Review of researches on smartphone applications for physical activity promotion in healthy adults

The effect of a hybrid structured pulmonary rehabilitation education program for patients with lung cancer with a high risk of postoperative pulmonary complications: A quasi-experimental study

PURPOSE

The absence of standardized protocols and education are the main obstacles to perioperative pulmonary rehabilitation (PR), especially for patients with high-risk factors of postoperative pulmonary complications (PPCs). We aimed to explore the effect of a hybrid structured pulmonary rehabilitation education program (SPREP) on patients with lung cancer at high risk of PPCs.

METHODS

A quasi-experimental trial with a pre-post test design was conducted. The control group (n = 53) adopted routine perioperative pulmonary rehabilitation, while the intervention group (n = 53) received SPREP. Respiratory function, 6-min walk distance, Borg dyspnea scale, quality of life, anxiety-depression scores at admission, discharge, 2 weeks and 3 months post-discharge, and incidence of PPCs were compared between the two groups.

RESULTS

There were no significant differences on the 6-min walk distance and Borg Dyspnoea Scale at discharge between the two groups (P > 0.05), whereas the intervention group showed improved performance at the remaining time points (P < 0.05). In addition, the intervention group had improved exercise capacity, pulmonary function and quality of life, reduced levels of anxiety and depression at discharge, 2 weeks post-discharge and 3 months post-discharge (P < 0.05). In addition, incidence of PPCs was significantly reduced in the intervention group, especially postoperative pneumonia.

CONCLUSIONS

The SPREP could show significant benefits in enhancing exercise capacity, lung function, and quality of life, while diminishing the occurrence of PPCs and mitigating the levels of anxiety and depression, future large RCT need to further explore the efficacy.

TRIAL REGISTRATION

This study was registered with the China Clinical Trial Registration Center (ChiCTR) under the Clinical Trial Registration Number [ChiCTR2200066698].

Supportive eHealth Technologies and Their Effects on Physical Functioning and Quality of Life for People With Lung Cancer: Systematic Review

BACKGROUND

Despite advancements in treatment and early diagnosis, people with lung cancer are not living as long as those with other cancers. The more common symptoms of lung cancer, such as breathlessness, fatigue, and depression, can be alleviated by improving patients' physical functioning. Therefore, good symptom management and improved health-related quality of life (HRQoL) are priorities in this patient group. However, current health care services have limited capacity to provide this support. One way to address this issue of health care resources is to empower patients to self-manage their condition using eHealth technologies.

OBJECTIVE

The purpose of this review was to identify and assess available research on technologies that support persons with lung cancer to improve or maintain their physical functioning, HRQoL, or both.

METHODS

Six databases-PubMed, Web of Science, CINAHL, MEDLINE, SPORTDiscus, and PsycINFO-were searched from January 1, 1990, to April 30, 2023. Studies were suitable for inclusion if the participants included people with lung cancer aged >18 years who had been exposed to a physical activity, exercise, or training intervention that was delivered via an electronic or web-based application with or without a comparator. Furthermore, the study had to report on the impact of the intervention on physical functioning and HRQoL. Studies that focused on telemedicine without a digital intervention were excluded. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the quality of the included papers. Due to the heterogeneity of the studies, a narrative synthesis was undertaken.

RESULTS

This review is reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 794 papers were initially identified through our search, of which, after screening, 8 (1%) were confirmed suitable for inclusion in the review. As 2 (25%) of the 8 papers reported on different stages of the same study, we included only 7 studies in our analysis. The studies were undertaken between 2010 and 2018 across multiple countries and aimed to develop a technology and test its feasibility or acceptance. The 7 technologies identified included web-based applications, mobile apps, and gaming consoles. The studies demonstrated impact on walking distance, muscle strength, balance, dyspnea symptoms, and cancer-related fatigue. HRQoL scores also showed improvement.

CONCLUSIONS

The findings indicate that eHealth technologies can positively impact physical functioning and well-being for people with lung cancer, but there are limited studies that demonstrate the impact of these digital interventions over longer periods. None of the studies reported on the implementation or adoption of a mobile health or eHealth intervention in routine clinical practice, highlighting the need for further research in this area.

TRIAL REGISTRATION

PROSPERO CRD42023414094; https://tinyurl.com/39hhbwyx.

Influence of smartphone-based physical activity intervention on executive functions and cardiometabolic disease risk in obese young adults: a pilot randomised controlled trial

Purpose

Smartphone is an impending solution to influence long-term behavior change, including physical activity; however, the evidence regarding personalized prescription remains mixed in obese. We aimed to explore the influence of smartphone-based physical activity promotion on weight loss and cognitive functions in obese young adults.

Methods

In our pilot randomised controlled trial, 24 obese adults were randomized to two conditions: (1) EXI group receiving a smartphone-application based personalized physical activity prescription; (2) CONT group continuing their routine work for eight weeks. Executive functions and cardiometabolic risk variables [body and fat mass, waist circumference (WC), blood pressure (BP)] and executive functions were measured before and after eight weeks.

Results

Our study findings revealed a significant improvement in reaction times with overall (H = 7.71, p = 0.005), congruent stimuli (H = 4.43, p = 0.03) and incongruent stimuli (H = 5.35, p = 0.02) between groups. Though EXI participants reduced their fat mass by 5.07 kg more than CONT group users after eight weeks, the findings were statistically insignificant. Similarly, our study did not find significant differences in body mass, WC, BP or accuracy between EXI and CONT groups. There was a decreased user engagement (H = 5.80, p = 0.564) after the 3rd week of the study period.

Conclusion

Short-term smartphone-based physical activity programs may offer favourable cognitive benefits to young adults; however, the weight loss benefits remain unconvincing.

Trial Registration

The study was registered prospectively with the Clinical Trials Registry of India (CTRI/2022/02/040202).

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01182-9.

Burden of disability in type 2 diabetes mellitus and the moderating effects of physical activity

The growing diabetic epidemic has created a substantial burden, not only on the people with diabetes but also on society at large. This mini-review discussed the limitations and patterns of disability in type 2 diabetes mellitus and put forward a case for the moderating effects of physical activity (PA) in the management of diabetes. The limitations and impairments associated with diabetes include vascular, neurological, cardiac, and renal impairments. Moreover, individuals participate less in their daily lives and in their instrumental activities of daily living, which negatively impacts the quality of life of individuals with diabetes. This often leads to a loss of quality of life due to disabilities, resulting in an increased rate of disability-adjusted life years among people with type 2 diabetes mellitus. Moreover, there are psychosocial sequelae of diabetes mellitus. This necessitates looking for moderating factors that may reduce the burden of the disease. PA has been shown to be one of the factors that can mitigate these burdens. PA does this in several ways, including through the benefits it confers, such as a reduction of hemoglobin A1c, a reduction of excess fat in the liver and pancreas, and the reduction of cardiovascular risk factors, all of which favorably affect glycemic parameters. Specifically, PA regulates or moderates diabetes disability through two mechanisms: The regulation of glucolipid metabolism disorders and the optimization of body mass index and systemic conditions. Therefore, efforts should be directed at PA uptake through identified strategies. This will not only prevent diabetes or diabetes complications but will reduce its burden.

Selection of and Response to Physical Activity-Based Social Comparisons in a Digital Environment: Series of Daily Assessment Studies

BACKGROUND

Innovative approaches are needed to understand barriers to and facilitators of physical activity among insufficiently active adults. Although social comparison processes (ie, self-evaluations relative to others) are often used to motivate physical activity in digital environments, user preferences and responses to comparison information are poorly understood.

OBJECTIVE

We used an iterative approach to better understand users' selection of comparison targets, how they interacted with their selected targets, and how they responded to these targets.

METHODS

Across 3 studies, different samples of insufficiently active college students used the Fitbit system (Fitbit LLC) to track their steps per day as well as a separate, adaptive web platform each day for 7 to 9 days (N=112). The adaptive platform was designed with different layouts for each study; each allowed participants to select their preferred comparison target from various sets of options, view the desired amount of information about their selected target, and rate their physical activity motivation before and after viewing information about their selected target. Targets were presented as achieving physical activity at various levels below and above their own, which were accessed via the Fitbit system each day. We examined the types of comparison target selections, time spent viewing and number of elements viewed for each type of target, and day-level associations between comparison selections and physical activity outcomes (motivation and behavior).

RESULTS

Study 1 (n=5) demonstrated that the new web platform could be used as intended and that participants' interactions with the platform (ie, the type of target selected, the time spent viewing the selected target's profile, and the number of profile elements viewed) varied across the days. Studies 2 (n=53) and 3 (n=54) replicated these findings; in both studies, age was positively associated with time spent viewing the selected target's profile and the number of profile elements viewed. Across all studies, upward targets (who had more steps per day than the participant) were selected more often than downward targets (who had fewer steps per day than the participant), although only a subset of either type of target selection was associated with benefits for physical activity motivation or behavior.

CONCLUSIONS

Capturing physical activity-based social comparison preferences is feasible in an adaptive digital environment, and day-to-day differences in preferences for social comparison targets are associated with day-to-day changes in physical activity motivation and behavior. Findings show that participants only sometimes focus on the comparison opportunities that support their physical activity motivation or behavior, which helps explain previous, equivocal findings regarding the benefits of physical activity-based comparisons. Additional investigation of day-level determinants of comparison selections and responses is needed to fully understand how best to harness comparison processes in digital tools to promote physical activity.

Refining the design of a smartphone application for people with chronic low back pain using mixed quantitative and qualitative approaches

INTRODUCTION

A mobile application has the potential to involve people with chronic NSLBP in their rehabilitation. To refine the design of a smartphone application for people with chronic NSLBP using mixed quantitative and qualitative approaches.

METHODS

We used a user-centred design approach involving people with chronic NSLBP and healthcare professionals (HCPs). We used a three-step methodology: developing consensus on the features, content, and design of the app; developing a user interface; and usability testing of the app and assessing users' experience. Transcripts of interviews of users were analyzed by qualitative content analysis.

RESULTS

A total of 18 people (aged 45 [23-53] years old) with chronic NSLBP, and 7 HCPs (aged 29.5 [25-55] years old) involved in NSLBP management were interviewed. The overall experience of using the smartphone eLombactif app was initially assessed. Then, with close-ended questions we evaluated users' judgements on the content, its presentation and navigation. Finally, we asked for suggestions: "application content and functionality" and "content presentation" from participants regarding the use and development of the app analyzed by a qualitative methodology.

CONCLUSIONS

This study described how we refined the design of our application for people with chronic NSLBP using a qualitative and quantitative approaches. This methodology allows for deepening the knowledge of the needs and expectations of potential users by measuring their user experience.IMPLICATIONS FOR REHABILITATIONNon-specific low back pain (NSLBP) is a major global public health issue leading to considerable economic cost and is primarily responsible for pain and disability.Mobile application has the potential to involve people with chronic NSLBP in their rehabilitation.This study described how we refined the design of our application for people with chronic NSLBP using a qualitative and quantitative approaches.

Smart Walk: A Culturally Tailored Smartphone-Delivered Physical Activity Intervention for Cardiometabolic Risk Reduction among African American Women

This article reports the results of Smart Walk: a randomized pilot trial of an 8-month culturally tailored, smartphone-delivered physical activity (PA) intervention for African American women with obesity. Sixty participants (age range = 24−49 years; BMI range = 30−58 kg/m2) were randomized to the Smart Walk intervention (n = 30) or a wellness comparison intervention (n = 30). Results supported the acceptability and feasibility of the intervention, as demonstrated by participant retention (85% at 4 months and 78% at 8 months), Smart Walk app use, and intervention satisfaction (i.e., 100% of PA participants completing the intervention [n = 24] reported they would recommend it to friend). Smart Walk participants also reported greater increases in moderate-to-vigorous PA (4-month between-arm difference in change [b] = 43.3 min/week; p = 0.018; Cohen’s d = 0.69; 8-month b = 56.6 min/week; p = 0.046; d = 0.63) and demonstrated clinically relevant, although not statistically significant (p-values > 0.05), baseline to 4 months improvements in cardiorespiratory fitness (b = 1.67 mL/kg/min; d = 0.40), systolic blood pressure (b = −3.33 mmHg; d = 0.22), diastolic blood pressure (b = −4.28 mmHg; d = 0.37), and pulse wave velocity (b = −0.46 m/s; d = 0.33). Eight-month cardiometabolic outcomes followed similar trends, but had high rates of missing data (45−53%) due to COVID-19 restrictions. Collectively, findings demonstrated favorable outcomes for acceptability and feasibility, while also highlighting key areas for refinement in future research.

Middle-aged and older adults' acceptance of mobile nutrition and fitness apps: A systematic mixed studies review

BACKGROUND

To promote healthy aging, the support of digital mobile health tools such as mobile applications (apps) addressing a healthy diet or physical activity appears promising, particularly when initiated before entering old age. For such tools to be effective, middle-aged and older adults' acceptance need to be studied in depth.

OBJECTIVE

The aim of this systematic review was to provide an integrative synthesis of the current state of research regarding the question in how far middle-aged and older adults (people aged 50 years and above) accept mobile nutrition and fitness apps to gain a deeper understanding of the influencing factors shaping this target group's usage behaviour and needs.

METHODS

The review process followed the PRISMA guidelines. The databases Medline, Embase, Web of Science as well as reference lists were systematically searched. Study quality was assessed using the MMAT and AXIS appraisal tools. Data of the included studies were extracted and thereupon narratively synthesized, involving thematic analysis.

RESULTS

Of N = 8823 articles screened, n = 7 studies could be identified-five quantitative, cross-sectional ones and two qualitative studies. Overall, the synthesized findings showed a lower acceptance among middle-aged and older adults compared to younger populations, which was particularly reflected in lower usage rates and more negative attitudes towards such apps (e.g., Perceived usefulness, Ease of use). The target group's acceptance of fitness apps was greater compared to nutrition apps. Findings on contextual factors and social determinants were inconsistent (e.g., regarding gender differences).

CONCLUSION

While cross-study comparability was limited, the synthesized evidence underscores the importance to target mobile nutrition and fitness apps to the distinctive and heterogeneous needs of middle-aged and, particularly, of older adults. The scarcity of the existing body of knowledge highlights the need of further (longitudinal) research.

PROSPERO PROTOCOL REGISTER NUMBER

CRD42020159409.

Impact of COVID-19 on the self-reported physical activity of people with complete thoracic spinal cord injury full-time manual wheelchair users

CONTEXT

The emergence of COVID-19 caused a new public health crisis, leading to major changes in daily life routines, often including physical activity (PA) levels. The main goal of this study was to analyze the differences in self-reported physical activity of people with complete spinal cord injuries between the time prior to the COVID-19 lockdown and the lockdown period itself.

METHODS

A sample of 20 participants with complete thoracic spinal cord injuries completed the Physical Activity Scale for Individuals with Physical Disabilities before and during the COVID-19 lockdown.

RESULTS

The results showed differences between the pre-lockdown and lockdown measurements in total self-reported PA (z=-3.92; P<0.001; d=1.28), recreational PA (z=-3.92; P<0.001; d=1.18) and occupational PA (z=-2.03; P=0.042; d=0.55). Nevertheless, no differences were found in housework PA between the two time periods. Furthermore, the results showed differences in total minutes (z=-3.92; P<0.001; d=1.75), minutes spent on recreational activities (z=-3.82; P<0.001; d=1.56) and minutes spent on occupational activities (z=-2.032; P=0.042; d=0.55) of moderate/vigorous intensity.

CONCLUSIONS

Individuals with thoracic spinal cord injuries who were full-time manual wheelchair users displayed lower levels of PA during the pandemic than in the pre-pandemic period. The results suggest that the prohibition and restrictions on carrying out recreational and/or occupational activities are the main reasons for this inactivity. Physical activity promotion strategies should be implemented within this population to lessen the effects of this physical inactivity stemming from the COVID-19 pandemic.

Effects of a Gamified, Behavior Change Technique-Based Mobile App on Increasing Physical Activity and Reducing Anxiety in Adults With Autism Spectrum Disorder: Feasibility Randomized Controlled Trial

BACKGROUND

Physical activity (PA) has an impact on physical and mental health in neurotypical populations, and addressing these variables may improve the prevalent burden of anxiety in adults with autism spectrum disorder (ASD). Gamified mobile apps using behavior change techniques present a promising way of increasing PA and reducing sedentary time, thus reducing anxiety in adults with ASD.

OBJECTIVE

This study aimed to compare the effectiveness of a gamified and behavior change technique-based mobile app, PuzzleWalk, versus a commercially available app, Google Fit, on increasing PA and reducing sedentary time as an adjunct anxiety treatment for this population.

METHODS

A total of 24 adults with ASD were assigned to either the PuzzleWalk or Google Fit group for 5 weeks using a covariate-adaptive randomization design. PA and anxiety were assessed over 7 days at 3 different data collection periods (ie, baseline, intervention start, and intervention end) using triaxial accelerometers and the Beck Anxiety Inventory. Group differences in outcome variables were assessed using repeated-measures analysis of covariance, adjusting for age, sex, and BMI.

RESULTS

The findings indicated that the PuzzleWalk group spent a significantly longer amount of time on app use compared with the Google Fit group (F2,38=5.07; P=.01; partial η2=0.21), whereas anxiety was unfavorably associated with increases in light PA and decreases in sedentary time after intervention (all P<.05).

CONCLUSIONS

Further research is needed to clarify the determinants of physical and mental health and their interrelationship in adults with ASD to identify the factors that facilitate the use and adoption of mobile health technologies in these individuals. Despite these mixed results, the small changes in PA or anxiety may be clinically significant for adults with ASD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05466617; https://clinicaltrials.gov/show/NCT05466617.

UK Adults' Exercise Locations, Use of Digital Programs, and Associations with Physical Activity During the COVID-19 Pandemic: Longitudinal Analysis of Data From the Health Behaviours During the COVID-19 Pandemic Study

BACKGROUND

Digital physical activity (PA) program use has been associated with higher PA guideline adherence during COVID-19 pandemic confinements. However, little is known longitudinally about exercise locations (inside vs outside the home environment), digital program use, and their associations with moderate-to-vigorous PA (MVPA) and muscle-strengthening activities (MSAs) during the pandemic.

OBJECTIVE

The aims of this study were to assess the relationship between exercise location and use of digital programs with PA guideline adherence during the COVID-19 pandemic, describe how individuals exercised inside and outside of their home environments, and explore which sociodemographic and contextual factors were associated with exercise locations and digital PA program use.

METHODS

Active UK adults (N=1938) who participated in the 1-month follow-up survey of the Health Behaviours During the COVID-19 Pandemic (HEBECO) study (FU1, June-July 2020) and at least one more follow-up survey (FU2, August-September; FU3, November-December 2020) reported exercise locations and types of exercises inside and outside their homes, including digital programs (online/app-based fitness classes/programs), MVPA, and MSA. Generalized linear mixed models were used to assess associations of exercise location and digital PA program use with PA guideline adherence (MVPA, MSA, full [combined] adherence), and predictors of exercise location and digital program use.

RESULTS

As the pandemic progressed, active UK adults were less likely to exercise inside or to use digital PA programs compared with periods of initial confinement: 61% (95% CI 58%-63%; weighted n=1024), 50% (95% CI 48%-53%; weighted n=786), and 49% (95% CI 46%-51%; weighted n=723) performed any exercise inside their homes at FU1, FU2, and FU3, respectively. At FU1, FU2, and FU3, 22% (95% CI 21%-25%; weighted n=385), 17% (95% CI 15%-19%; weighted n=265), and 16% (95% CI 14%-18%; weighted n=241) used digital PA programs, respectively. Most participants who exercised inside already owned indoor equipment, used digital PA programs, or had their own workout routines, whereas MVPA and gentle walking were the most common exercise types performed outside the home. Being female, nonwhite, having a condition limiting PA, indoor exercising space, a lower BMI, and living in total isolation were associated with increased odds of exercising inside the home or garden compared with outside exercise only. Digital PA program users were more likely to be younger, female, highly educated, have indoor space to exercise, and a lower BMI. While exercising inside was positively associated with MSA and exercising outside was positively associated with MVPA guideline adherence, both inside (vs outside only) and outside (vs inside only) activities contributed to full PA guideline adherence (odds ratio [OR] 5.05, 95% CI 3.17-8.03 and OR 1.89, 95% CI 1.10-3.23, respectively). Digital PA program use was associated with a higher odds of MSA (OR 3.97-8.71) and full PA (OR 2.24-3.95), but not with MVPA guideline adherence.

CONCLUSIONS

During the COVID-19 pandemic, full PA guideline adherence was associated with exercising inside and outside of one's home environment and using digital PA programs. More research is needed to understand the reach, long-term adherence, and differences between digital PA solutions.

Encouraging People with Spinal Cord Injury to Take Part in Physical Activity in the COVID-19 Epidemic through the mHealth ParaSportAPP

BACKGROUND

Although mHealth tools have great potential for health interventions, few experimental studies report on their use by people with spinal cord injuries in physical activity.

OBJECTIVE

The main objective of this study was to analyze the effect of the ParaSportAPP on different physical and psychological variables in people with paraplegia.

METHODS

Fourteen of these subjects made up the final sample. All the participants performed two pre-tests (control period) and a post-test with 8 months between the evaluations (COVID-19 broke out between pre-test 2 and the post-test). The ParaSportAPP was installed on their smartphones when they performed pre-test 2. The same tests were performed in the same order in all the evaluations: (i) the questionnaires PASIPD, HADS, RS-25; SCIM III and AQoL-8D, (ii) respiratory muscle strength, (iii) spirometry and (iv) cardiopulmonary exercise test.

RESULTS

The results showed no differences in any of the variables studied between the measurement times.

CONCLUSIONS

Although none of the variables experienced improvements, the ParaSportAPP mobile application was able to lessen the impact of the pandemic on the variables studied.

Self-tracking of daily physical activity using a fitness tracker and the effect of the 10,000 steps goal

Activity self-tracking technologies have become a popular tool for monitoring physical activity, used to assist individuals in increasing physical activity. Previous findings, however, are inconclusive on whether standalone activity self-tracking, alone or in combination with a step goal, is efficient in encouraging physical activity behavior. This study aimed at investigating the effects of mere activity self-tracking and activity self-tracking with a daily 10,000 steps goal on physical activity levels in a randomized-controlled parallel group trial (N = 150; mean age= 24.66, standard deviation = 4.75), using a publicly available fitness tracker and associated smartphone application. Two experimental groups, one of which without and the other with step goal, recorded daily physical activity (daily step count) via a fitness tracker wearable and associated smartphone application and via daily self-reports of activity over the course of 6 weeks. An unequipped control group recorded physical activity only via daily self-reports. Both experimental groups were compared against each other based on step count data, and against the control group based on daily self-reports of activity. Results of mixed-effect multilevel analyses suggest that activity tracking using fitness trackers and externally assigned goals do not drive greater physical activity behavior. Rather, results indicate substantial individual differences that should be targeted in future studies to better understand individual behavioral processes boosting or hindering daily activity.

Associations Between Smartphone Use for Physical Activity by South Korean College Students and Behavioral Change Constructs of the Transtheoretical Model

We examined associations between smartphone uses to assist physical activity (PA) and change constructs of the transtheoretical model (TTM) among Korean college students. Our participants were 242 college students who completed a cross-sectional survey of their smartphone use, PA, and TTM constructs. We applied Poisson regression models to test the associations between stages of change and smartphone PA use frequencies in four categories over the previous week: 1= watching PA instruction videos; 2 = tracking PA; 3 = searching and booking sites for PA; and 4 = finding and making appointments with PA partners. The associations between these smartphone uses and participants' self-efficacy, decisional balance, processes of change, and PA were tested via ordinary least squares regression models. Results were that participants in the precontemplation and maintenance stages were the least and most frequent users of the smartphones in all four categories, respectively. Category one usage was positively associated with participants' scores on pros (β = .22, p = .004), cognitive processes of change (β = .30, p < .001), and behavioral processes of change (β = .28, p < .001). Category two usage was positively associated with PA (β = .06, p = .048). While category three usage was not significantly associated with any TTM constructs except for stages of change, category four usage was positively associated with self-efficacy (β = .28, p < .001), pros (β = .30, p < .001), cognitive processes of change (β = .31, p < .001), behavioral processes of change (β = .06, p <. 001), and PA (β = .45, p < .001). These findings suggest that (a) active college students are likely to take advantage of smartphone to assist their PA, and (b) smartphones can help motivate college students toward regular PA.

Comparative effectiveness of smartphone healthcare applications for improving quality of life in lung cancer patients: study protocol

BACKGROUND

Although pulmonary rehabilitation is helpful for patients following lung cancer surgery, rehabilitation is not widely available, due in part to a lack of medical resources. Recent developments in digital health care have overcome the space limitations associated with in-person health care. This study will evaluate and compare the efficacy of three different smartphone healthcare systems in patients with lung cancer.

METHODS

This single center randomized controlled study is designed to evaluate the efficacy of digital healthcare applications for lung cancer patients after thoracoscopic lung resection. A total of 320 patients will be enrolled and randomized 1:1:1:1 into four different groups, with one group each using the smartphone applications NOOM, Walkon, and Efilcare and the fourth being the control group without intervention. Questionnaires will be administered to patients at baseline and after 3, 6, and 12 months. The primary endpoint will be the score on the EuroQol five-dimension index. Secondary endpoints will include other questionnaires about quality of life and dyspnea.

DISCUSSION

This prospective randomized controlled study may allow assessments and comparisons of the efficacy of various smartphone applications in patients who undergo lung cancer surgery. This process may enable the introduction of healthcare interventions that maintain quality of life in patients with lung cancer. Trial registration CRIS, KCT0005447. Registered 06 October 2020, https://cris.nih.go.kr/cris/search/detailSearch.do/19346.

Technical Feasibility of Supervision of Stretching Exercises by a Humanoid Robot Coach for Chronic Low Back Pain: The R-COOL Randomized Trial

Adherence to exercise programs for chronic low back pain (CLBP) is a major issue. The R-COOL feasibility study evaluated humanoid robot supervision of exercise for CLBP. Aims are as follows: (1) compare stretching sessions between the robot and a physiotherapist (control), (2) compare clinical outcomes between groups, and (3) evaluate participant perceptions of usability and satisfaction and therapist acceptability of the robot system. Prospective, randomized, controlled, single-blind, 2-centre study comparing a 3-week (3 hours/day, 5 days/week) physical activity program. Stretching sessions (30 minutes/day) were supervised by a physiotherapist (control) or the robot. Primary outcome: daily physical activity time (adherence). Secondary outcomes: lumbar pain, disability and fear and beliefs, participant perception of usability (system usability scale) and satisfaction, and physiotherapist acceptability (technology acceptance model). Clinical outcomes were compared between groups with a Student t-test and perceptions with a Wilcoxon test. Data from 27 participants were analysed (n = 15 control and n = 12 robot group). Daily physical activity time did not differ between groups, but adherence declined (number of movements performed with the robot decreased from 82% in the first week to 72% in the second and 47% in the third). None of the clinical outcomes differed between groups. The median system usability scale score was lower in the robot group: 58 (IQR 11.8) points vs. 87 (IQR 9.4) in the control group at 3 weeks (p < 0.001). Median physiotherapist rating of the technology acceptance model was <3 points, suggesting a negative opinion of the robot. In conclusion, adherence to robot exercise reduced over time; however, lumbar pain, disability, or fear and beliefs did not differ between groups. The results of the participant questionnaires showed that they were willing to use such a system, although several technical issues suggested the KERAAL system could be improved to provide fully autonomous supervision of physical activity sessions.

Understanding what we know so far about young people's engagement with wellbeing apps. A scoping review and narrative synthesis

Background

Increased levels of wellbeing contribute to people being more productive, resilient, physically healthy and showing lower levels of mental illness. Using mobile apps to increase wellbeing in young people is becoming the method of choice. This study sought to critically appraise the current evidence base with regards to young people's (16–24 years of age) engagement with wellbeing apps.

Methods

A systematic review of the literature and narrative synthesis was conducted to investigate users’ characteristics and other potential engagement elements. A total of 11,245 titles, 160 abstracts and 68 full-text articles published between 2002 and 2021 were screened, of which 22 studies were included.

Results

Main themes/findings indicated that a user's engagement with wellbeing apps was dependant on the presence of strong identity elements, including motivation, mood and values; design elements such as meaningful rewards, short duration of studies and seamless automatic delivery with low contact with researchers; and being innovative and contextualised. The majority of the studies did not report outcomes by social determinants such as ethnicity, education and others.

Conclusion

This research reflects on the need to consider participants’ individuality when designing app mediated wellbeing interventions.

Effects of technology-based physical activity interventions for women after bariatric surgery: study protocol for a three-arm randomised controlled trial

INTRODUCTION

A recent meta-analysis provided proof of efficacy for mobile technology to increase physical activity or weight loss in the short term. Videoconferencing may also be effective, especially as it reduces the barriers related to face-to-face physical activity interventions. Both technologies seem particularly interesting for bariatric surgery management, but their long-term effects on physical activity maintenance are unknown. Moreover, the mechanisms underlying their effectiveness, such as technology acceptability and motivational processes, have not been examined.The objectives of this study are to determine the effects of two technology-based (mobile technology and videoconferencing) physical activity programmes after bariatric surgery compared with standard care and to assess the contribution of acceptability and motivational mechanisms in explaining these effects on physical activity, physiological measures and health indicators.

METHODS AND ANALYSIS

One hundred and twenty young women who have undergone bariatric surgery in the last 3-6 months will be included. The volunteers will be randomly assigned to one of three arms: CONTROL (standard care), ACTI-MOBIL (mobile technology) or ACTI-VISIO (videoconferencing). The primary outcome is the distance travelled during a 6 min walk test relativised according to Capadaglio's theoretical distance. Secondary outcomes are behavioural measures of physical activity, physiological measures, health indicators, technology acceptability and motivational concepts. Data will be collected at baseline (T0), 3 months (T3) and 6 months (T6). The technology groups will receive a physical activity programme for 12 weeks (between T0 and T3). A mixed model approach will be used to analyse the change in outcomes over time for each group.

ETHICS AND DISSEMINATION

This study protocol was reviewed and approved by the French East 1 Protection of Persons Ethics Committee (number: 2020.A00172-37) and the French National Commission for Information Technology and Civil Liberties (number: UCA-R20-034). The results will be disseminated through conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT04478331.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Can a 'rewards-for-exercise app' increase physical activity, subjective well-being and sleep quality? An open-label single-arm trial among university staff with low to moderate physical activity levels

BACKGROUND

This study examined the impact of a 'rewards-for-exercise' mobile application on physical activity, subjective well-being and sleep quality among 148 employees in a UK university with low to moderate physical activity levels.

METHODS

A three-month open-label single-arm trial with a one-year follow-up after the end of the trial. Participants used the Sweatcoin application which converted their outdoor steps into a virtual currency used for the purchase of products available at the university campus' outlets, using an in-app marketplace. The primary outcome measure was self-reported physical activity. Secondary measures included device-measured physical activity, subjective well-being (i.e., life satisfaction, positive affect, negative affect), and self-reported sleep quality.

RESULTS

The findings show an increase in self-reported physical activity (d = 0.34), life satisfaction (d = 0.31), positive affect (d = 0.29), and sleep quality (d = 0.22) during the three-month trial period.

CONCLUSION

The study suggests that mobile incentives-for-exercise applications might increase physical activity levels, positive affect, and sleep quality, at least in the short term. The observed changes were not sustained 12 months after the end of the trial.

Results of a Culturally Tailored Smartphone-Delivered Physical Activity Intervention Among Midlife African American Women: Feasibility Trial

BACKGROUND

Regular aerobic physical activity (PA) is an important component of healthy aging. However, only 27%-40% of African American women achieve national PA guidelines. Available data also show a clear decline in PA as African American women transition from young adulthood (ie, 25-44 years) into midlife. This decline in PA during midlife coincides with an increased risk for African American women developing cardiometabolic disease conditions, including obesity, type 2 diabetes, and cardiovascular disease. Thus, effective efforts are needed to promote PA among sedentary African American women during midlife.

OBJECTIVE

This study aims to examine the acceptability and feasibility of a culturally tailored, smartphone-delivered PA intervention, originally developed to increase PA among African American women aged 24-49 years, among a slightly older sample of midlife African American women aged 50-65 years.

METHODS

A single-arm pretest-posttest study design was implemented. In total, 20 insufficiently active African American (ie, ≤60 min per week of PA) women between the ages of 50-65 years participated in the 4-month feasibility trial. The Smart Walk intervention was delivered through the study Smart Walk smartphone app and text messages. Features available on the Smart Walk app include personal profile pages, multimedia PA promotion modules, discussion board forums, and an activity tracking feature that integrates with Fitbit activity monitors. Self-reported PA and social cognitive theory mediators targeted by the intervention (ie, self-regulation, behavioral capability, outcome expectations, self-efficacy, and social support) were assessed at baseline and at 4 months. Feasibility and acceptability were assessed using a postintervention satisfaction survey that included multiple-choice and open-ended questions evaluating participant perceptions of the intervention and suggestions for intervention improvement. Wilcoxon signed-rank tests were used to examine pre- and postintervention changes in the PA and social cognitive theory variables. The effect size estimates were calculated using the Pearson r test statistic.

RESULTS

Participants increased moderate-to-vigorous PA (median 30 minutes per week increase; r=0.503; P=.002) and reported improvements in 2 theoretical mediators (self-regulation: r=0.397; P=.01; behavioral capability: r=0.440; P=.006). Nearly all participants (14/15, 93% completing the satisfaction survey) indicated that they would recommend the intervention to a friend. Participants' suggestions for improving the intervention included enhancing the intervention's provisions of social support for PA.

CONCLUSIONS

The results provide preliminary support for the feasibility of the smartphone-based approach to increase PA among midlife African American women. However, before larger-scale implementation among midlife African American women, enhancements to the social support components of the intervention are warranted.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04073355; https://clinicaltrials.gov/ct2/show/NCT04073355.

Validation of Using Smartphone Built-In Accelerometers to Estimate the Active Energy Expenditures of Full-Time Manual Wheelchair Users with Spinal Cord Injury

This study aimed to investigate the validity of using built-in smartphone accelerometers to estimate the active energy expenditures of full-time manual wheelchair users with spinal cord injury (SCI). Twenty participants with complete SCI completed 10 5-min daily activities that involved the upper limbs, during which their oxygen consumption and upper limb activity were registered using a portable gas analyzer and a smartphone (placed on the non-dominant arm), respectively. Time series of 1-min averaged oxygen consumption and 55 accelerometer variables (13 variables for each of the four axes and three additional variables for the correlations between axes) were used to estimate three multiple linear models, using a 10-fold cross-validation method. The results showed that models that included either all variables and models or that only included the linear variables showed comparable performance, with a correlation of 0.72. Slightly worse general performance was demonstrated by the model that only included non-linear variables, although it proved to be more accurate at estimating the energy expenditures (EE) during specific tasks. These results suggest that smartphones could be a promising low-cost alternative to laboratory-grade accelerometers to estimate the energy expenditure of wheelchair users with spinal cord injury during daily activities.

Accuracy of Mobile Applications versus Wearable Devices in Long-Term Step Measurements

Fitness sensors and health systems are paving the way toward improving the quality of medical care by exploiting the benefits of new technology. For example, the great amount of patient-generated health data available today gives new opportunities to measure life parameters in real time and create a revolution in communication for professionals and patients. In this work, we concentrated on the basic parameter typically measured by fitness applications and devices-the number of steps taken daily. In particular, the main goal of this study was to compare the accuracy and precision of smartphone applications versus those of wearable devices to give users an idea about what can be expected regarding the relative difference in measurements achieved using different system typologies. In particular, the data obtained showed a difference of approximately 30%, proving that smartphone applications provide inaccurate measurements in long-term analysis, while wearable devices are precise and accurate. Accordingly, we challenge the reliability of previous studies reporting data collected with phone-based applications, and besides discussing the current limitations, we support the use of wearable devices for mHealth.

A Mobile Application for Exercise Intervention in People Living with HIV

PURPOSE

This study aimed to assess 16-wk improvements of physical fitness, metabolic, and psychological parameters in people living with HIV (PLWH) exercising with the support of a smartphone application, as compared with a control group exercising without application.

METHODS

This was a randomized, open-label, pilot study enrolling PLWH in a 16-wk protocol consisting of moderate physical activity three times per week, which included an initial coach-supervised period of 4 wk, followed by 12 wk where participants trained independently. Participants were allocated to either an experimental group that trained using a smartphone application (APP) or a control group that practiced following a hard copy training program (No-APP). At baseline (BL) and after 16 wk (W16), patients were assessed for cardiorespiratory fitness, body composition, blood lipid profile, and POMS.

RESULTS

Forty-eight PLWH were screened and 38 were eligible: 20 were allocated to the APP group and 18 to the No-APP group. Two APP and two No-APP participants were lost to follow-up. Intention-to-treat analysis showed a W16 improvement from BL of ≥15% V˙ O2peak in 13 (72%) of 18 in APP, but only in 3 (19%) of 16 in No-APP participants (P = 0.025). Significant W16 improvements were observed in APP, but not in No-APP participants, in V˙O2peak; fat mass and fat-free mass percent; total cholesterol, LDL cholesterol, and triglycerides; vigor; and total mood by POMS. Accordingly, significant percent change differences between the APP and the No-APP groups were observed in V˙O2peak; fat and fat-free mass percent; total cholesterol, LDL cholesterol, and triglycerides; and depression, vigor, anger, and total mood by POMS.

CONCLUSIONS

Exercising using a smartphone application improved cardiorespiratory fitness, body composition, cholesterol profiles, and psychological outcomes in PLWH.

Needs and Requirements in the Designing of Mobile Interventions for Patients With Peripheral Arterial Disease: Questionnaire Study

Background

The development of mobile interventions for noncommunicable diseases has increased in recent years. However, there is a dearth of apps for patients with peripheral arterial disease (PAD), who frequently have an impaired ability to walk.

Objective

Using a patient-centered approach for the development of mobile interventions, we aim to describe the needs and requirements of patients with PAD regarding the overall care situation and the use of mobile interventions to perform supervised exercise therapy (SET).

Methods

A questionnaire survey was conducted in addition to a clinical examination at the vascular outpatient clinic of the West-German Heart and Vascular Center of the University Clinic Essen in Germany. Patients with diagnosed PAD were asked to answer questions on sociodemographic characteristics, PAD-related need for support, satisfaction with their health care situation, smartphone and app use, and requirements for the design of mobile interventions to support SET.

Results

Overall, a need for better support of patients with diagnosed PAD was identified. In total, 59.2% (n=180) expressed their desire for more support for their disease. Patients (n=304) had a mean age of 67 years and half of them (n=157, 51.6%) were smartphone users. We noted an interest in smartphone-supported SET, even for people who did not currently use a smartphone. “Information,” “feedback,” “choosing goals,” and “interaction with physicians and therapists” were rated the most relevant components of a potential app.

Conclusions

A need for the support of patients with PAD was determined. This was particularly evident with regard to disease literacy and the performance of SET. Based on a detailed description of patient characteristics, proposals for the design of mobile interventions adapted to the needs and requirements of patients can be derived.

A Personalized Physical Activity Coaching App for Breast Cancer Survivors: Design Process and Early Prototype Testing

Background

Existing evidence supports the many benefits of physical activity (PA) in breast cancer survival. However, few breast cancer survivors adhere to the recommended levels of activity. A PA coaching app that provides personalized feedback, guidance, and motivation to the user might have the potential to engage these individuals in a more active lifestyle, in line with the general recommendations. To develop a successful tool, it is important to involve the end users in the design process and to make theoretically grounded design decisions.

Objective

This study aimed to execute the design process and early prototype evaluation of a personalized PA coaching app for posttreatment breast cancer survivors. In particular, the study explored a design combining behavioral theory and tailored coaching strategies.

Methods

The design process was led by a multidisciplinary team, including technical and health professionals, and involved input from a total of 22 survivors. The process comprised 3 stages. In stage 1, the literature was reviewed and 14 patients were interviewed to understand the needs and considerations of the target population toward PA apps. In stage 2, the global use case for the tool was defined, the features were ideated and refined based on theory, and a digital interactive prototype was created. In stage 3, the prototype went through usability testing with 8 patients and was subjected to quality and behavior change potential evaluations by 2 human-computer interaction experts.

Results

The design process has led to the conceptualization of a personalized coaching app for walking activities that addresses the needs of breast cancer survivors. The main features of the tool include a training plan and schedule, adaptive goal setting, real-time feedback and motivation during walking sessions, activity status through the day, activity history, weekly summary reports, and activity challenges. The system was designed to measure users’ cadence during walking, use this measure to infer their training zone, and provide real-time coaching to control the intensity of the walking sessions. The outcomes from user testing and expert evaluation of the digital prototype were very positive, with scores from the system usability scale, mobile app rating scale, and app behavior change scale of 95 out of 100, 4.6 out of 5, and 15 out of 21, respectively.

Conclusions

Implementing a user-centered design approach for the development and early evaluation of an app brings essential considerations to tailor the solution to the user’s needs and context. In addition, informing the design on behavioral and tailored coaching theories supports the conceptualization of the PA coaching system. This is critical for optimizing the usability, acceptability, and long-term effectiveness of the tool. After successful early in-laboratory testing, the app will be developed and evaluated in a pilot study in a real-world setting.

Validation of a portable system for spatial-temporal gait parameters based on a single inertial measurement unit and a mobile application

There is a lack of commercially available low-cost technologies to assess gait clinically in non-controlled environments. As a consequence of this, there has been poor massification of motion measurement technologies that are both objective and reliable in nature. Advances about the study of gait and its interpretation in recent years using inertial sensors have allowed proposing acceptable alternatives for the development of portable and low-cost systems that contribute to people’s health in places and institutions that cannot acquire or maintain the operation of commercially available systems. A system based on a custom single Inertial Measurement Unit and a mobile application is proposed. Thus, an investigation is carried out using methodologies and algorithms found in the literature in order to get the main gait events and the spatial-temporal gait parameters. Twenty healthy Chilean subjects were assessed using a motion capture system simultaneously with the proposed tool. The results show that it is possible to estimate temporal gait parameters with slight differences respect gold--standard. We reach maximum mean differences of -2.35±5.02[step/min] for cadence, 0.03±0.04[sec] for stride time,0.02±0.03[sec] for step time, ±0.02[sec] for a single support time, 0.01±0.02[sec] for double support time and 0.01±0.03[m] for step length. As a result of experimental findings, we propose a new technological tool that can perform gait analysis. Our proposed system is user-friendly, low-cost, and portable. Therefore, we suggest that it could be an attractive technological tool that healthcare professionals could harness to objectively measure gait in environments that are either within the community or controlled. We also suggest that the tool could be used in countries where advanced clinical tools cannot be acquired. Therefore, we propose in this paper that our system is an attractive, alternative system that can be used for gait analysis by health professionals worldwide.

Validation of a portable system for spatial-temporal gait parameters based on a single inertial measurement unit and a mobile application

There is a lack of commercially available low-cost technologies to assess gait clinically in non-controlled environments. As a consequence of this, there has been poor massification of motion measurement technologies that are both objective and reliable in nature. Advances about the study of gait and its interpretation in recent years using inertial sensors have allowed proposing acceptable alternatives for the development of portable and low-cost systems that contribute to people’s health in places and institutions that cannot acquire or maintain the operation of commercially available systems. A system based on a custom single Inertial Measurement Unit and a mobile application is proposed. Thus, an investigation is carried out using methodologies and algorithms found in the literature in order to get the main gait events and the spatial-temporal gait parameters. Twenty healthy Chilean subjects were assessed using a motion capture system simultaneously with the proposed tool. The results show that it is possible to estimate temporal gait parameters with slight differences respect gold--standard. We reach maximum mean differences of -2.35±5.02[step/min] for cadence, 0.03±0.04[sec] for stride time,0.02±0.03[sec] for step time, ±0.02[sec] for a single support time, 0.01±0.02[sec] for double support time and 0.01±0.03[m] for step length. As a result of experimental findings, we propose a new technological tool that can perform gait analysis. Our proposed system is user-friendly, low-cost, and portable. Therefore, we suggest that it could be an attractive technological tool that healthcare professionals could harness to objectively measure gait in environments that are either within the community or controlled. We also suggest that the tool could be used in countries where advanced clinical tools cannot be acquired. Therefore, we propose in this paper that our system is an attractive, alternative system that can be used for gait analysis by health professionals worldwide.

The French eHealth Acceptability Scale Using the Unified Theory of Acceptance and Use of Technology 2 Model: Instrument Validation Study

Background

Technology-based physical activity suggests new opportunities for public health initiatives. Yet only 45% of technology interventions are theoretically based, and the acceptability mechanisms have been insufficiently studied. Acceptability and acceptance theories have provided interesting insights, particularly the unified theory of acceptance and use of technology 2 (UTAUT2). In several studies, the psychometric qualities of acceptability scales have not been well demonstrated.

Objective

The aim of this study was to adapt the UTAUT2 to the electronic health (eHealth) context and provide a preliminary validation of the eHealth acceptability scale in a French sample.

Methods

In line with the reference validation methodologies, we carried out the following stages of validating the scale with a total of 576 volunteers: translation and adaptation, dimensionality tests, reliability tests, and construct validity tests. We used confirmatory factor analysis to validate a 22-item instrument with 7 subscales: Performance Expectancy, Effort Expectancy, Social Influence, Facilitating Conditions, Hedonic Motivation, Price Value, and Habit.

Results

The dimensionality tests showed that the bifactor confirmatory model presented the best fit indexes: χ²₁₇₃=434.86 (P<.001), χ²/df=2.51, comparative fit index=.97, Tucker-Lewis index=.95, and root mean square error of approximation=.053 (90% CI .047-.059). The invariance tests of the eHealth acceptability factor structure by sex demonstrated no significant differences between models, except for the strict model. The partial strict model demonstrated no difference from the strong model. Cronbach alphas ranged from .77 to .95 for the 7 factors. We measured the internal reliability with a 4-week interval. The intraclass correlation coefficients for each subscale ranged from .62 to .88, and there were no significant differences in the t tests from time 1 to time 2. Assessments for convergent validity demonstrated that the eHealth acceptability constructs were significantly and positively related to behavioral intention, usage, and constructs from the technology acceptance model and the theory of planned behavior.

Conclusions

The 22-item French-language eHealth acceptability scale, divided into 7 subscales, showed good psychometric qualities. This scale is thus a valid and reliable tool to assess the acceptability of eHealth technology in French-speaking samples and offers promising avenues in research, clinical practice, and marketing.

Social Comparison Features in Physical Activity Promotion Apps: Scoping Meta-Review

Background

Smartphone apps promoting physical activity (PA) are abundant, but few produce substantial and sustained behavior change. Although many PA apps purport to induce users to compare themselves with others (by invoking social comparison processes), improvements in PA and other health behaviors are inconsistent. Existing literature suggests that social comparison may motivate PA for some people under some circumstances. However, 2 aspects of work that apply social comparison theory to PA apps remain unclear: (1) how comparison processes have been operationalized or harnessed in existing PA apps and (2) whether incorporating sources of variability in response to comparison have been used to tailor comparison features of apps, which could improve their effectiveness for promoting PA.

Objective

The aim of this meta-review was to summarize existing systematic, quantitative, and narrative reviews of behavior change techniques in PA apps, with an emphasis on social comparison features, to examine how social comparison is operationalized and implemented.

Methods

We searched PubMed, Web of Science, and PsycINFO for reviews of PA smartphone apps. Of the 3743 initial articles returned, 26 reviews met the inclusion criteria. Two independent raters extracted the data from these reviews, including the definition of social comparison used to categorize app features, the percentage of apps categorized as inducing comparison, specific features intended to induce comparison, and any mention of tailoring comparison features. For reference, these data were also extracted for related processes (such as behavioral modeling, norm referencing, and social networking).

Results

Of the included review articles, 31% (8/26) categorized app features as prompting social comparison. The majority of these employed Abraham and Michie’s earliest definition of comparison, which differs from versions in later iterations of the same taxonomy. Very few reviews specified what dimension users were expected to compare (eg, steps, physical fitness) or which features of the apps were used to induce comparison (eg, leaderboards, message boards). No review referenced tailoring of comparison features. In contrast, 54% (14/26) reviews categorized features for prompting behavioral modeling and 31% (8/26) referenced tailoring app features for users’ personal goals or preferences.

Conclusions

The heterogeneity across reviews of PA apps and the absence of relevant information (eg, about dimensions or features relevant for comparison) create confusion about how to best harness social comparison to increase PA and its effectiveness in future research. No evidence was found that important findings from the broader social comparison literature (eg, that people have differing preferences for and responses to social comparison information) have been incorporated in the design of existing PA apps. Greater integration of the mobile health (mHealth) and social comparison literatures may improve the effectiveness of PA apps, thereby increasing the public health impact of these mHealth tools.

International Registered Report Identifier (IRRID)

RR2-https://osf.io/nh4td/

A Comparison of Physical Activity Mobile Apps With and Without Existing Web-Based Social Networking Platforms: Systematic Review

BACKGROUND

Physical activity mobile apps present a unique medium to disseminate scalable interventions to increase levels of physical activity. However, the effectiveness of mobile apps has previously been limited by low levels of engagement. Existing Web-based social networking platforms (eg, Facebook and Twitter) afford high levels of popularity, reach, and sustain engagement and, thus, may present an innovative strategy to enhance the engagement, and ultimately the effectiveness of mobile apps.

OBJECTIVE

This study aimed to comparatively examine the effectiveness of, and engagement with, interventions that incorporate physical activity mobile apps in conjunction with and without existing Web-based social networking platforms (eg, Facebook and Twitter).

METHODS

A systematic review was conducted by following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines. A systematic search of the following databases was conducted: Medline, PsycINFO, Web of Science, Scopus, CINAHL, ProQuest, SPORTDiscus, EMBASE, and Cochrane. According to the comparative objective of this review, 2 independent literature searches were conducted. The first incorporated terms related to apps and physical activity; the second also incorporated terms related to Web-based social networking. The results of the two searches were synthesized and compared narratively.

RESULTS

A total of 15 studies were identified, 10 incorporated a physical activity app alone and 5 incorporated an app in conjunction with an existing Web-based social networking platform. Overall, 10 of the 15 interventions were effective in improving one or more physical activity behaviors. Specifically, improvements in physical activity behaviors were reported in 7 of the 10 interventions incorporating physical activity apps alone and in 3 of the 5 interventions incorporating physical activity apps in conjunction with existing Web-based social networking platforms. Interventions incorporating physical activity apps alone demonstrated a decline in app engagement. In contrast, the physical activity apps in conjunction with existing Web-based social networking platforms showed increased and sustained intervention engagement.

CONCLUSIONS

The interventions incorporating physical activity apps in conjunction with and without existing Web-based social networking platforms demonstrated effectiveness in improving physical activity behaviors. Notably, however, the interventions that incorporated existing Web-based social networking platforms achieved higher levels of engagement than those that did not. This review provides preliminary evidence that existing Web-based social networking platforms may be fundamental to increase engagement with physical activity interventions.

Sports psychiatry: mental health and mental disorders in athletes and exercise treatment of mental disorders

Sports psychiatry has developed for the past 3 decades as an emerging field within psychiatry and sports medicine. An International society has been established in 1994 and also national interest groups were implemented, mostly within the national organizations for psychiatry, some also containing the topic of exercise treatment of mental disorders. Where are we now 30 years later? We systematically but also selectively review the medical literature on exercise, sport, psychiatry, mental health and mental disorders and related topics. The number of publications in the field has increased exponentially. Most topics keep remaining on the agenda, e.g., head trauma and concussion, drug abuse and doping, performance enhancement, overtraining, ADHD or eating disorders. Supported by the growing literature, evidence-based recommendations have become available now in many clinical areas. A relatively new phenomenon is muscle dysmorphia, observed in weightlifters, bodybuilders but also in college students and gym users. Further, sports therapy of mental disorders has been studied by more and more high-quality randomized controlled clinical trials. Mostly as a complementary treatment, however, for some disorders already with a 1a evidence level, e.g., depression, dementia or MCI but also post-traumatic stress disorder. Being grown up and accepted nowadays, sports psychiatry still represents a fast-developing field. The reverse side of the coin, sport therapy of mental disorders has received a scientific basis now. Who else than sports psychiatry could advance sport therapy of mental disorders? We need this enthusiasm for sports and psychiatry for our patients with mental disorders and it is time now for a broadening of the scope. Optimized psychiatric prevention and treatment of athletes and ideal sport-related support for individuals with mental disorders should be our main purpose and goal.

Feedback on Physical Activity Through a Wearable Device Connected to a Mobile Phone App in Patients With Metabolic Syndrome: Pilot Study

Background

Little is known of the effect of wearable devices on metabolic impairments in clinical settings. We hypothesized that a wearable device that can monitor and provide feedback on physical activity may help resolve metabolic syndrome.

Objective

This study aimed to examine the objective effects of the use of these devices on metabolic syndrome resolution.

Methods

Patients diagnosed with metabolic syndrome were recruited. Participants were prescribed regular walking using a wearable device (Coffee WALKIE +Dv.3, GC Healthcare CI, Korea) on their wrist for 12 weeks. Participants received self-feedback on the amount of their exercise through an app on their mobile phone. The information on physical activities of the participants was uploaded automatically to a website. Thus, a trained nurse could provide individuals with feedback regarding the physical activity via telephone consultation on alternate weeks. Blood pressure (BP), body composition, fasting plasma glucose, and lipid profiles were recorded. The primary outcome was metabolic syndrome resolution. The secondary outcome was an improvement in the components of metabolic impairment.

Results

Of the 53 participants recruited, 20 participants with a median age of 46 (range 36-50) years completed the trial. There was no significant difference in the amount of calorie expenditure at weeks 4, 8, and 12. After 12 weeks, metabolic syndrome was resolved in 9 of 20 participants (45%), and the mean number of metabolic impairment components per person decreased from 3.4 to 2.9. Particularly, the mean systolic and diastolic BP decreased from mean 136.6 (SD 18.5) mm Hg to mean 127.4 (SD 19.5) mm Hg and from mean 84.0 (SD 8.1) mm Hg to mean 77.4 (SD 14.4) mm Hg (both P=.02), respectively.

Conclusions

This study found that a 12-week intervention via feedback, based on a wearable physical activity monitor, helped metabolic syndrome patients to be more engaged in regular walking and it improved impaired metabolic components, especially in BP. However, some practical challenges regarding patients’ adherence and sustained engagement were observed.

Effects of Mobile Health Including Wearable Activity Trackers to Increase Physical Activity Outcomes Among Healthy Children and Adolescents: Systematic Review

BACKGROUND

Children and adolescents do not meet the current recommendations on physical activity (PA), and as such, the health-related benefits of regular PA are not achieved. Nowadays, technology-based programs represent an appealing and promising option for children and adolescents to promote PA.

OBJECTIVE

The aim of this review was to systematically evaluate the effects of mobile health (mHealth) and wearable activity trackers on PA-related outcomes in this target group.

METHODS

Electronic databases such as the Cochrane Central Register of Controlled Trials, PubMed, Scopus, SPORTDiscus, and Web of Science were searched to retrieve English language articles published in peer-reviewed journals from January 2012 to June 2018. Those included were articles that contained descriptions of interventions designed to increase PA among children (aged 6 to 12 years) only, or adolescents (aged 13 to 18 years) only, or articles that include both populations, and also, articles that measured at least 1 PA-related cognitive, psychosocial, or behavioral outcome. The interventions had to be based on mHealth tools (mobile phones, smartphones, tablets, or mobile apps) or wearable activity trackers. Randomized controlled trials (RCTs) and non-RCTs, cohort studies, before-and-after studies, and cross-sectional studies were considered, but only controlled studies with a PA comparison between groups were assessed for methodological quality.

RESULTS

In total, 857 articles were identified. Finally, 7 studies (5 with tools of mHealth and 2 with wearable activity trackers) met the inclusion criteria. All studies with tools of mHealth used an RCT design, and 3 were of high methodological quality. Intervention delivery ranged from 4 weeks to 12 months, whereby mainly smartphone apps were used as a tool. Intervention delivery in studies with wearable activity trackers covered a period from 22 sessions during school recess and 8 weeks. Trackers were used as an intervention and evaluation tool. No evidence was found for the effect of mHealth tools, respectively wearable activity trackers, on PA-related outcomes.

CONCLUSIONS

Given the small number of studies, poor compliance with accelerometers as a measuring instrument for PA, risk of bias, missing RCTs in relation to wearable activity trackers, and the heterogeneity of intervention programs, caution is warranted regarding the comparability of the studies and their effects. There is a clear need for future studies to develop PA interventions grounded on intervention mapping with a high methodological study design for specific target groups to achieve meaningful evidence.

Effects of exercise using a mobile device on cardiopulmonary function, metabolic risk factors, and self-efficacy in obese women

The purpose of this study was to determine the effects of a 12-week walking exercise using a mobile device on cardiopulmonary function, metabolic risk factors, and self-efficacy in obese middle-aged women. For this study, 14 middle-aged subjects with obesity were included and performed walking exercise of 50%–60% maximum oxygen uptake intensity 3 times a week for 12 weeks. As a result, weight, % body fat, body mass index, and waist circumference significantly reduced. In addition, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and hemoglobin A_1c significantly reduced, while high-density lipoprotein cholesterol and flexibility significantly increased. Furthermore, exercise using a mobile device significantly increased self-efficacy. In conclusion, walking exercise using a mobile device is a good method to constantly increase the exercise participation rate, as it improves metabolic risk factor and obesity index, and increases self-efficacy.

Group-Based Trajectory Analysis of Physical Activity Change in a US Weight Loss Intervention

BACKGROUND

The obesity epidemic is a global concern. Standard behavioral treatment including increased physical activity, reduced energy intake, and behavioral change counseling is an effective lifestyle intervention for weight loss.

PURPOSE

To identify distinct step count patterns among weight loss intervention participants, examine weight loss differences by trajectory group, and examine baseline factors associated with trajectory group membership.

METHODS

Both groups received group-based standard behavioral treatment while the experimental group received up to 30 additional, one-on-one self-efficacy enhancement sessions. Data were analyzed using group-based trajectory modeling, analysis of variance, chi-square tests, and multinomial logistic regression.

RESULTS

Participants (N = 120) were mostly female (81.8%) and white (73.6%) with a mean (SD) body mass index of 33.2 (3.8) kg/m2. Four step count trajectory groups were identified: active (>10,000 steps/day; 11.7%), somewhat active (7500-10,000 steps/day; 28.3%), low active (5000-7500 steps/day; 27.5%), and sedentary (<5000 steps/day; 32.5%). Percent weight loss at 12 months increased incrementally by trajectory group (5.1% [5.7%], 7.8% [6.9%], 8.0% [7.4%], and 13.63% [7.0%], respectively; P = .001). At baseline, lower body mass index and higher perceived health predicted membership in the better performing trajectory groups.

CONCLUSIONS

Within a larger group of adults in a weight loss intervention, 4 distinct trajectory groups were identified and group membership was associated with differential weight loss.

The SMART Study, a Mobile Health and Citizen Science Methodological Platform for Active Living Surveillance, Integrated Knowledge Translation, and Policy Interventions: Longitudinal Study

Background

Physical inactivity is the fourth leading cause of death worldwide, costing approximately US $67.5 billion per year to health care systems. To curb the physical inactivity pandemic, it is time to move beyond traditional approaches and engage citizens by repurposing sedentary behavior (SB)–enabling ubiquitous tools (eg, smartphones).

Objective

The primary objective of the Saskatchewan, let’s move and map our activity (SMART) Study was to develop a mobile and citizen science methodological platform for active living surveillance, knowledge translation, and policy interventions. This methodology paper enumerates the SMART Study platform’s conceptualization, design, implementation, data collection procedures, analytical strategies, and potential for informing policy interventions.

Methods

This longitudinal investigation was designed to engage participants (ie, citizen scientists) in Regina and Saskatoon, Saskatchewan, Canada, in four different seasons across 3 years. In spring 2017, pilot data collection was conducted, where 317 adult citizen scientists (≥18 years) were recruited in person and online. Citizen scientists used a custom-built smartphone app, Ethica (Ethica Data Services Inc), for 8 consecutive days to provide a complex series of objective and subjective data. Citizen scientists answered a succession of validated surveys that were assigned different smartphone triggering mechanisms (eg, user-triggered and schedule-triggered). The validated surveys captured physical activity (PA), SB, motivation, perception of outdoor and indoor environment, and eudaimonic well-being. Ecological momentary assessments were employed on each day to capture not only PA but also physical and social contexts along with barriers and facilitators of PA, as relayed by citizen scientists using geo-coded pictures and audio files. To obtain a comprehensive objective picture of participant location, motion, and compliance, 6 types of sensor-based (eg, global positioning system and accelerometer) data were surveilled for 8 days. Initial descriptive analyses were conducted using geo-coded photographs and audio files.

Results

Pictures and audio files (ie, community voices) showed that the barriers and facilitators of active living included intrinsic or extrinsic motivations, social contexts, and outdoor or indoor environment, with pets and favorable urban design featuring as the predominant facilitators, and work-related screen time proving to be the primary barrier.

Conclusions

The preliminary pilot results show the flexibility of the SMART Study surveillance platform in identifying and addressing limitations based on empirical evidence. The results also show the successful implementation of a platform that engages participants to catalyze policy interventions. Although SMART Study is currently geared toward surveillance, using the same platform, active living interventions could be remotely implemented. SMART Study is the first mobile, citizen science surveillance platform utilizing a rigorous, longitudinal, and mixed-methods investigation to temporally capture behavioral data for knowledge translation and policy interventions.

A pilot study of an accelerometer-equipped smartphone to monitor older adults with cancer receiving chemotherapy in Mexico

OBJECTIVES

Older adults with cancer in developing countries face challenges accessing healthcare due to a lack of personnel and infrastructure. A decline in physical activity (defined as a decrease in the number of daily steps) may be a novel method for the timely detection of toxicity in older adults receiving chemotherapy in resource-constrained settings.

MATERIALS AND METHODS

In this feasibility study, patients aged ≥65years starting first-line chemotherapy for solid tumors were given a smartphone with a pedometer application. Daily steps were monitored daily for one cycle. If a ≥15% decrease from baseline was identified, the patient was called and the presence of toxicity assessed. The intervention would be feasible if ≥75% of the subjects recorded steps for ≥75% of the planned chemotherapy days.

RESULTS

Forty patients (median age 73; 57% [N=23] female) were included. Seventy percent (N=28) had stage III-IV disease with 45% (N=18) gastrointestinal, 23% (N=9) breast, and 32% (N=13) other malignancies. Mean pre-treatment daily steps was 3111 (Standard Deviation [SD] 1731), and median follow-up was 21days (range 2-28). Despite having limited exposure to mobile technology, most (93%) patients used the smartphone appropriately, and 85% found it easy to use. Sixty percent of patients (N=24) had toxicities managed over the phone, 27.5% (N=10) were sent for urgent medical attention and 15% (N=6) were hospitalized.

CONCLUSION

Using smartphones to monitor older adults with cancer receiving chemotherapy in a resource-constrained setting is feasible and acceptable. A decrease in the number of daily steps was common and helped to identify chemotherapy toxicity.