Increasing Physical Activity in Mothers Using Video Exercise Groups and Exercise Mobile Apps: Randomized Controlled Trial

Digital Behavior Change Intervention Designs for Habit Formation: Systematic Review

BACKGROUND

With the development of emerging technologies, digital behavior change interventions (DBCIs) help to maintain regular physical activity in daily life.

OBJECTIVE

To comprehensively understand the design implementations of habit formation techniques in current DBCIs, a systematic review was conducted to investigate the implementations of behavior change techniques, types of habit formation techniques, and design strategies in current DBCIs.

METHODS

The process of this review followed the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. A total of 4 databases were systematically searched from 2012 to 2022, which included Web of Science, Scopus, ACM Digital Library, and PubMed. The inclusion criteria encompassed studies that used digital tools for physical activity, examined behavior change intervention techniques, and were written in English.

RESULTS

A total of 41 identified research articles were included in this review. The results show that the most applied behavior change techniques were the self-monitoring of behavior, goal setting, and prompts and cues. Moreover, habit formation techniques were identified and developed based on intentions, cues, and positive reinforcement. Commonly used methods included automatic monitoring, descriptive feedback, general guidelines, self-set goals, time-based cues, and virtual rewards.

CONCLUSIONS

A total of 32 commonly design strategies of habit formation techniques were summarized and mapped to the proposed conceptual framework, which was categorized into target-mediated (generalization and personalization) and technology-mediated interactions (explicitness and implicitness). Most of the existing studies use the explicit interaction, aligning with the personalized habit formation techniques in the design strategies of DBCIs. However, implicit interaction design strategies are lacking in the reviewed studies. The proposed conceptual framework and potential solutions can serve as guidelines for designing strategies aimed at habit formation within DBCIs.

Exploring the Feasibility, Acceptability, and Potential Benefits of the Mom Movement Intervention (MOMmi)

OBJECTIVE

To explore the feasibility, acceptability, and potential benefits associated with a mind-body intervention and varied delivery styles among women during the postpartum period.

DESIGN

Mixed-methods feasibility study.

SETTING

Fraser Valley, British Columbia, Canada.

PARTICIPANTS

Forty-three women (93% White), with an average age of 32.1 (SD = 2.9) years, who had given birth within the last 6 months.

METHODS

Participants were randomized to three physical activity groups. Validated questionnaires were administered before and after the 12-week intervention. Attendance and feasibility metrics and qualitative semistructured interviews were conducted to assess the intervention.

RESULTS

The intervention and trial were partially feasible, and retention to the intervention was high; however, adherence as assessed by attendance was lower than expected. There was high acceptability among those in the group-based, in-person intervention. There was moderate acceptability among those in the individual, home-based asynchronous program.

CONCLUSION

Findings highlight the necessity of better understanding what is desired by this population or simply providing more options to participants so that we can tailor physical activity to their needs and provide the necessary support.

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

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

Exercises for fibromyalgia syndrome: what YouTube tells us as a source of information for patient and physician education

OBJECTIVE

YouTube, a popular worldwide source to access health information online, may have an impact in enhancing exercise therapy for fibromyalgia patients. This study is aimed to investigate the quality and reliability of exercise videos prepared for fibromyalgia syndrome on YouTube.

METHODS

A thorough search on YouTube using six search terms related to fibromyalgia treatment and exercise was conducted. The videos with content on exercises for fibromyalgia, acceptable audio-video quality, and are in English language were included, whereas duplicates were excluded from the analysis. Quality was determined using the Global Quality Scale (GQS) and JAMA system, and reliability using the mDISCERN criteria.

RESULTS

Out of a total of 600 videos, 70 videos that met the inclusion criteria were included in the analysis. Physicians were found to produce content mostly in high and medium quality (%70.2), other medical professionals mostly in low and medium quality (93.8%), while non-medical users mostly in low quality (86.7%). Ninety percent of the videos targeted patients, while 10% targeted healthcare professionals as an audience, and the majority (93.7%) of videos targeting patients were of low and medium quality, as most (85.7%) of the videos targeting healthcare professionals were of high quality.

CONCLUSION

YouTube can be used as a tool to increase exercise adherence in fibromyalgia patients, as it offers a wide range of content that is easily accessible and useful at times. To implement this tool, physicians need to upload more content online as they stand for pioneers of high-quality information dissemination on the internet. KeyPoints • This research emphasizes the need for high-quality online healthcare information which is accessed by a vast number of individuals and the implementations that effectively address and prevent the spread of misinformation. • Additionally, it presents suggestions for the future regarding the uploading of such content on the internet. • Physicians hold the key responsibility in ensuring the availability of high-quality online health content, thereby carrying significant implications for its overall impact.

Effect of smartphone apps on glycemic control in young patients with type 1 diabetes: A meta-analysis

Objectives

Achieving glycemic control is a great challenge for young patients with type 1 diabetes (T1D), especially during the transition from childhood to adulthood. As various smartphone apps have been developed to improve glycemic control in T1D, we performed a meta-analysis of randomized controlled trials to assess the effect of smartphone apps on glycemic control in young patients with T1D.

Methods

We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials comparing combined usual care and smartphone app treatment to usual care alone. This meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The primary outcomes were the weighted difference in means (WMD) of HbA1c change from baseline and the person-years incidence of mild hypoglycemia or severe hypoglycemia between intervention and control groups. We assessed pooled data by use of a random-effects model.

Results

Of 1,190 identified studies, nine were eligible and included in our analysis (N = 748 participants). Relative to the control, using smartphone apps yielded a non-significant reduction in glycated hemoglobin (HbA1c) (WMD = −0.26, 95% CI: −0.56 to 0.05; p = 0.10) and no increased frequency of mild hypoglycemia (WMD = 1.87, 95% CI: −1.52 to 5.27; p = 0.49) or severe hypoglycemia (WMD = −0.04, 95% CI: −0.35 to 0.27; p = 0.80). In further subgroup analysis, compared with the recording-style app group, the auxiliary-style app group exhibited a significant reduction in HbA1c (WMD = −0.83, 95% CI: −1.10 to −0.56, p < 0.001).

Conclusion

The current pooled data analysis did not reveal a significant reduction in HbA1c in young patients with T1D undergoing treatment with smartphone apps and usual care in combination. However, auxiliary-style apps with insulin or carbo calculators were beneficial in reducing HbA1c.

A Group-Based, Videoconference-Delivered Physical Activity Program for Cancer Survivors

Introduction/Purpose

Virtually supervised, group-based exercise presents an innovative way to expand the reach of exercise-oncology programs and help cancer survivors increase physical activity (PA) and connect with other participants. This study examined the feasibility, acceptability, and preliminary effects of a group-based PA program delivered exclusively using videoconferencing software.

Methods

This study used a single-group pre-post design. The 8-wk program consisted of aerobic and resistance exercise sessions once per week and three PA behavior change discussion sessions in groups of four to six. Feasibility was determined by enrollment, retention, safety, and adherence. Postprogram surveys evaluated acceptability using a Likert scale and open-ended responses. Changes in PA (Godin Leisure-Time Exercise Questionnaire), quality of life (QOL; Functional Assessment of Cancer Therapy- General), and upper and lower body muscular endurance (bicep curl and sit-to-stand test) were also evaluated.

Results

Enrollment was feasible (n = 61 of 65 who expressed interest in the program), and retention (86.9%) and adherence (88% for exercise, 91% for discussion) were high; no adverse events were reported. Participants (mean age, 59.9 ± 10.1 yr; 96.2% female; 64.2% ovarian cancer, 28.3% breast cancer, 7.5% other cancer) reported they enjoyed the program (median, 7 of 7), and videoconferencing software was easy to use and had good video and audio quality (median, 5 of 5). From preprogram to postprogram, participants increased their weekly minutes of aerobic (mean (SD) change, 82.4 (144.2)) and resistance (mean (SD) change, 31.9 (42.7)) PA; sit-to-stand (mean (SD) change, 1.4 (3.9)) and bicep curl (mean (SD) change, 5.3 (6.8)) repetitions; and emotional (mean (SD) change, 0.82 (2.3) points), functional (mean (SD) change, 1.2 (3.6) points), and total QOL (mean (SD) change, 3 (7.9) points; all P < 0.05).

Conclusions

A group-based PA program delivered using videoconference technology is feasible and acceptable for cancer survivors, and may increase PA and improve physical fitness and some aspects of QOL. A larger, controlled intervention is needed to determine efficacy, as well as pragmatic studies to directly compare this approach with conventional strategies (i.e., face-to-face programs).

Telehealth interventions for physical activity and exercise participation in postpartum women: A quantitative systematic review

Postpartum women are one of the least physically active vulnerable populations globally and telehealth has been proposed as a potential method of delivering effective exercise interventions for this population. However, clinical practice guidelines are based upon the recommendations for the general population and therefore, the most efficacious exercise dose and the delivery method for this population is unclear. This quantitative systematic review will examine the implementation and outcomes of telehealth exercise interventions in the postpartum population to synthesise the degree to which these outcomes have been assessed and evaluated. Five databases were searched from January 2001 to March 2022. Studies implementing synchronous telehealth exercise interventions for postpartum women were included. Interventions were examined against the Template for Intervention Description and Replication (TIDieR) checklist that assesses intervention reporting completeness and replicability. Of the 1036 records identified, 16 studies progressed to data extraction. Six interventions provided individualised exercise prescription, and only four were delivered by university-level exercise practitioners. Physical activity participation was well reported, however health-related outcomes (i.e., muscular strength and aerobic capacity) were very minimally assessed. Only one intervention utilised modern video conferencing as the primary telehealth communication method. With the minimal assessment of health-related outcomes, there is limited scope to assess the effectiveness of these interventions for postpartum women. Future research interventions need to be reported according to a validated trial reporting system and focus on relevant health related outcomes including postpartum depressive symptoms, quality of life, cardiovascular fitness, muscular strength and body composition.

Feasibility of Internet-Based Physical-Cognitive Exercise for Health Benefits of Middle-Aged Obese Women

INTRODUCTION

Obesity in middle-aged women markedly increases the risk for non-communicable diseases, neurodegenerative diseases, and physical and cognitive problems. Exercise, particularly combined physical-cognitive exercise, has been demonstrated to have beneficial effects on both physical and cognitive health. However, middle-aged women often face barriers to engaging in exercise, which include time constraints, lack of motivation, and enjoyment. Incorporating an exercise program into a technology-based intervention in the home environment may help overcome these barriers and promote health benefits. Therefore, this study aimed to assess the feasibility of home-based, physical-cognitive internet-based exercise for middle-aged obese women.

METHODS

A total of 33 middle-aged obese women were enrolled in the study. Participants performed an intervention for 60 min/day, 3 days/week for 3 months. Feasibility outcomes (adherence, adverse events, physical performances, obesity parameters, and enjoyment of the program) were measured.

RESULTS

Average exercise adherence was 91.67%, and no adverse events were reported in this feasibility study. At the end of the training period, body weight and BMI were significantly decreased compared to baseline. As for physical performances, both cardiorespiratory fitness and lower limb muscle power were significantly improved at post-training when compared to baseline. Furthermore, the participants experienced a high level of exercise enjoyment, and it was maintained over the 3-month training period.

CONCLUSION

These findings suggest that home-based, internet-based physical-cognitive exercise was safe and feasible for reducing obesity parameters, improving physical function, maintaining enjoyment over the course of training, and facilitating adherence to exercise in middle-aged obese women.

Measurement of Adherence to mHealth Physical Activity Interventions and Exploration of the Factors That Affect the Adherence: Scoping Review and Proposed Framework

BACKGROUND

Mobile health (mHealth) is widely used as an innovative approach to delivering physical activity (PA) programs. Users' adherence to mHealth programs is important to ensure the effectiveness of mHealth-based programs.

OBJECTIVE

Our primary aim was to review the literature on the methods used to assess adherence, factors that could affect users' adherence, and the investigation of the association between adherence and health outcomes. Our secondary aim was to develop a framework to understand the role of adherence in influencing the effectiveness of mHealth PA programs.

METHODS

MEDLINE, PsycINFO, EMBASE, and CINAHL databases were searched to identify studies that evaluated the use of mHealth to promote PA in adults aged ≥18 years. We used critical interpretive synthesis methods to summarize the data collected.

RESULTS

In total, 54 papers were included in this review. We identified 31 specific adherence measurement methods, which were summarized into 8 indicators; these indicators were mapped to 4 dimensions: length, breadth, depth, and interaction. Users' characteristics (5 factors), technology-related factors (12 factors), and contextual factors (1 factor) were reported to have impacts on adherence. The included studies reveal that adherence is significantly associated with intervention outcomes, including health behaviors, psychological indicators, and clinical indicators. A framework was developed based on these review findings.

CONCLUSIONS

This study developed an adherence framework linking together the adherence predictors, comprehensive adherence assessment, and clinical effectiveness. This framework could provide evidence for measuring adherence comprehensively and guide further studies on adherence to mHealth-based PA interventions. Future research should validate the utility of this proposed framework.

Prescribing Intensity in Resistance Training Using Rating of Perceived Effort: A Randomized Controlled Trial

Introduction: Rating of perceived effort (RPE) scales are used to prescribe intensity in resistance training (RT) in several ways. For instance, trainees can reach a specific RPE value by modifying the number of repetitions, lifted loads, or other training variables. Given the multiple approaches of prescribing intensity using RPE and its growing popularity, we compared the effects of two RPE prescription approaches on adherence rates, body composition, performance and psychological outcomes, in an online RT intervention.

Methods: We randomly assigned 57 healthy participants without RT experience (60% females, age range: 18–45) to one of two groups that received two weekly RT sessions using a resistance-band for 8 weeks. In the fixed-repetition group, participants adjusted the band resistance with the goal of completing 10 repetitions and reaching a 7-RPE on a 0–10 scale by the 10th repetition. In the open-repetition group, participants selected their preferred band resistance and completed repetitions until reaching a 7-RPE by the final repetition. We measured body composition, performance, and program satisfaction rates.

Results: We assessed 46 participants at post-test, 24 from the fixed-repetition group and 22 from the open-repetition group. We observed non-significant and trivial differences between groups in all outcomes (p > 0.05). We then combined the pre-post change scores of the two groups. We found that adherence rates began at 89% and gradually decreased to 42%. On average, participants increased their fat-free mass [0.3 kg (95% CI: 0.1–0.6)], isometric mid-thigh pull [5.5 kg (95% CI: 0.8–10.4)], isometric knee-extension [2.2 kg (95% CI: 0.8–3.7)], and push-ups [6.3 repetitions (95% CI: 4.5–8.2)]. We observed non-significant and trivial changes in bodyweight, grip-force, and countermovement jump. Participants reported high satisfaction rates with all components of the program.

Conclusion: Participants in both groups improved their body composition and physical capacity to a similar extent, and reported comparable satisfaction rates with the programs they followed. Accordingly, either prescription approach can be used to deliver online RT sessions based on personal preferences and logistical constraints. However, since adherences rates declined over the course of the study, future research should test additional strategies aiming to maintain adherence rates.

Enhancing Physical Activity and Psychological Well-Being in College Students during COVID-19 through WeActive and WeMindful Interventions

This study aimed to examine the immediate and short-term effects of aerobic and resistance training (WeActive) and mindful exercise (WeMindful) virtual interventions in improving physical activity (PA) and resilience among college students. Participants were 55 students who were randomly assigned to either the WeActive group (n = 31) or the WeMindful group (n = 24). Both groups attended two virtual 30 min aerobic and resistance training sessions (WeActive) or mindful exercise sessions (WeMindful) per week for eight weeks. All participants completed the International Physical Activity Questionnaire and the Connor–Davidson Resilience Scale (CD-RISC-10) via Qualtrics one week prior to (pre-test) and after the intervention (post-test) and 6 weeks after the intervention (follow up). There was a significant main effect of time for resilience (F = 3.4.15, p = 0.024), where both the WeActive group and the WeMindful group significantly increased the resilience scores from pre-test to follow up (t = −2.74, p = 0.02; t = −2.54, p = 0.04), respectively. For moderate physical activity (MPA), there was a significant interaction effect of time with group (F = 4.81, p = 0.01, η² = 0.038), where the WeActive group significantly increased MPA over time from pre-test to follow-up test as compared to the WeMindful group (t = −2.6, p = 0.033). Only the WeActive intervention was effective in increasing MPA. Both interventions were effective in increasing resilience from pre-test to 6 week follow up.

Engagement With Web-Based Fitness Videos on YouTube and Instagram During the COVID-19 Pandemic: Longitudinal Study

Background

The COVID-19 pandemic has drastically changed the physical activity (PA) landscape through the closures of gymnasiums, schools, and many outdoor spaces. Physical distancing guidelines have also reduced opportunity for PA. The popularity of free web-based home fitness videos on video hosting platforms (eg, YouTube and Instagram) has spiked during the pandemic. Many web-based fitness videos offer a convenient, accessible, and cost-effective means of engaging in PA through regularly posted videos or discrete programs. Notably, traditional PA programs often suffer from poor adherence and high dropout rates, despite many advantages over web-based workout programs (eg, equipment, feedback, and in-person engagement). Thus, notwithstanding clear advantages of these web-based fitness videos, their ability to maintain long-term engagement and adherence is unknown.

Objective

We explored patterns of engagement (ie, views, likes, and comments) for channels posting daily or program-based web-based fitness videos since the declaration of COVID-19 as a pandemic, over 4 months. Our secondary objective was to examine potential moderators of engagement metrics.

Methods

An environmental scan was used to identify eligible channels. Eligible channels were (1) freely available on YouTube or Instagram and (2) posted daily or weekday series workouts or offered quarantine-specific workout programs. Searches for eligible channels were conducted on June 1 and 4, 2020. Engagement metrics of views, likes, and comments were then collected from channels’ videos posted between March 11 and June 26 or 30, 2020, inclusive, on June 26 or July 8, 2020. A series of multilevel modeling analyses were conducted to examine longitudinal changes in each of the 3 outcome variables.

Results

Ten channels were deemed eligible and included in analyses; 6 posted regularly, while the other 4 posted discrete workout programs. Multilevel models revealed that both views and likes significantly decreased across days. Visually, channels display the sharpest drop in engagement within the first week. Linear change estimate indicates that the number of views initially declined by 24,700 per day (95% CI –44,400 to –11,300, P=.01) on average across all the channels. Channels with more subscribers declined in their views, likes, and comments at a significantly higher rate than those with fewer subscribers (P≤.04). The day of the week a video is posted, “virality,” and content of a video appear to influence engagement. Integrating behavior change techniques and posting new and varied videos often may help garner further engagement with these videos. Future research should examine common elements of videos, which drive engagement.

Conclusions

Despite raw engagement metrics, each channel demonstrated peak engagement with the initial video followed by decreased engagement with subsequent videos. As many countries maintain restrictions on traditional PA facilities owing to the COVID-19 pandemic, determining methods to improve engagement and adherence with web-based fitness videos becomes increasingly important.

Promoting Mental Health in Parents of Young Children Using eHealth Interventions: A Systematic Review and Meta-analysis

Parent stress and mental health problems negatively impact early child development. This study aimed to systematically review and meta-analyze the effect of eHealth interventions on parent stress and mental health outcomes, and identify family- and program-level factors that may moderate treatment effects. A search of PsycINFO, Medline, CINAHL, Cochrane and Embase databases was conducted from their inception dates to July 2020. English-language controlled and open trials were included if they reported: (a) administration of an eHealth intervention, and (b) stress or mental health outcomes such as self-report or clinical diagnosis of anxiety and depression, among (c) parents of children who were aged 1–5 years old. Non-human studies, case reports, reviews, editorials, letters, dissertations, and books were excluded. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Random-effects meta-analyses of standardized mean differences (SMD) were conducted and meta-regressions tested potential moderators. 38 studies were included (N = 4360 parents), from 13 countries (47.4% USA). Meta-analyses indicated eHealth interventions were associated with better self-reported mental health among parents (overall SMD = .368, 95% CI 0.228, 0.509), regardless of study design (k = 30 controlled, k = 8 pre-post) and across most outcomes (k = 17 anxiety, k = 19 depression, k = 12 parenting stress), with small to medium effect sizes. No significant family- or program-level moderators emerged. Despite different types and targets, eHealth interventions offer a promising and accessible option to promote mental health among parents of young children. Further research is needed on moderators and the long-term outcomes of eHealth interventions. Prospero Registration: CRD42020190719.

Parent Physical Activity: A Systematic Review of the Literature and Recommendations for Parents of Children With Autism Spectrum Disorder

BACKGROUND

The aims of this review were to describe exercise interventions, facilitators, and barriers to physical activity for parents of children with autism spectrum disorder.

METHODS

A systematic review of the literature, appraising the validity of each article with Melnyk and Fineout-Overholt's level of evidence, from different databases CINAHL, Cochrane, PsycINFO, PubMed, ProQuest, and Web of Science between 2000 and 2020 was conducted. As the initial search revealed no articles on exercise interventions and only 2 articles with children with autism spectrum disorder, the aim was widened to all parents of children.

RESULTS

Forty-five articles were identified on barriers to physical activity including being the primary caregiving parent, perception of guilt and selfishness, and adhering to exercise programs they do as part of research, once research ends. Facilitators for physical activity including parents being more likely to exercise if they can bring their child with them and parents preferring exercise that is a lifelong habit, such as walking.

CONCLUSIONS

Due to the lack of research on parents of children with autism spectrum disorder, recommendations include development and testing of interventions for parents of children with this condition including family-based exercise interventions where children and parents have a choice to exercise together.

Effects of Tele-Exercise on Body Weight, Body Mass Index, and Fat Mass of Obese Employees

Purpose: Obesity is a growing health problem in Indonesia caused by physical inactivity. Meanwhile, employees are a group that is susceptible to obesity as they often have limited time while working sedentarily in front of a desk or computer, especially during the COVID-19 pandemic. This causes risks of many cardiovascular diseases, obesity and can indirectly cause death. Tele-exercise, a live online video exercise, may be the solution to this problem. Therefore, the purpose of this study is to analyse the effects of tele-exercise on body weight, BMI, and fat mass percentage as indicators of obesity. Methods: The research was conducted from July 2020 to January 2021 according to the policy regarding the pandemic. Also, it used a pre-post quasy experimental design. A total of 39 subjects were given tele-exercise involving 2 strength training and 1 cardio training per week for 3 months. Findings: Subsequently, the results showed that exercise had a significant effect (p<0.05) on BMI and body weight, while fat mass percentage only decreased significantly (p<0.05) from the second to third assessment. Originality: To our knowledge, this is the first study analysing the effects of tele-exercise on obese employee’s body weight, body mass index and fat mass. Conclusion: This proves that tele-Exercise is an effective therapy for obesity that does not require a large space, and has beneficial online aspects, especially during the pandemic. The timing of measurement and hydration status should be considered to assess the body composition.

Quality assessment of smartphone fitness apps used to increase physical activity level and improve general health in adults: A systematic review

Introduction

Mobile exercise apps for smartphones have been used with intervention measures to increase physical activity. This study aimed to identify and evaluate the quality of fitness apps for smartphones that were used to increase the level of physical activity and improve the overall health of healthy adults.

Methods

The systematic review was performed in five electronic databases EMBASE, MEDLINE, CINAHL, Academic Research Premier e Cochrane Reviews, and Trials. The search terms were grouped into three categories according to the principles of population, intervention, comparison, and outcomes. The following includes examples of the group terms: population (healthy adults), intervention (smartphone apps), and outcomes (physical activity level).

Results

Of the 3924 potential articles, 74 were read for full-text analysis. Only seven studies were included in the review. The methodological evaluation of the studies and the apps’ quality showed that only one study and one app were evaluated with good quality. All studies used a type of application to improve the level of physical activity (measured by the number of daily steps), reporting an increase and improvement in some general health indices (calorie expenditure, weight, BMI) in healthy adults, regardless of frequency and duration of intervention and applications.

Conclusion

We cannot say that the use of smartphone applications improves the level of physical activity and general health. The low methodological quality of the studies and the possibility to evaluate the applications used (Mars Scale) due to the lack of technical standardization presented in the studies, despite the app used showing positive results in all studies.

Telehealth: A Useful Tool for the Management of Nutrition and Exercise Programs in Pediatric Obesity in the COVID-19 Era

The COVID-19 pandemic has led to the implementation of policies that mandate various restrictions on daily life, including social distancing, the closure of public services and schools, and movement limitations. Even though these restrictive measures decreased the COVID-19 spread, they may have detrimental effects on various lifestyle components such as physical inactivity, sedentary behavior, and dietary habits, influencing the maintenance of weight and contributing to obesity among children and adolescents. The coexistence of childhood obesity and COVID-19 and changes in the bioecological environment have put children and adolescents at increased risk for developing obesity and exacerbating the severity of this disorder. The use of telehealth technology is a modern approach useful for the delivery of health care services by health care professionals, where distance is a critical factor. Telehealth is effective in promoting increased self-monitoring and behavioral change, and provides the opportunity to perform online nutritional support and exercise training programs to promote a healthy lifestyle and reduce sedentary behaviors in children and adolescents. Telehealth, including tele-exercise and tele-nutrition, has the potential to address many of the key challenges in providing health services, including in patients with obesity during the COVID-19 outbreak. This narrative review aims to describe the role of telehealth as an opportunity in the management of pediatric obesity in the COVID-19 era, and to deliver nutrition and exercise programs for the maintenance of health.

Couple-Based Physical Activity Planning for New Parents: A Randomized Trial

INTRODUCTION

The demands of parenthood may limit the pursuit of moderate-to-vigorous intensity physical activity (MVPA), establish inactivity patterns into middle age, and lead to long-term poorer health and well-being. The purpose of this study was to examine the efficacy of a couple-based planning skills intervention to support MVPA from baseline (~2 months after birth) up to 6 months later in first-time parents.

STUDY DESIGN

Randomized trial.

PARTICIPANTS

264 parents (132 couples) at the 2-month point of parenting their first child.

INTERVENTION

Couples were randomized to either an education control (n=58 couples) or an education plus planning condition (n=74 couples).

MAIN OUTCOME MEASURES

MVPA was assessed via accelerometry and self-report at baseline, 6 weeks, 3 months, and 6 months. Health-related fitness (aerobic fitness, muscular strength, flexibility) and BMI tests were conducted at baseline and 6 months. Rolling recruitment was between 2014 and 2017.

RESULTS

The accelerometry results had large amounts of missing data that were not missing at random, so only self-reported MVPA was analyzed. Dyadic multilevel modeling conducted in 2020 showed that mothers' MVPA had a significant quadratic pattern over time that was similar for both conditions, and BMI decreased while strength and flexibility increased. Fathers did not have significant outcomes. Participants who were not meeting MVPA guidelines at baseline responded to the education plus planning condition with increased MVPA (father B=1.31, mother B=1.14, p<0.05) compared with those who initially met those guidelines.

CONCLUSIONS

Mothers may be more responsive than fathers to MVPA interventions in early parenthood. Already active parents likely have little to be gained from additional intervention. Future research is needed to effectively promote MVPA during fatherhood and identify novel ways to sustain PA past the early response to an intervention.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02290808.

Approaches to Promote Reduction in Sedentary Behavior in Patients With Minor Ischemic Stroke: A Randomized Controlled Trial

OBJECTIVE

The purpose of this study was to determine whether an approach that promotes reduction in sedentary behavior (SB) during hospitalization and after hospital discharge reduces SB in patients with minor ischemic stroke (MIS) compared with an approach that promotes an increase in physical activity levels.

DESIGN

Randomized controlled trial design.

SETTING

During hospitalization and after hospital discharge.

PARTICIPANTS

We randomly assigned patients (N=61) with MIS (average age, 71.3±8.3y; 65.6% men) admitted to an acute hospital to either the intervention group (reduced SB, n=31) or the control group (increased physical activity levels, n=30).

INTERVENTIONS

During hospitalization, the intervention group received education on reducing SB, goal setting for SB after hospital discharge, and self-monitoring of SB and step count. In contrast, the control group received education on increasing physical activity levels and self-monitoring of step count. Patients in both groups wore an accelerometer during hospitalization until 3 months after hospital discharge. The intervention group received self-monitoring of SB and step count, stickers including information about reducing their SB, and phone calls once every 2 weeks for encouragement and feedback. The control group only wore the accelerometer.

MAIN OUTCOME MEASURES

The primary outcome was SB (in percentage) at 3 months after hospital discharge.

RESULTS

There was an interaction between the 2 groups for SB. Compared with the control group, the intervention group showed a significantly reduced SB (intervention group: baseline, 70.5%; 3 months after hospital discharge, 48.6%; control group: baseline, 71.5%; 3 months after hospital discharge, 57.5%; F value=5.981; P=.018).

CONCLUSIONS

The results suggested that an approach that promotes SB reduction during hospitalization and after hospital discharge is effective in reducing SB in patients with MIS 3 months after hospital discharge.

Promoting Health via mHealth Applications Using a French Version of the Mobile App Rating Scale: Adaptation and Validation Study

Background

In the recent decades, the number of apps promoting health behaviors and health-related strategies and interventions has increased alongside the number of smartphone users. Nevertheless, the validity process for measuring and reporting app quality remains unsatisfactory for health professionals and end users and represents a public health concern. The Mobile Application Rating Scale (MARS) is a tool validated and widely used in the scientific literature to evaluate and compare mHealth app functionalities. However, MARS is not adapted to the French culture nor to the language.

Objective

This study aims to translate, adapt, and validate the equivalent French version of MARS (ie, MARS-F).

Methods

The original MARS was first translated to French by two independent bilingual scientists, and their common version was blind back-translated twice by two native English speakers, culminating in a final well-established MARS-F. Its comprehensibility was then evaluated by 6 individuals (3 researchers and 3 nonacademics), and the final MARS-F version was created. Two bilingual raters independently completed the evaluation of 63 apps using MARS and MARS-F. Interrater reliability was assessed using intraclass correlation coefficients. In addition, internal consistency and validity of both scales were assessed. Mokken scale analysis was used to investigate the scalability of both MARS and MARS-F.

Results

MARS-F had a good alignment with the original MARS, with properties comparable between the two scales. The correlation coefficients (r) between the corresponding dimensions of MARS and MARS-F ranged from 0.97 to 0.99. The internal consistencies of the MARS-F dimensions engagement (ω=0.79), functionality (ω=0.79), esthetics (ω=0.78), and information quality (ω=0.61) were acceptable and that for the overall MARS score (ω=0.86) was good. Mokken scale analysis revealed a strong scalability for MARS (Loevinger H=0.37) and a good scalability for MARS-F (H=0.35).

Conclusions

MARS-F is a valid tool, and it would serve as a crucial aid for researchers, health care professionals, public health authorities, and interested third parties, to assess the quality of mHealth apps in French-speaking countries.

Smart Wearable Device Users' Behavior Is Essential for Physical Activity Improvement

BACKGROUNDS

This study aimed to explore the effect on physical activity and sedentary behavior of users of wearable devices, and understand the association between physical activity and behavior.

METHODS

This study conducted a three-arm, randomized controlled trial for 12 weeks. Healthy adults without experience of using a wearable device were recruited and were randomly assigned to a control group with a mobile app and two experimental groups with different smart wearable devices. Data were collected through questionnaires.

RESULTS

No significant effect of group, time, or group-by-time interaction among groups for physical activity, sedentary time, or sleep quality was found. Wearing duration significantly positively predicted changes in low-intensity and total physical activity. The number of times the device was checked negatively predicted a change in sedentary time.

CONCLUSIONS

The behavior of wearable device users is an essential factor for successfully increasing physical activity and decreasing sedentary time.

Use of active video games with or without videoconferencing on health outcomes in adolescent and young adult cancer survivors: a systematic review

PURPOSE

Adolescent and young adult (AYA) cancer survivors experience greater functional deficits compared to non-cancer peers or older survivors with a similar diagnosis. Physical activity (PA) is a key strategy for mitigating functional decline, and motivation and peer support are critical PA facilitators in AYA cancer survivors. Active video games (AVGs) may be a "gateway" method to promote PA. Further, integrating AVGs into group videoconferencing, a medium used by AYAs to socialize, can capitalize on peer support needed for PA motivation. Thus, we examined the use of AVGs and/or videoconferencing in PA interventions that included AYA survivors and the effect on physical function and health outcomes.

METHODS

Seven electronic databases were searched from incept to January 2020. Search terms included videoconferencing, video games, exercise, and cancer. The protocol is registered on PROSPERO: CRD42020163491. Two reviewers evaluated eligibility and methodological quality using Cochrane's risk of bias tools.

RESULTS

Six unique studies were included with 97% reviewer agreement. All used AVGs, none used videoconferencing alone, and one used both. Study designs and outcome measures were heterogeneous. Only one study solely targeted AYA survivors. Most were low to medium quality. Few showed significant improvements in quality of life (QOL) and fatigue (n=3), coordination/balance (n=2), and aerobic capacity (n=1).

CONCLUSIONS

PA interventions using AVGs and/or videoconferencing may improve QOL and fatigue, but evidence on function is lacking. Rigorous interventions targeting AYA survivors are needed.

IMPLICATIONS FOR CANCER SURVIVORS

Using AVGs and/or videoconferencing to facilitate PA may improve QOL and fatigue.

Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population

BACKGROUND

Social networking platforms offer a wide reach for public health interventions allowing communication with broad audiences using tools that are generally free and straightforward to use and may be combined with other components, such as public health policies. We define interactive social media as activities, practices, or behaviours among communities of people who have gathered online to interactively share information, knowledge, and opinions.

OBJECTIVES

We aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects. Our secondary objective was to assess the effects of these interventions on the health of populations who experience health inequity as defined by PROGRESS-Plus. We assessed whether there is evidence about PROGRESS-Plus populations being included in studies and whether results are analysed across any of these characteristics.

SEARCH METHODS

We searched CENTRAL, CINAHL, Embase, MEDLINE (including trial registries) and PsycINFO. We used Google, Web of Science, and relevant web sites to identify additional studies and searched reference lists of included studies. We searched for published and unpublished studies from 2001 until June 1, 2020. We did not limit results by language.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), controlled before-and-after (CBAs) and interrupted time series studies (ITSs). We included studies in which the intervention website, app, or social media platform described a goal of changing a health behaviour, or included a behaviour change technique. The social media intervention had to be delivered to adults via a commonly-used social media platform or one that mimicked a commonly-used platform. We included studies comparing an interactive social media intervention alone or as a component of a multi-component intervention with either a non-interactive social media control or an active but less-interactive social media comparator (e.g. a moderated versus an unmoderated discussion group). Our main outcomes were health behaviours (e.g. physical activity), body function outcomes (e.g. blood glucose), psychological health outcomes (e.g. depression), well-being, and adverse events. Our secondary outcomes were process outcomes important for behaviour change and included knowledge, attitudes, intention and motivation, perceived susceptibility, self-efficacy, and social support.

DATA COLLECTION AND ANALYSIS

We used a pre-tested data extraction form and collected data independently, in duplicate. Because we aimed to assess broad outcomes, we extracted only one outcome per main and secondary outcome categories prioritised by those that were the primary outcome as reported by the study authors, used in a sample size calculation, and patient-important.

MAIN RESULTS

We included 88 studies (871,378 participants), of which 84 were RCTs, three were CBAs and one was an ITS. The majority of the studies were conducted in the USA (54%). In total, 86% were conducted in high-income countries and the remaining 14% in upper middle-income countries. The most commonly used social media platform was Facebook (39%) with few studies utilising other platforms such as WeChat, Twitter, WhatsApp, and Google Hangouts. Many studies (48%) used web-based communities or apps that mimic functions of these well-known social media platforms. We compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. We only reported the RCT results in our 'Summary of findings' table. We found a range of effects on health behaviours, such as breastfeeding, condom use, diet quality, medication adherence, medical screening and testing, physical activity, tobacco use, and vaccination. For example, these interventions may increase physical activity and medical screening tests but there was little to no effect for other health behaviours, such as improved diet or reduced tobacco use (20,139 participants in 54 RCTs). For body function outcomes, interactive social media interventions may result in small but important positive effects, such as a small but important positive effect on weight loss and a small but important reduction in resting heart rate (4521 participants in 30 RCTs). Interactive social media may improve overall well-being (standardised mean difference (SMD) 0.46, 95% confidence interval (CI) 0.14 to 0.79, moderate effect, low-certainty evidence) demonstrated by an increase of 3.77 points on a general well-being scale (from 1.15 to 6.48 points higher) where scores range from 14 to 70 (3792 participants in 16 studies). We found no difference in effect on psychological outcomes (depression and distress) representing a difference of 0.1 points on a standard scale in which scores range from 0 to 63 points (SMD -0.01, 95% CI -0.14 to 0.12, low-certainty evidence, 2070 participants in 12 RCTs). We also compared studies assessing interactive social media interventions with those with an active but less interactive social media control (11 studies). Four RCTs (1523 participants) that reported on physical activity found an improvement demonstrated by an increase of 28 minutes of moderate-to-vigorous physical activity per week (from 10 to 47 minutes more, SMD 0.35, 95% CI 0.12 to 0.59, small effect, very low-certainty evidence). Two studies found little to no difference in well-being for those in the intervention and control groups (SMD 0.02, 95% CI -0.08 to 0.13, small effect, low-certainty evidence), demonstrated by a mean change of 0.4 points on a scale with a range of 0 to 100. Adverse events related to the social media component of the interventions, such as privacy issues, were not reported in any of our included studies. We were unable to conduct planned subgroup analyses related to health equity as only four studies reported relevant data.

AUTHORS' CONCLUSIONS

This review combined data for a variety of outcomes and found that social media interventions that aim to increase physical activity may be effective and social media interventions may improve well-being. While we assessed many other outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of our included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase our understanding of the potential effect of these interventions on reducing health inequities.

Staying physically active during the COVID-19 quarantine: exploring the feasibility of live, online, group training sessions among older adults

The COVID-19 outbreak has led to recurring quarantines resulting in drastic reductions in physical activity (PA) levels. Given its health benefits, there is a need to explore strategies to increase PA rates during this period. Video-conferencing platforms can be used to deliver live, online, group PA sessions. However, there are only few established PA protocols on how to use such platforms. Hence, the purposes of this study were to (a) design an online PA protocol and (b) explore its feasibility among older adults during a quarantine. A group of exercise specialists developed a PA protocol while accounting for challenges that may arise when using a video-conferencing platform (“Zoom”). A special focus was placed on safety, individualization, and motivational aspects. Then, 31 community dwelling older adults (71.5 ± 4 years) were recruited via social media to follow this protocol twice a week for 8 weeks. Outcome measures included adverse events, adherence rates, and satisfaction with the protocol, its delivery, and technological aspects. Twenty-eight participants completed the protocol. No adverse events occurred, and adherence rates were high (90%). Most participants (97%) indicated they would participate in such a program in the future and highly rated all aspects of the protocol (median score >6 in 1–7 Likert scales). The PA protocol delivered live via a video-conferencing platform was found to be safe and feasible with this cohort. It can therefore be implemented in practice, and in future studies planning to utilize home-based PA sessions for older adults.

Comparisons of physical activity and sedentary behavior between owners and non-owners of commercial wearable devices

AIMS

Wearable devices are a new strategy for promoting physical activity in a free-living condition that utilizes self-monitoring, self-awareness, and self-determination. The main purpose of this study was to explore health benefits of commercial wearable devices by comparing physical activity, sedentary time, sleep quality, and other health outcomes between individuals who used and those that did not use commercial wearable devices.

METHODS

The research design was a cross-sectional study using an Internet survey in Taiwan. Self-administered questionnaires included the International Physical Activity Questionnaire-Short Form, Pittsburgh Sleep Quality Index, Health-Promoting Lifestyle Profile, and World Health Organization Quality-of-Life Scale.

RESULTS

In total, 781 participants were recruited, including 50% who were users of wearable devices and 50% non-users in the most recent 3 months. Primary outcomes revealed that wearable device users had significantly higher self-reported walking, moderate physical activity, and total physical activity, and significantly lower sedentary time than non-users. Wearable device users had significantly better sleep quality than non-users.

CONCLUSION

Wearable devices inspire users' motivation, engagement, and interest in physical activity through habit formation. Wearable devices are recommended to increase physical activity and decrease sedentary behavior for promoting good health.

Acceptability of a structured diet and exercise weight loss intervention in breast cancer survivors living with an overweight condition or obesity: A qualitative analysis

BACKGROUND

Weight loss increases survivorship following breast cancer diagnosis. However, most breast cancer survivors (BCS) do not meet diet and exercise recommendations.

AIM

The purpose of this study was to explore the barriers and facilitators of BCS who had lymphedema and who participated in a 22-week weight loss lifestyle intervention.

METHODS AND RESULTS

Participants completed semi-structured interviews about barriers and facilitators to intervention adherence. Interviews were transcribed verbatim and a thematic analysis was conducted. Participants (n = 17) were 62 ± 8.0 years of age with a mean body mass index of 34.0 ± 7.1 kg/m² . Four themes emerged: (1) facilitators of intervention adherence, (2) barriers of intervention adherence, (3) continuation of healthy habits post intervention, and (4) recommendations for intervention improvements. Facilitators of intervention adherence were education, social support, routine, motivation, goal-setting, meal-provisioning, self-awareness, and supervised exercise. Barriers to intervention adherence were personal life, health, meal dissatisfaction, seasonality, unchallenging exercises, and exercising alone. All women planned to continue the acquired healthy habits post intervention. Recommendations to improve the study included addressing the exercise regime, meal-provisioning, and dietary intake monitoring methods.

CONCLUSION

Future strategies to engage BCS in weight loss interventions should promote group exercise, offer individualized meal-provisioning and exercise regimes, provide transition tools, and allow participants to choose their self-monitoring method.

TECHNOSOCIALITY AND HEALTH PROMOTION IN THE DAILY LIVES OF PRIMARY CARE USERS: A SCOPING REVIEW

ABSTRACT Objective: to map available evidence on the use of technologies by Primary Health Care users in the context of health promotion. Method: this is a scoping review according to Joanna Briggs Institute, and the recommendations of the international guide Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were followed. The PCC strategy (participants, concept and context) was used. The search in the databases was carried out from January to April 2020. Results: a total of 5,267 studies were retrieved and 28 articles were selected for review. The article origin was diverse, with the largest number being from the United States of America (7), the predominant language is English, the year was 2018 and the level of evidence 2. Studies show that users obtain benefits in health care through the use of technologies. Conclusion: health interventions, using technology, positively impact people’s behavior and lifestyle, focusing on the prevention and control of chronic diseases. It is noteworthy that technologies used in isolation cannot overcome behavioral barriers and their use does not replace one-to-one care and monitoring.

Exercise as a Therapeutic Intervention

Evidence supports exercise as a first-line option for many chronic diseases. Although recommendations suggest 150 to 300 minutes a week of moderate-intensity or 75 to 150 minutes a week of vigorous-intensity aerobic activity, replacing sedentary behaviors with light-intensity activities reduces risks of all-cause mortality, and cardiovascular disease (CVD) mortality and incidence of CVD and type 2 diabetes mellitus. Exercise has positive effects on brain function, cognition, and depressive symptoms. Based on such evidence, health care providers should incorporate evaluation of physical activity into patient care. Patients should be evaluated for readiness and ability to exercise and encouraged to increase activity level.

Effectiveness of Individual Real-Time Video Counseling on Smoking, Nutrition, Alcohol, Physical Activity, and Obesity Health Risks: Systematic Review

Background

Real-time video communication technology allows virtual face-to-face interactions between the provider and the user, and can be used to modify risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. No systematic reviews have examined the effectiveness of individual real-time video counseling for addressing each of the risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity.

Objective

This systematic review aims to examine the effectiveness of individually delivered real-time video counseling on risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity.

Methods

The MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), PsycINFO, Cochrane Register of Controlled Trials, and Scopus databases were searched for eligible studies published up to November 21, 2019. Eligible studies were randomized or cluster randomized trials that tested the effectiveness of individual real-time video communication interventions on smoking, nutrition, alcohol, physical activity, and obesity in any population or setting; the comparator was a no-intervention control group or any other mode of support (eg, telephone); and an English-language publication.

Results

A total of 13 studies were eligible. Four studies targeted smoking, 3 alcohol, 3 physical activity, and 3 obesity. In 2 of the physical activity studies, real-time video counseling was found to significantly increase physical activity when compared with usual care at week 9 and after 5 years. Two obesity studies found a significant change in BMI between a video counseling and a documents group, with significantly greater weight loss in the video counseling group than the in-person as well as the control groups. One study found that those in the video counseling group were significantly more likely than those in the telephone counseling group to achieve smoking cessation. The remaining studies found no significant differences between video counseling and telephone counseling or face-to-face counseling for smoking cessation, video counseling and face-to-face treatment on alcohol consumption, video counseling and no counseling for physical activity, and video counseling and face-to-face treatment on BMI. The global methodological quality rating was moderate in 1 physical activity study, whereas 12 studies had a weak global rating.

Conclusions

Video counseling is potentially more effective than a control group or other modes of support in addressing physical inactivity and obesity and is not less effective in modifying smoking and alcohol consumption. Further research is required to determine the relative benefits of video counseling in terms of other policy and practice decision-making factors such as costs and feasibility.

How does MobileMums work? Mediators of a physical activity intervention

Objectives: To establish which Social Cognitive Theory constructs mediated effects of the MobileMums (MMP) program on increased duration and frequency of moderate-vigorous physical activity (MVPA) in women with young children (<5 years). Methods: This secondary data analysis is from a community-based randomised controlled trial. Over 12 weeks, intervention participants received a minimum of 52 individually tailored text messages, one face-to-face and one telephone-delivered session with a trained behavioural counsellor. Participants identified a support person who also received 12 weeks of individually tailored text messages. Control participants received minimal intervention contact. Data were collected pre- and post-program. Five potential mediators were assessed: barrier self-efficacy, goal setting skills, outcome expectancies, perceived environmental opportunity for physical activity and social support for physical activity. Results: Improvements in MVPA frequency were mediated by improvements in barrier self-efficacy, goal setting skills, outcome expectancies and perceived social support. Improvements in MVPA duration resulting from the MMP were mediated by improvements in women's barrier self-efficacy and goal setting skills. Conclusions: MMP improved targeted theoretical constructs and this led to changes in women's MVPA. These findings are valuable for refinement and translation of the MMP and for further research to create theory- and evidence-based physical activity behaviour change programs for women with young children.

Mobile Health Technologies in Cardiopulmonary Disease

Mobile health (mHealth) technologies are modernizing medicine by affording greater patient engagement, monitoring, outreach, and health-care delivery. The cardiopulmonary fields have led the integration of mHealth into clinical practice and research. mHealth technologies in these areas include smartphone applications, wearable devices, and handheld devices, among others, and provide real-time monitoring of numerous important physiological measurements and other key parameters. Use of mHealth-compatible devices has increased in recent years, and age and socioeconomic gaps of ownership are narrowing. These tools provide physicians and researchers with a better understanding of an individual's health and well-being. mHealth interventions have shown utility in the prevention, monitoring, and management of atrial fibrillation, heart failure, and myocardial infarction. With the growing prevalence of cardiopulmonary disease, mHealth technologies may become a more essential element of care within and outside of traditional health-care settings. mHealth is continuously developing as a result of technologic advancements and better understandings of mHealth utility. However, there is little regulation on the mHealth platforms available for commercial use and even fewer guidelines on implementing evidence-based practices into mHealth technologies. Online security is another challenge and necessitates development in data collection infrastructure to manage the extraordinary volume of patient data. Continued research on long-term implications of mHealth technology and the integration of effective interventions into clinical practice is required.