3 and 6 months. RESULTS While 1270 participants (85.81% of 1480 actual starters) completed the 6-month trial, 1233 (83.31%) self-reported PA at both baseline and month 6, but only 730 (49.32%) had sufficient objective PA data at both time points. For the total cohort after 6 months, a greater improvement in self-reported total PA (P=.02) and PA during leisure (nonsport) (P=.03) was observed in personalized groups compared with the control group. For individuals advised to increase PA, we also observed greater improvements in those two self-reported indices (P=.006 and P=.008, respectively) with increased personalization of the advice (L2 and L3 vs L1). However, there were no significant differences in accelerometer results between personalized and control groups, and no significant effect of adding phenotypic or genotypic information to the tailored feedback at month 3 or 6. After 6 months, there were small but significant improvements in the objectively measured physical activity level (P<.05), moderate PA (P<.01), and sedentary time (P<.001) for individuals advised to increase PA, but these changes were similar across all groups. CONCLUSIONS Different levels of personalization produced similar small changes in objective PA. We found no evidence that personalized advice is more effective than conventional "one size fits all" guidelines to promote changes in PA in our Web-based intervention when PA was measured objectively. Based on self-reports, PA increased to a greater extent with more personalized advice. Thus, it is crucial to measure PA objectively in any PA intervention study. TRIAL REGISTRATION ClinicalTrials.gov NCT01530139; http://clinicaltrials.gov/show/NCT01530139 (Archived by WebCite at: http://www.webcitation.org/6XII1QwHz).
Collapse
Affiliation(s)
- Cyril Fm Marsaux
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre + (MUMC+), Maastricht, Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Short CE, Hayman M, Rebar AL, Gunn KM, De Cocker K, Duncan MJ, Turnbull D, Dollman J, van Uffelen JG, Vandelanotte C. Physical activity recommendations from general practitioners in Australia. Results from a national survey. Aust N Z J Public Health 2015; 40:83-90. [DOI: 10.1111/1753-6405.12455] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/01/2015] [Accepted: 06/01/2015] [Indexed: 12/17/2022] Open
Affiliation(s)
- Camille E. Short
- Freemasons Foundation Centre of Men's Health, School of Medicine; University of Adelaide; South Australia
| | - Mel Hayman
- School of Medical and Applied Sciences; Central Queensland University
| | - Amanda L. Rebar
- School of Human, Health, and Social Sciences; Central Queensland University
| | - Kate M. Gunn
- Flinders Centre for Innovation in Cancer, School of Medicine; Flinders University; South Australia
| | - Katrien De Cocker
- Department of Movement and Sports Sciences; Universiteit Gent; Belgium
| | - Mitch J. Duncan
- Priority Research Centre for Physical Activity and Nutrition, School of Medicine & Public Health; The University of Newcastle; New South Wales
| | | | - James Dollman
- Exercise for Health and Human Performance Research Group, School of Health Sciences; University of South Australia
| | | | | |
Collapse
|
34
|
Jansen-Kosterink S, in 't Veld RH, Hermens H, Vollenbroek-Hutten M. A Telemedicine Service as Partial Replacement of Face-to-Face Physical Rehabilitation: The Relevance of Use. Telemed J E Health 2015; 21:808-13. [DOI: 10.1089/tmj.2014.0173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Hermie Hermens
- Telemedicine Group, Roessingh Research and Development, Enschede, The Netherlands
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, University of Twente, Enschede, The Netherlands
| | - Miriam Vollenbroek-Hutten
- Telemedicine Group, Roessingh Research and Development, Enschede, The Netherlands
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, University of Twente, Enschede, The Netherlands
| |
Collapse
|
35
|
Friederichs SAH, Oenema A, Bolman C, Lechner L. Long term effects of self-determination theory and motivational interviewing in a web-based physical activity intervention: randomized controlled trial. Int J Behav Nutr Phys Act 2015; 12:101. [PMID: 26283094 PMCID: PMC4538737 DOI: 10.1186/s12966-015-0262-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/05/2015] [Indexed: 11/10/2022] Open
Abstract
Background Our main objective in the current study was to evaluate the long-term effectiveness (12 months from baseline) of I Move (a web-based computer tailored physical activity intervention, based on self-determination theory and motivational interviewing). To this end, we compared I Move to a web-based computer tailored physical activity intervention based on traditional health behavior theories (Active Plus), and to a no-intervention control group. As a secondary objective, the present study aimed to identify participant characteristics that moderate the long term effects of I Move and Active Plus. Methods A randomized controlled trial was conducted, comparing three research conditions: 1) the I Move condition, participants in this condition received I Move; 2) the Active Plus condition, participants in this condition received Active Plus; 3) the control condition; participants in this condition received no intervention and were placed on a waiting list. Main outcome measures were weekly minutes of moderate to vigorous physical activity and weekly days with minimal 30 min of physical activity. All measurements were taken by web-based questionnaires via the study website. Intervention effects were analyzed using multilevel linear regression analyses. Results At 12 months from baseline, I Move was found to be effective in increasing weekly minutes of moderate to vigorous physical activity (ES = .13), while Active Plus was not. In contrast, Active Plus was found to be effective in increasing weekly days with ≥ 30 min PA at 12 months (ES = .11), while I Move was not. No moderators of the effects of I Move were found. Conclusions The results suggest that web-based computer tailored physical activity interventions might best include elements based on both self-determination theory/motivational interviewing and traditional health behavioral theories. To be more precise, it is arguable that the focus of the theoretical foundations, used in new web-based PA interventions should depend on the intended program outcome. In order to draw firm conclusions, however, more research on the effects of self-determination theory and motivational interviewing in web-based physical activity promotion is needed. Trial registration Dutch Trial Register NTR4129
Collapse
Affiliation(s)
- Stijn A H Friederichs
- Open University of the Netherlands, Faculty of Psychology and Educational Sciences, P.O. box 2960, 6401, DL, Heerlen, The Netherlands.
| | - Anke Oenema
- Department of Health Promotion, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Catherine Bolman
- Open University of the Netherlands, Faculty of Psychology and Educational Sciences, P.O. box 2960, 6401, DL, Heerlen, The Netherlands.
| | - Lilian Lechner
- Open University of the Netherlands, Faculty of Psychology and Educational Sciences, P.O. box 2960, 6401, DL, Heerlen, The Netherlands.
| |
Collapse
|
36
|
Zeng EY, Vilardaga R, Heffner JL, Mull KE, Bricker JB. Predictors of Utilization of a Novel Smoking Cessation Smartphone App. Telemed J E Health 2015; 21:998-1004. [PMID: 26171733 DOI: 10.1089/tmj.2014.0232] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Understanding the characteristics of high and low utilizers of smartphone applications (apps) for smoking cessation would inform development of more engaging and effective apps, yet no studies to date have addressed this critical question. Informed by prior research on predictors of cessation Web site utilization, this study examines the degree to which baseline demographic factors (gender, age, and education), smoking-related factors (smoking level and friends' smoking), and psychological factors (depression and anxiety) are predictive of utilization of a smartphone app for smoking cessation called SmartQuit. MATERIALS AND METHODS Data came from 98 participants randomized to SmartQuit as part of a pilot trial from March to May 2013. We used negative binomial count regressions to examine the relationship between user characteristics and utilization of the app over an 8-week treatment period. RESULTS Lower education (risk ratio [RR]=0.492; p=0.021), heavier smoking (RR=0.613; p=0.033), and depression (RR=0.958; p=0.017) prospectively predicted lower app utilization. Women (RR=0.320; p=0.022), those with lower education (RR=0.491; p=0.013), and heavier smokers (RR=0.418; p=0.039) had lower utilization of app features known to predict smoking cessation. CONCLUSIONS Many of the predictors of utilization of smoking cessation apps are the same as those of cessation Web sites. App-delivered smoking cessation treatment effectiveness could be enhanced by focusing on increasing engagement of women, those with lower education, heavy smokers, and those with current depressive symptoms.
Collapse
Affiliation(s)
- Emily Y Zeng
- 1 Department of Psychology, University of Washington , Seattle, Washington.,2 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - Roger Vilardaga
- 2 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center , Seattle, Washington.,3 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington
| | - Jaimee L Heffner
- 2 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - Kristin E Mull
- 2 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - Jonathan B Bricker
- 1 Department of Psychology, University of Washington , Seattle, Washington.,2 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center , Seattle, Washington
| |
Collapse
|
37
|
Lee S, Lindquist R. A review of technology-based interventions to maintain weight loss. Telemed J E Health 2015; 21:217-32. [PMID: 25692454 DOI: 10.1089/tmj.2014.0052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND For many decades, healthcare providers and researchers have developed weight-loss interventions to help people achieve weight loss. Unfortunately, it is typical for people to lose weight quickly during the intervention period but then slowly regain weight until they return to their approximate baseline. Technology-based maintenance interventions are among the newest approaches to long-term weight loss. Several advantages make technology helpful for maintaining weight loss. The purpose of this article was to review and critique the randomized controlled trials of technology-based weight-loss maintenance interventions (WLMIs) for adults. MATERIALS AND METHODS A systematic search through electronic databases and a manual citation search were conducted. Limited numbers of controlled trials published since 2000 that included randomization, and technology-based WLMIs were identified. RESULTS The characteristics of the eight studies were diverse. The average score of study design quality was moderate. The results of the effectiveness of technology-based WLMIs were mixed. Technology-based WLMIs are more likely to be effective than usual care but not more effective than personal contact. CONCLUSIONS Based on the review, guidelines were established for the selection and potential success of technology-based WLMIs. The effectiveness of technology-based maintenance interventions for weight loss varied, and potential strategies and approaches are discussed to improve their effectiveness. Further studies are needed to better evaluate and refine the efficacy of technology-based WLMIs.
Collapse
Affiliation(s)
- Sohye Lee
- School of Nursing, University of Minnesota , Minneapolis, Minnesota
| | | |
Collapse
|
38
|
Reed JL, Prince SA, Cole CA, Nerenberg KA, Hiremath S, Tulloch HE, Fodor JG, Szczotka A, McDonnell LA, Mullen KA, Pipe AL, Reid RD. E-health physical activity interventions and moderate-to-vigorous intensity physical activity levels among working-age women: a systematic review protocol. Syst Rev 2015; 4:3. [PMID: 25589330 PMCID: PMC4506417 DOI: 10.1186/2046-4053-4-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/30/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The rapid pace of modern life requires working-age women to juggle occupational, family, and social demands. Despite the large numbers of working-age women in developed countries and the proven benefits of regular moderate-to-vigorous intensity aerobic physical activity (MVPA) in chronic disease prevention, few women meet current physical activity (PA) recommendations of 150 min of MVPA per week. It is important that appropriate and effective behavioral interventions targeting PA are identified and developed to improve the MVPA levels of working-age women. As women worldwide embrace modern technologies, e-health innovations may provide opportune and convenient methods of implementing programs and strategies to target PA in an effort to improve MVPA levels and cardiometabolic health. Previous reviews on this topic have been limited; none have focused on working-age women from developed countries who exhibit inappropriately low PA levels. It remains unknown as to which e-health interventions are most effective at increasing MVPA levels in this population. The purpose of this systematic review is to examine the effectiveness of e-health interventions in raising MVPA levels among working-age women in developed countries and to examine the effectiveness of these interventions in improving the health of women. METHODS Eight electronic databases will be searched to identify all prospective cohort and experimental studies examining the impact of e-health interventions for increasing MVPA levels among working-age women (mean age 18-65 years) in developed countries. Gray literature including theses, dissertations, and government reports will also be examined. Study quality will be assessed using a modified Downs and Black checklist, and risk of bias will be assessed within and across all included studies using the Cochrane's risk of bias tool and Grades of Recommendation, Assessment, Development and Evaluation approach. A quantitative synthesis in the form of meta-analyses for measures of MVPA and health outcomes will be conducted where possible. DISCUSSION This review will determine the effectiveness of e-health interventions in raising MVPA levels in working-age women in developed countries. It will form a contemporary, rigorously developed, and reliable research base for policy makers and stakeholders; and inform and influence the development and implementation of effective e-health interventions designed to increase MVPA levels and improve health outcomes in this population. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014009534.
Collapse
Affiliation(s)
- Jennifer L Reed
- />Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - Stephanie A Prince
- />Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - Christie A Cole
- />Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - Kara A Nerenberg
- />Division of General Medicine, Alberta Health Services, Calgary, AB T2N 1X9 Canada
| | - Swapnil Hiremath
- />Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9 Canada
| | - Heather E Tulloch
- />Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - J George Fodor
- />Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - Agnieszka Szczotka
- />Berkman Library, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - Lisa A McDonnell
- />Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - Kerri-Anne Mullen
- />Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - Andrew L Pipe
- />Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - Robert D Reid
- />Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| |
Collapse
|
39
|
Valle CG, Tate DF, Mayer DK, Allicock M, Cai J, Campbell MK. Physical activity in young adults: a signal detection analysis of Health Information National Trends Survey (HINTS) 2007 data. JOURNAL OF HEALTH COMMUNICATION 2014; 20:134-46. [PMID: 25375396 PMCID: PMC4852744 DOI: 10.1080/10810730.2014.917745] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Many young adults are insufficiently active to achieve the health benefits of regular physical activity. Using signal detection analysis of data from the 2007 Health Information National Trends Survey, the authors examined distinct subgroups of 18-39 year-old adults who vary in their likelihood of not meeting physical activity recommendations. We randomly split the sample and conducted signal detection analysis on the exploratory half to identify subgroups and interactions among sociodemographic and health communication variables that predicted engaging in less than 150 minutes per week of moderate-intensity physical activity (low physical activity). We compared rates of low physical activity among subgroups with similarly defined subgroups in the validation sample. Overall, 62% of participants did not meet physical activity recommendations. Among 8 subgroups identified, low physical activity rates ranged from 31% to 90%. Predictors of low physical activity were general health, body mass index (BMI), perceived cancer risk, health-related Internet use, and trust in information sources. The least active subgroup (90% low physical activity) included young adults in poor to good health with a BMI of 30.8 or more (obese). The most active subgroup (31% low physical activity) comprised those in very good to excellent health, who used a website to help with diet, weight, or physical activity, and had little to no trust in health information on television. Findings suggest potential intervention communication channels and can inform targeted physical activity interventions for young adults.
Collapse
Affiliation(s)
- Carmina G Valle
- a Lineberger Comprehensive Cancer Center , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | | | | | | | | | | |
Collapse
|
40
|
Collins JL, Champion JD. Assessment of mobile device and SMS Use for Diet and Exercise Information Among Rural Mexican-American adolescents. J Pediatr Nurs 2014; 29:493-502. [PMID: 24704179 PMCID: PMC4164588 DOI: 10.1016/j.pedn.2014.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 12/20/2022]
Abstract
This is a pilot study regarding the use of mobile technology and short message service (SMS) for diet and exercise among rural Mexican American adolescents (RMAA). Authors used convenience sampling to recruit RMAA seeking care at a rural healthcare clinic and conducted three focus groups (n=12). Content analysis was used to identify categories and subcategories. Participants applied diet and exercise information in their lives based on an interaction with community and through the use of use mobile devices. Culturally sensitive use of mobile devices and SMS may be a tool to provide rural adolescent populations with resources.
Collapse
|
41
|
Lindqvist AK, Mikaelsson K, Westerberg M, Gard G, Kostenius C. Moving from idea to action: promoting physical activity by empowering adolescents. Health Promot Pract 2014; 15:812-8. [PMID: 24879445 DOI: 10.1177/1524839914535777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Physical activity provides fundamental health benefits for children and youth. The aim of the study was to explore the possibility of conducting an empowerment-inspired intervention and examine the impact of the intervention in promoting moderate and vigorous physical activity (MVPA) among adolescents. METHOD A nonrandomized trial with a concurrent control group was carried out. Physical activity data were collected before and after the intervention with daily questions by short message service. Self-efficacy, social support, and attitude were also measured before and after the intervention since they were possible mediators. RESULTS The intervention was created by the students, the researchers, and the teachers using an empowerment-based approach. Students in the intervention group (n = 21) increased their MVPA on average by 4.9 (SD = 28.9) minutes per day, and students in the control group (n = 25) reduced their MVPA on average by 25.4 (SD = 23.0) minutes per day (p = .000). CONCLUSIONS The intervention might have contributed to a promotion of physical activity among students in the intervention group. The most valuable contribution this study provides is the knowledge that it is possible to develop and conduct an empowerment-inspired intervention to promote adolescent physical activity.
Collapse
Affiliation(s)
| | | | | | - Gunvor Gard
- Luleå University of Technology, Luleå, Sweden
| | | |
Collapse
|
42
|
Stephens SK, Cobiac LJ, Veerman JL. Improving diet and physical activity to reduce population prevalence of overweight and obesity: an overview of current evidence. Prev Med 2014; 62:167-78. [PMID: 24534460 DOI: 10.1016/j.ypmed.2014.02.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/27/2014] [Accepted: 02/05/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of this study is to provide an overview of interventions to reduce or prevent overweight or obesity and improve diet or physical activity. METHODS A review of meta-analyses and/or systematic reviews of these interventions in any setting or age group were conducted. Narrative systematic reviews were included for intervention categories with limited meta-analyses available. Summary measures including weighted mean difference, standardised mean difference, and I-squared, were examined. RESULTS A total of 60 meta-analyses and 23 systematic reviews met the inclusion criteria. Dietary interventions and multi-component interventions targeting overweight and obesity appeared to have the greatest effects, particularly in comparison with workplace or technology or internet-based interventions. Pharmaceutical and surgical interventions produced favourable results for specific population sub-groups (i.e. morbidly obese). Population-wide strategies such as policy interventions have not been widely analysed. The effectiveness of the interventions to assist in maintaining behaviour or weight change remains unclear. CONCLUSIONS Various individually targeted interventions were shown to reduce body weight, although effect sizes were typically modest, and the durability of effects has been questioned. New approaches to evaluating population-based interventions, such as taxes and regulation, are recommended. Future research modelling the long-term effects of interventions across the lifespan would also be beneficial.
Collapse
Affiliation(s)
- Samantha K Stephens
- The University of Queensland, School of Population Health, Brisbane, Queensland, Australia.
| | - Linda J Cobiac
- The University of Queensland, School of Population Health, Brisbane, Queensland, Australia.
| | - J Lennert Veerman
- The University of Queensland, School of Population Health, Brisbane, Queensland, Australia.
| |
Collapse
|
43
|
Antypas K, Wangberg SC. An Internet- and mobile-based tailored intervention to enhance maintenance of physical activity after cardiac rehabilitation: short-term results of a randomized controlled trial. J Med Internet Res 2014; 16:e77. [PMID: 24618349 PMCID: PMC3967125 DOI: 10.2196/jmir.3132] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/04/2014] [Accepted: 02/20/2014] [Indexed: 12/11/2022] Open
Abstract
Background An increase in physical activity for secondary prevention of cardiovascular disease and cardiac rehabilitation has multiple therapeutic benefits, including decreased mortality. Internet- and mobile-based interventions for physical activity have shown promising results in helping users increase or maintain their level of physical activity in general and specifically in secondary prevention of cardiovascular diseases and cardiac rehabilitation. One component related to the efficacy of these interventions is tailoring of the content to the individual. Objective Our trial assessed the effect of a longitudinally tailored Internet- and mobile-based intervention for physical activity as an extension of a face-to-face cardiac rehabilitation stay. We hypothesized that users of the tailored intervention would maintain their physical activity level better than users of the nontailored version. Methods The study population included adult participants of a cardiac rehabilitation program in Norway with home Internet access and a mobile phone. The participants were randomized in monthly clusters to a tailored or nontailored (control) intervention group. All participants had access to a website with information regarding cardiac rehabilitation, an online discussion forum, and an online activity calendar. Those using the tailored intervention received tailored content based on models of health behavior via the website and mobile fully automated text messages. The main outcome was self-reported level of physical activity, which was obtained using an online international physical activity questionnaire at baseline, at discharge, and at 1 month and 3 months after discharge from the cardiac rehabilitation program. Results Included in the study were 69 participants. One month after discharge, the tailored intervention group (n=10) had a higher median level of overall physical activity (median 2737.5, IQR 4200.2) than the control group (n=14, median 1650.0, IQR 2443.5), but the difference was not significant (Kolmogorov-Smirnov Z=0.823, P=.38, r=.17). At 3 months after discharge, the tailored intervention group (n=7) had a significantly higher median level of overall physical activity (median 5613.0, IQR 2828.0) than the control group (n=12, median 1356.0, IQR 2937.0; Kolmogorov-Smirnov Z=1.397, P=.02, r=.33). The median adherence was 45.0 (95% CI 0.0-169.8) days for the tailored group and 111.0 (95% CI 45.1-176.9) days for the control group; however, the difference was not significant (P=.39). There were no statistically significant differences between the 2 groups in stage of change, self-efficacy, social support, perceived tailoring, anxiety, or depression. Conclusions Because of the small sample size and the high attrition rate at the follow-up visits, we cannot make conclusions regarding the efficacy of our approach, but the results indicate that the tailored version of the intervention may have contributed to the long-term higher physical activity maintained after cardiac rehabilitation by participants receiving the tailored intervention compared with those receiving the nontailored intervention. Trial Registration ClinicalTrials.gov: NCT01223170; http://clinicaltrials.gov/show/NCT01223170 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL).
Collapse
|
44
|
Friederichs SAH, Oenema A, Bolman C, Guyaux J, van Keulen HM, Lechner L. I Move: systematic development of a web-based computer tailored physical activity intervention, based on motivational interviewing and self-determination theory. BMC Public Health 2014; 14:212. [PMID: 24580802 PMCID: PMC3944675 DOI: 10.1186/1471-2458-14-212] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 02/24/2014] [Indexed: 12/01/2022] Open
Abstract
Background This article describes the systematic development of the I Move intervention: a web-based computer tailored physical activity promotion intervention, aimed at increasing and maintaining physical activity among adults. This intervention is based on the theoretical insights and practical applications of self-determination theory and motivational interviewing. Methods/design Since developing interventions in a systemically planned way increases the likelihood of effectiveness, we used the Intervention Mapping protocol to develop the I Move intervention. In this article, we first describe how we proceeded through each of the six steps of the Intervention Mapping protocol. After that, we describe the content of the I Move intervention and elaborate on the planned randomized controlled trial. Discussion By integrating self-determination theory and motivational interviewing in web-based computer tailoring, the I Move intervention introduces a more participant-centered approach than traditional tailored interventions. Adopting this approach might enhance computer tailored physical activity interventions both in terms of intervention effectiveness and user appreciation. We will evaluate this in an randomized controlled trial, by comparing the I Move intervention to a more traditional web-based computer tailored intervention. Trial registration NTR4129
Collapse
Affiliation(s)
- Stijn A H Friederichs
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P,O, box 2960, Heerlen, DL 6401, The Netherlands.
| | | | | | | | | | | |
Collapse
|
45
|
Antypas K, Wangberg SC. Combining users' needs with health behavior models in designing an internet- and mobile-based intervention for physical activity in cardiac rehabilitation. JMIR Res Protoc 2014; 3:e4. [PMID: 24413185 PMCID: PMC3913925 DOI: 10.2196/resprot.2725] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/02/2013] [Accepted: 10/27/2013] [Indexed: 11/13/2022] Open
Abstract
Background Internet-based physical activity interventions have great potential in supporting patients in cardiac rehabilitation. Health behavior change theories and user input are identified as important contributors in the effectiveness of the interventions, but they are rarely combined in a systematic way in the design of the interventions. Objective The aim of this study is to identify the appropriate theoretical framework, along with the needs of the users of a physical activity intervention for cardiac rehabilitation, and to combine them into an effective Internet- and mobile-based intervention. Methods We explain the theoretical framework of the intervention in a narrative overview of the existing health behavior change literature as it applies to physical activity. We also conducted a focus group with 11 participants of a cardiac rehabilitation program and used thematic analysis to identify and analyze patterns of meaning in the transcribed data. Results We chose stage-based approaches, specifically the transtheoretical model and the health action process approach as our main framework for tailoring, supplemented with other theoretical concepts such as regulatory focus within the appropriate stages. From the thematic analysis of the focus group data, we identified seven themes: (1) social, (2) motivation, (3) integration into everyday life, (4) information, (5) planning, (6) monitoring and feedback, and (7) concerns and potential problems. The final design of the intervention was based on both the theoretical review and the user input, and it is explained in detail. Conclusions We applied a combination of health behavioral theory and user input in designing our intervention. We think this is a promising design approach with the potential to combine the high efficacy of theory-based interventions with the higher perceived usefulness of interventions designed according to user input. Trial Registration Clinicaltrials.gov NCT01223170; http://clinicaltrials.gov/show/NCT01223170 (Archived by WebCite at http://www.webcitation.org/6M5FqT9Q2).
Collapse
Affiliation(s)
- Konstantinos Antypas
- Norwegian Center for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
| | | |
Collapse
|
46
|
Holtz B, Krein SL, Bentley DR, Hughes ME, Giardino ND, Richardson CR. Comparison of Veteran experiences of low-cost, home-based diet and exercise interventions. ACTA ACUST UNITED AC 2014; 51:149-60. [DOI: 10.1682/jrrd.2013.04.0088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/11/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Bree Holtz
- Center for Clinical Management Research, Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI
| | - Sarah L. Krein
- Center for Clinical Management Research, Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI
| | - Douglas R. Bentley
- Center for Clinical Management Research, Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI
| | - Maria E. Hughes
- Center for Clinical Management Research, Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI
| | | | - Caroline R. Richardson
- Center for Clinical Management Research, Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, MI;Department of Family Medicine, University of Michigan, Ann Arbor, MI
| |
Collapse
|
47
|
Friederichs SAH, Oenema A, Bolman C, Guyaux J, Van Keulen HM, Lechner L. Motivational interviewing in a web-based physical activity intervention: questions and reflections. Health Promot Int 2013; 30:803-15. [PMID: 24101160 DOI: 10.1093/heapro/dat069] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to identify which question/reflection format leads to the most favorable results in terms of effect on autonomous motivation and appreciation for the intervention in a web-based computer-tailored physical activity (PA) intervention, based on principles from self-determination theory (SDT) and motivational interviewing (MI). For this purpose, a randomized trial was conducted among 465 Dutch adults, comparing three web-based computer-tailored MI/SDT PA interventions, including (i) exclusively open-ended questions (without skillful reflections), (ii) exclusively multiple choice questions (with skillful reflections) and (iii) including both question types (with skillful reflections). Measurements included motivation-related determinants of PA and process variables, measured at baseline, directly following the intervention and 1-month post-intervention. Results suggest that open-ended questions represent an important element in web-based MI in terms of effect on autonomous motivation. In order to optimize appreciation of the intervention, a combination of both open-ended and multiple choice question types seems to hold most promise. The findings of this study suggest that both open-ended and multiple choice questions should be included in web-based computer-tailored SDT/MI PA interventions. More research is needed to reveal the optimal configuration of this novel intervention type.
Collapse
Affiliation(s)
- Stijn A H Friederichs
- Department of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Anke Oenema
- Department of Health Education and Promotion, Maastricht University, Maastricht, The Netherlands
| | - Catherine Bolman
- Department of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Janneke Guyaux
- Department of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | | | - Lilian Lechner
- Department of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| |
Collapse
|
48
|
O'Reilly GA, Spruijt-Metz D. Current mHealth technologies for physical activity assessment and promotion. Am J Prev Med 2013; 45:501-7. [PMID: 24050427 PMCID: PMC4199827 DOI: 10.1016/j.amepre.2013.05.012] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/16/2013] [Accepted: 05/22/2013] [Indexed: 11/20/2022]
Abstract
CONTEXT Novel mobile assessment and intervention capabilities are changing the face of physical activity (PA) research. A comprehensive systematic review of how mobile technology has been used for measuring PA and promoting PA behavior change is needed. EVIDENCE ACQUISITION Article collection was conducted using six databases from February to June 2012 with search terms related to mobile technology and PA. Articles that described the use of mobile technologies for PA assessment, sedentary behavior assessment, and/or interventions for PA behavior change were included. Articles were screened for inclusion and study information was extracted. EVIDENCE SYNTHESIS Analyses were conducted from June to September 2012. Mobile phone-based journals and questionnaires, short message service (SMS) prompts, and on-body PA sensing systems were the mobile technologies most utilized. Results indicate that mobile journals and questionnaires are effective PA self-report measurement tools. Intervention studies that reported successful promotion of PA behavior change employed SMS communication, mobile journaling, or both SMS and mobile journaling. CONCLUSIONS mHealth technologies are increasingly being employed to assess and intervene on PA in clinical, epidemiologic, and intervention research. The wide variations in technologies used and outcomes measured limit comparability across studies, and hamper identification of the most promising technologies. Further, the pace of technologic advancement currently outstrips that of scientific inquiry. New adaptive, sequential research designs that take advantage of ongoing technology development are needed. At the same time, scientific norms must shift to accept "smart," adaptive, iterative, evidence-based assessment and intervention technologies that will, by nature, improve during implementation.
Collapse
Affiliation(s)
- Gillian A O'Reilly
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | | |
Collapse
|
49
|
Foster C, Richards J, Thorogood M, Hillsdon M. Remote and web 2.0 interventions for promoting physical activity. Cochrane Database Syst Rev 2013; 9:CD010395. [PMID: 24085594 PMCID: PMC9674455 DOI: 10.1002/14651858.cd010395.pub2] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Remote and web 2.0 interventions for promoting physical activity (PA) are becoming increasingly popular but their ability to achieve long term changes are unknown. OBJECTIVES To compare the effectiveness of remote and web 2.0 interventions for PA promotion in community dwelling adults (aged 16 years and above) with a control group exposed to placebo or no or minimal intervention. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, CINAHL, and some other databases (from earliest dates available to October 2012). Reference lists of relevant articles were checked. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared remote and web 2.0 PA interventions for community dwelling adults with a placebo or no or minimal intervention control group. We included studies if the principal component of the intervention was delivered using remote or web 2.0 technologies (for example the internet, smart phones) or more traditional methods (for example telephone, mail-outs), or both. To assess behavioural change over time, the included studies had a minimum of 12 months follow-up from the start of the intervention to the final results. We excluded studies that had more than a 20% loss to follow-up if they did not apply an intention-to-treat analysis. DATA COLLECTION AND ANALYSIS At least two authors independently assessed the quality of each study and extracted the data. Non-English language papers were reviewed with the assistance of an interpreter who was an epidemiologist. Study authors were contacted for additional information where necessary. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for the continuous measures of self-reported PA and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios and 95% CIs were calculated. MAIN RESULTS A total of 11 studies recruiting 5862 apparently healthy adults met the inclusion criteria. All of the studies took place in high-income countries. The effect of the interventions on cardiovascular fitness at one year (two studies; 444 participants) was positive and moderate with significant heterogeneity of the observed effects (SMD 0.40; 95% CI 0.04 to 0.76; high quality evidence). The effect of the interventions on self-reported PA at one year (nine studies; 4547 participants) was positive and moderate (SMD 0.20; 95% CI 0.11 to 0.28; moderate quality evidence) with heterogeneity (I2 = 37%) in the observed effects. One study reported positive results at two years (SMD 0.20; 95% CI 0.08 to 0.32; moderate quality evidence). When studies were stratified by risk of bias, the studies at low risk of bias (eight studies; 3403 participants) had an increased effect (SMD 0.28; 95% CI 0.16 to 0.40; moderate quality evidence). The most effective interventions applied a tailored approach to the type of PA and used telephone contact to provide feedback and to support changes in PA levels. There was no evidence of an increased risk of adverse events (seven studies; 2892 participants). Risk of bias was assessed as low (eight studies; 3060 participants) or moderate (three studies; 2677 participants). There were no differences in effectiveness between studies using different types of professionals delivering the intervention (for example health professional, exercise specialist). There was no difference in pooled estimates between studies that generated the prescribed PA using an automated computer programme versus a human, nor between studies that used pedometers as part of their intervention compared to studies that did not. AUTHORS' CONCLUSIONS We found consistent evidence to support the effectiveness of remote and web 2.0 interventions for promoting PA. These interventions have positive, moderate sized effects on increasing self-reported PA and measured cardio-respiratory fitness, at least at 12 months. The effectiveness of these interventions was supported by moderate and high quality studies. However, there continues to be a paucity of cost effectiveness data and studies that include participants from varying socioeconomic or ethnic groups. To better understand the independent effect of individual programme components, longer term studies, with at least one year follow-up, are required.
Collapse
Affiliation(s)
- Charles Foster
- University of OxfordBritish Heart Foundation Health Promotion Research Group, Nuffield Department of Population HealthOld Road CampusHeadingtonOxfordUKOX3 7LF
| | - Justin Richards
- University of OxfordBritish Heart Foundation Health Promotion Research Group, Nuffield Department of Population HealthOld Road CampusHeadingtonOxfordUKOX3 7LF
| | - Margaret Thorogood
- Division of Health SciencesPublic Health and EpidemiologyWarwick Medical School, University of WarwickGibbet HillCoventryUKCV4 7AL
| | - Melvyn Hillsdon
- University of ExeterSchool of Sport and Health SciencesSt Luke's CampusExeterUKEX1 2LU
| | | |
Collapse
|
50
|
Ma J, Xiao L, Blonstein AC. Measurement of self-monitoring web technology acceptance and use in an e-health weight-loss trial. Telemed J E Health 2013; 19:739-45. [PMID: 23952787 DOI: 10.1089/tmj.2013.0009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Research on technology acceptance and use in e-health weight-loss interventions is limited. Using data from a randomized controlled trial of two e-health interventions, we evaluated the acceptance and use of a self-monitoring Web site for weight loss. MATERIALS AND METHODS We examined eight theoretical constructs about technology acceptance using adapted 5-point Likert scales and the association of measured Web site usage and weight loss. RESULTS All scales had high internal consistency (Cronbach's alpha=0.74-0.97) in both interventions and at 3 and 15 months (end of intensive and maintenance intervention, respectively). From 3 to 15 months mean scores changed unfavorably for two constructs (compatibility and behavioral intention) among coach-led intervention participants, who received ongoing feedback on their self-monitoring entries. Among self-directed intervention participants, who received minimal coach support, mean scores changed unfavorably for five constructs (usefulness, ease of use, concern, compatibility, and behavioral intention). At 3 months, usefulness, ease of use, effect, compatibility, and behavioral intention in the coach-led group (Pearson r=0.33-0.5) and usefulness and affect in the self-directed group (r=0.43-0.46) were significantly correlated with Web site usage, which was correlated with weight loss (β=-0.02, p≤0.001 for both interventions). From 3 to 15 months, mean score changes for usefulness and behavioral intention correlated significantly with Web site usage in the coach-led group. CONCLUSIONS The adapted acceptance measures showed acceptable psychometric properties and significant associations with actual Web site use, which correlated with weight loss. Better understanding of technology acceptance and use in e-health weight-loss interventions may improve participant adherence and outcome.
Collapse
Affiliation(s)
- Jun Ma
- 1 Palo Alto Medical Foundation Research Institute , Palo Alto, California
| | | | | |
Collapse
|