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Cheng Q, Dang T, Nguyen TA, Velen K, Nguyen VN, Nguyen BH, Vu DH, Long CH, Do TT, Vu TM, Marks GB, Yapa M, Fox GJ, Wiseman V. mHealth application for improving treatment outcomes for patients with multidrug-resistant tuberculosis in Vietnam: an economic evaluation protocol for the V-SMART trial. BMJ Open 2023; 13:e076778. [PMID: 38081668 PMCID: PMC10729151 DOI: 10.1136/bmjopen-2023-076778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION The Strengthen the Management of Multidrug-Resistant Tuberculosis in Vietnam (V-SMART) trial is a randomised controlled trial of using mobile health (mHealth) technologies to improve adherence to medications and management of adverse events (AEs) in people with multidrug-resistant tuberculosis (MDR-TB) undergoing treatment in Vietnam. This economic evaluation seeks to quantify the cost-effectiveness of this mHealth intervention from a healthcare provider and societal perspective. METHODS AND ANALYSIS The V-SMART trial will recruit 902 patients treated for MDR-TB across seven participating provinces in Vietnam. Participants in both intervention and control groups will receive standard community-based therapy for MDR-TB. Participants in the intervention group will also have a purpose-designed App installed on their smartphones to report AEs to health workers and to facilitate timely management of AEs. This economic evaluation will compare the costs and health outcomes between the intervention group (mHealth) and the control group (standard of care). Costs associated with delivering the intervention and health service utilisation will be recorded, as well as patient out-of-pocket costs. The health-related quality of life (HRQoL) of study participants will be captured using the 36-Item Short Form Survey (SF-36) questionnaire and used to calculate quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios (ICERs) will be based on the primary outcome (proportion of patients with treatment success after 24 months) and QALYs gained. Sensitivity analysis will be conducted to test the robustness of the ICERs. A budget impact analysis will be conducted from a payer perspective to provide an estimate of the total budget required to scale-up delivery of the intervention. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the University of Sydney Human Research Ethics Committee (2019/676), the Scientific Committee of the Ministry of Science and Technology, Vietnam (08/QD-HDQL-NAFOSTED) and the Institutional Review Board of the National Lung Hospital, Vietnam (13/19/CT-HDDD). Study findings will be published in peer-reviewed journals and conference proceedings. TRIAL REGISTRATION NUMBER ACTRN12620000681954.
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Affiliation(s)
- Qinglu Cheng
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Tho Dang
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - Thu-Anh Nguyen
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kavindhran Velen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Binh Hoa Nguyen
- Vietnam National Tuberculosis Control Program, Hanoi, Vietnam
| | - Dinh Hoa Vu
- Hanoi University of Pharmacy, Hanoi, Vietnam
| | | | - Thu Thuong Do
- Vietnam National Tuberculosis Control Program, Hanoi, Vietnam
| | - Truong-Minh Vu
- Ho Chi Minh City Institute for Development Studies, Ho Chi Minh City, Vietnam
| | - Guy B Marks
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Manisha Yapa
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gregory J Fox
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Virginia Wiseman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Bolibar Ribas B, Llobera-Cànaves J, García-Ortiz L, Bellón JÁ, Ramos R, García-Campayo J, Sánchez-Pérez Á, Claveria A, Martínez V, Vicens E, Minué C, Gil-Guillen V, Berenguera A, Moleras-Serra A. [The Research Network on Preventive Activities and Health Promotion (redIAPP): a reference network and promoter of primary care research]. Aten Primaria 2023; 55:102694. [PMID: 37481824 PMCID: PMC10391719 DOI: 10.1016/j.aprim.2023.102694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/14/2023] [Accepted: 05/21/2023] [Indexed: 07/25/2023] Open
Abstract
The Research Network on Preventive Activities and Health Promotion (redIAPP), a reference network and promoter of primary care research was created in 2003 thanks to the program Thematic Networks for Cooperative Research in Health (RETICS) of the Instituto de Salud Carlos III (ISCIII). Its creation has meant a radical change in the situation of research in primary care. Throughout its 19 years (2003-2021), different research groups and autonomous communities have participated, and different lines of research have been developed with numerous projects and publications. Despite the difficulties suffered, it has created a collaborative research experience between different autonomous communities with great vitality and with important results for primary care. The redIAPP, therefore, has been a great reference for research in primary care and for the deepening of its area of knowledge. Several lines of improvement are suggested for the future of primary care research.
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Affiliation(s)
- Bonaventura Bolibar Ribas
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - Joan Llobera-Cànaves
- Unitat de Recerca en Atenció Primaria de Mallorca, Servei de Salut de les Illes Balears (Ib-Salut), Palma, España; Institut de Investigació Sanitària de les Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma, España
| | - Luis García-Ortiz
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de salud de Castilla y León (SACyL), Salamanca, España; Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España; Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, Salamanca, España
| | - Juan-Ángel Bellón
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, España; Centro de Salud El Palo, Servicio Andaluz de Salud (SAS), Málaga, España; Departmento de Salud Pública y Psiquiatría, Facultad de Medicina, Universidad de Málaga (UMA), Málaga, España
| | - Rafel Ramos
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Grup de Recerca en Salut Vascular, Institut d'Investigació Biomèdica de Girona (IdibGi), Parc Hospitalari Martí Julià, Girona, España; Department de Ciències Mèdiques, Facultat de Medicina, Campus Salut, Universitat de Girona, Girona, España; Atenció Primària, Institut Català de la Salut, Girona, Catalonia, España
| | - Javier García-Campayo
- Grupo de Aragón en Investigación en Atención Primaria (GAIAP), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España; Servicio de Psiquiatría, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
| | - Álvaro Sánchez-Pérez
- Unidad de Investigación Atención Primaria de Bizkaia, Subdirección para la Coordinación de la Atención Primaria, Dirección General Osakidetza, Bilbao, España; Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios Sanitarios, Instituto Investigación Biocruces Bizkaia, Barakaldo, España
| | - Ana Claveria
- Área Sanitaria de Vigo. Servicio Galego de Saúde (SERGAS), Grupo I-Saúde, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Galicia, España
| | - Vicente Martínez
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha, Cuenca, España; Facultad de Medicina, Universidad Autónoma de Chile, Talca, Chile
| | - Enric Vicens
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, España
| | - César Minué
- Grupo Clínico Asociado Madrid. Servicio Madrileño de Salud. CS Perales del Río, Madrid, España
| | - Vicente Gil-Guillen
- Departamento de Medicina Clínica. Universidad Miguel Hernández, Alicante, España; Unidad de Investigación. Hospital General Universitario de Elda, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL. Hospital General Universitario de Alicante, Alicante, España
| | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - Anna Moleras-Serra
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España.
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Römer C, Wolfarth B. Prediction of Relevant Training Control Parameters at Individual Anaerobic Threshold without Blood Lactate Measurement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4641. [PMID: 36901647 PMCID: PMC10001845 DOI: 10.3390/ijerph20054641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Active exercise therapy plays an essential role in tackling the global burden of obesity. Optimizing recommendations in individual training therapy requires that the essential parameters heart rate HR(IAT) and work load (W/kg(IAT) at individual anaerobic threshold (IAT) are known. Performance diagnostics with blood lactate is one of the most established methods for these kinds of diagnostics, yet it is also time consuming and expensive. METHODS To establish a regression model which allows HR(IAT) and (W/kg(IAT) to be predicted without measuring blood lactate, a total of 1234 performance protocols with blood lactate in cycle ergometry were analyzed. Multiple linear regression analyses were performed to predict the essential parameters (HR(IAT)) (W/kg(IAT)) by using routine parameters for ergometry without blood lactate. RESULTS HR(IAT) can be predicted with an RMSE of 8.77 bpm (p < 0.001), R2 = 0.799 (|R| = 0.798) without performing blood lactate diagnostics during cycle ergometry. In addition, it is possible to predict W/kg(IAT) with an RMSE (root mean square error) of 0.241 W/kg (p < 0.001), R2 = 0.897 (|R| = 0.897). CONCLUSIONS It is possible to predict essential parameters for training management without measuring blood lactate. This model can easily be used in preventive medicine and results in an inexpensive yet better training management of the general population, which is essential for public health.
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Kushniruk A, Middelweerd A, van Empelen P, Preuhs K, Konijnendijk AAJ, Oude Nijeweme-d'Hollosy W, Schrijver LK, Laverman GD, Vollenbroek-Hutten MMR. A Digital Lifestyle Coach (E-Supporter 1.0) to Support People With Type 2 Diabetes: Participatory Development Study. JMIR Hum Factors 2023; 10:e40017. [PMID: 36633898 PMCID: PMC9947918 DOI: 10.2196/40017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/29/2022] [Accepted: 11/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate behavior change techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with type 2 diabetes (T2D). OBJECTIVE This paper aimed to describe the systematic development of E-Supporter 1.0. METHODS Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which BCTs were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options, and decision rules. In the last phase, E-Supporter 1.0 integrated in the Diameter app was evaluated using a usability test in 9 people with T2D to assess intervention usage and acceptability. RESULTS The main intervention objectives were to stimulate light to moderate-vigorous physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the health action process approach and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (eg, action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. On the basis of IF-THEN rules, intervention options could be tailored to, among others, type of behavioral goal and (barriers to) goal achievement. Data on these variables could be collected using app data, activity tracker data, and daily ecological momentary assessments. Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content. CONCLUSIONS The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic diseases and lifestyle behaviors, enhancing the degree of tailoring and evaluating intervention effects on acceptability, use, and cost-effectiveness.
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Affiliation(s)
| | - Anouk Middelweerd
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Pepijn van Empelen
- Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | - Katharina Preuhs
- Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | | | | | - Laura K Schrijver
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Gozewijn D Laverman
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Board of Directors, Medisch Spectrum Twente, Enschede, Netherlands
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Kay MC, Miller HN, Askew S, Spaulding EM, Chisholm M, Christy J, Yang Q, Steinberg DM. Patterns of Engagement With an Application-Based Dietary Self-Monitoring Tool Within a Randomized Controlled Feasibility Trial. AJPM FOCUS 2022; 1:100037. [PMID: 37791242 PMCID: PMC10546506 DOI: 10.1016/j.focus.2022.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction The Dietary Approaches to Stop Hypertension dietary pattern is a proven way to manage hypertension, but adherence remains low. Dietary tracking applications offer a highly disseminable way to self-monitor intake on the pathway to reaching dietary goals but require consistent engagement to support behavior change. Few studies use longitudinal dietary self-monitoring data to assess trajectories and predictors of engagement. We used dietary self-monitoring data from participants in Dietary Approaches to Stop Hypertension Cloud (N=59), a feasibility trial to improve diet quality among women with hypertension, to identify trajectories of engagement and explore associations between participant characteristics. Methods We used latent class growth modeling to identify trajectories of engagement with a publicly available diet tracking application and used bivariate and regression analyses to assess the associations of classifications of engagement with participant characteristics. Results We identified 2 latent classes of engagement: consistent engagers and disengagers. Consistent engagers were more likely to be older, more educated, and married or living with a partner. Although consistent engagers exhibited slightly greater changes in Dietary Approaches to Stop Hypertension score, the difference was not significant. Conclusions This study highlights an important yet underutilized methodologic approach for uncovering dietary self-monitoring engagement patterns. Understanding how certain individuals engage with digital technologies is an important step toward designing cost-effective behavior change interventions. Trial registration This study is registered at www.clinicaltrials.gov NCT03215472.
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Affiliation(s)
- Melissa C. Kay
- Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Hailey N. Miller
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
- School of Nursing, Duke University, Durham, North Carolina
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Erin M. Spaulding
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Miriam Chisholm
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Jacob Christy
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
- Medable, Inc., Palo Alto, California
| | - Qing Yang
- School of Nursing, Duke University, Durham, North Carolina
| | - Dori M. Steinberg
- School of Nursing, Duke University, Durham, North Carolina
- Equip Health, Inc., Carlsbad, California
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Stecher C, Pfisterer B, Harden SM, Epstein D, Hirschmann JM, Wunsch K, Buman MP. Assessing the Pragmatic Nature of mHealth Interventions Promoting Physical Activity: A Systematic Review and Meta-Analysis (Preprint). JMIR Mhealth Uhealth 2022; 11:e43162. [PMID: 37140972 DOI: 10.2196/43162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/20/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) apps can promote physical activity; however, the pragmatic nature (ie, how well research translates into real-world settings) of these studies is unknown. The impact of study design choices, for example, intervention duration, on intervention effect sizes is also understudied. OBJECTIVE This review and meta-analysis aims to describe the pragmatic nature of recent mHealth interventions for promoting physical activity and examine the associations between study effect size and pragmatic study design choices. METHODS The PubMed, Scopus, Web of Science, and PsycINFO databases were searched until April 2020. Studies were eligible if they incorporated apps as the primary intervention, were conducted in health promotion or preventive care settings, included a device-based physical activity outcome, and used randomized study designs. Studies were assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Pragmatic-Explanatory Continuum Indicator Summary-2 (PRECIS-2) frameworks. Study effect sizes were summarized using random effect models, and meta-regression was used to examine treatment effect heterogeneity by study characteristics. RESULTS Overall, 3555 participants were included across 22 interventions, with sample sizes ranging from 27 to 833 (mean 161.6, SD 193.9, median 93) participants. The study populations' mean age ranged from 10.6 to 61.5 (mean 39.6, SD 6.5) years, and the proportion of males included across all studies was 42.8% (1521/3555). Additionally, intervention lengths varied from 2 weeks to 6 months (mean 60.9, SD 34.9 days). The primary app- or device-based physical activity outcome differed among interventions: most interventions (17/22, 77%) used activity monitors or fitness trackers, whereas the rest (5/22, 23%) used app-based accelerometry measures. Data reporting across the RE-AIM framework was low (5.64/31, 18%) and varied within specific dimensions (Reach=44%; Effectiveness=52%; Adoption=3%; Implementation=10%; Maintenance=12.4%). PRECIS-2 results indicated that most study designs (14/22, 63%) were equally explanatory and pragmatic, with an overall PRECIS-2 score across all interventions of 2.93/5 (SD 0.54). The most pragmatic dimension was flexibility (adherence), with an average score of 3.73 (SD 0.92), whereas follow-up, organization, and flexibility (delivery) appeared more explanatory with means of 2.18 (SD 0.75), 2.36 (SD 1.07), and 2.41 (SD 0.72), respectively. An overall positive treatment effect was observed (Cohen d=0.29, 95% CI 0.13-0.46). Meta-regression analyses revealed that more pragmatic studies (-0.81, 95% CI -1.36 to -0.25) were associated with smaller increases in physical activity. Treatment effect sizes were homogenous across study duration, participants' age and gender, and RE-AIM scores. CONCLUSIONS App-based mHealth physical activity studies continue to underreport several key study characteristics and have limited pragmatic use and generalizability. In addition, more pragmatic interventions observe smaller treatment effects, whereas study duration appears to be unrelated to the effect size. Future app-based studies should more comprehensively report real-world applicability, and more pragmatic approaches are needed for maximal population health impacts. TRIAL REGISTRATION PROSPERO CRD42020169102; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=169102.
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Affiliation(s)
- Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Bjorn Pfisterer
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Dana Epstein
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | | | - Kathrin Wunsch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
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Fuente-Vidal A, Guerra-Balic M, Roda-Noguera O, Jerez-Roig J, Montane J. Adherence to eHealth-Delivered Exercise in Adults with no Specific Health Conditions: A Scoping Review on a Conceptual Challenge. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10214. [PMID: 36011856 PMCID: PMC9408657 DOI: 10.3390/ijerph191610214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Adherence has emerged as a focal point and critical determinant of success for physical activity interventions. The term is used for both traditional and digital interventions, and for prescribed and nonprescribed activities. Many other terms for adherence are being used interchangeably, as there is no consensus on its precise conceptualization. This scoping review aimed to advance the definition of adherence to eHealth programs, specifically for the adult population with no specific health conditions. A total of 2983 papers, published between 1 January 2016 and 13 March 2022, were retrieved from different databases (including grey literature). Of those, 13 studies met the eligibility criteria and were included for review. The selected studies used a wide array of technologies and consisted mainly of exercise interventions. Most of the reviewed publications contemplated exercise adherence as a percentage of expected dose. Most (8 out of 13) studies neither assessed nor specified an expected use of the involved technology. Results suggest a need for homogeneity in the conceptualization of adherence to physical activity and exercise, including those interventions delivered digitally.
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Affiliation(s)
- Andrea Fuente-Vidal
- Research Group on Health, Physical Activity and Sport (SAFE), Blanquerna School of Psychology, Education and Sport Sciences, Universitat Ramon Llull, 08022 Barcelona, Spain
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Myriam Guerra-Balic
- Research Group on Health, Physical Activity and Sport (SAFE), Blanquerna School of Psychology, Education and Sport Sciences, Universitat Ramon Llull, 08022 Barcelona, Spain
| | | | - Javier Jerez-Roig
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Joel Montane
- Research Group on Health, Physical Activity and Sport (SAFE), Blanquerna School of Psychology, Education and Sport Sciences, Universitat Ramon Llull, 08022 Barcelona, Spain
- Blanquerna School of Health Science, Universitat Ramon Llull, 08025 Barcelona, Spain
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Kettle VE, Madigan CD, Coombe A, Graham H, Thomas JJC, Chalkley AE, Daley AJ. Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings: systematic review and meta-analysis of randomised controlled trials. BMJ 2022; 376:e068465. [PMID: 35197242 PMCID: PMC8864760 DOI: 10.1136/bmj-2021-068465] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine the effectiveness of physical activity interventions delivered or prompted by primary care health professionals for increasing moderate to vigorous intensity physical activity (MVPA) in adult patients. DESIGN Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES Databases (Medline and Medline in progress, Embase, PsycINFO, CINAHL, SPORTDiscus, Sports Medicine and Education Index, ASSIA, PEDro, Bibliomap, Science Citation Index, Conference Proceedings Citation Index), trial registries (Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, TRoPHI), and grey literature (OpenGrey) sources were searched (from inception to September 2020). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials of aerobic based physical activity interventions delivered or prompted by health professionals in primary care with a usual care control group or another control group that did not involve physical activity. STUDY SELECTION AND ANALYSIS Two independent reviewers screened the search results, extracted data from eligible trials and assessed the risk of bias using the Cochrane risk of bias tool (version 2). Inverse variance meta-analyses using random effects models examined the primary outcome of difference between the groups in MVPA (min/week) from baseline to final follow-up. The odds of meeting the guidelines for MVPA at follow-up were also analysed. RESULTS 14 566 unique reports were identified and 46 randomised controlled trials with a range of follow-ups (3-60 months) were included in the meta-analysis (n=16 198 participants). Physical activity interventions delivered or prompted by health professionals in primary care increased MVPA by 14 min/week (95% confidence interval 4.2 to 24.6, P=0.006). Heterogeneity was substantial (I2=91%, P<0.001). Limiting analyses to trials that used a device to measure physical activity showed no significant group difference in MVPA (mean difference 4.1 min/week, 95% confidence interval -1.7 to 9.9, P=0.17; I2=56%, P=0.008). Trials that used self-report measures showed that intervention participants achieved 24 min/week more MVPA than controls (95% confidence interval 6.3 to 41.8, P=0.008; I2=72%, P<0.001). Additionally, interventions increased the odds of patients meeting guidelines for MVPA by 33% (95% confidence interval 1.17 to 1.50, P<0.001; I2=25%, P=0.11) versus controls. 14 of 46 studies were at high risk of bias but sensitivity analyses excluding these studies did not alter the results. CONCLUSIONS Physical activity interventions delivered or prompted by health professionals in primary care appear effective at increasing participation in self-reported MVPA. Such interventions should be considered for routine implementation to increase levels of physical activity and improve health outcomes in the population. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021209484.
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Affiliation(s)
- Victoria E Kettle
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Claire D Madigan
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - April Coombe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Henrietta Graham
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Jonah J C Thomas
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Anna E Chalkley
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Amanda J Daley
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Negreiros A, Maciel RBT, Carvalho de Barros B, Padula RS. Quality assessment of smartphone fitness apps used to increase physical activity level and improve general health in adults: A systematic review. Digit Health 2022; 8:20552076221138305. [DOI: 10.1177/20552076221138305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Alexandher Negreiros
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- DepartmentofPhysicalTherapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Roberto B T Maciel
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Departmentof Life Sciences, Universidade do Estado da Bahia, Salvador, Brazil
| | | | - Rosimeire Simprini Padula
- Master and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- DepartmentofPhysicalTherapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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Benajiba N, Dodge E, Khaled MB, Chavarria EA, Sammartino CJ, Aboul-Enein BH. Technology-based nutrition interventions using the Mediterranean diet: a systematic review. Nutr Rev 2021; 80:1419-1433. [PMID: 34664675 DOI: 10.1093/nutrit/nuab076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
CONTEXT Over the past 2 decades, overweight and obesity rates have increased exponentially, along with related comorbidities including type 2 diabetes, hypertension, cardiovascular disease, and some cancers. The Mediterranean Diet (MDiet) has been suggested as a potential way to mitigate the health burdens related to overweight and obesity. OBJECTIVE For this review, the literature on MDiet-focused digital interventions was examined to determine efficacy, best practices, and potential limitations. DATA SOURCES The search was conducted across 15 databases for relevant publications published through April 2020 in English, French, Spanish, Arabic, or Italian. DATA EXTRACTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using a combination of keywords and phrases and evaluated independently for relevance, merit, and inclusion and exclusion criteria. DATA ANALYSIS The systematic literature review resulted in 15 articles that met the search criteria. Ten interventions were delivered online, and 5 were delivered via smartphone using an app. The majority of online MDiet-focused interventions were effective, particularly when modeled after evidence-based and best-practice online nutrition education interventions. Such interventions also are effective for promoting positive health behaviors and health outcomes, such as increased physical activity, increased levels of high-density lipoprotein cholesterol, and a lower total high-density lipoprotein cholesterol ratio. CONCLUSION Technology-based interventions to educate and promote adherence to the MDiet are successful in helping individuals achieve the stated outcomes. More research is needed to determine the efficacy of MDiet interventions delivered via smartphone apps.
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Affiliation(s)
- Nada Benajiba
- Nada Benajiba is with the Department of Health Basic Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. Elizabeth Dodge is with the College of Graduate & Professional Studies, University of New England, Portland, Maine, USA. Meghit Boumédiène Khaled is with the Faculty of Life and Natural Science, Department of Biology, Laboratory of Nutrition, Pathology, Biotechnology and Health, Djillali Liabes University of Sidi-Bel-Abbes, Sidi-Bel-Abbes, Algeria. Enmanuel A. Chavarria is with the Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA. Cara J. Sammartino is with the College of Health & Wellness, Department of Health Science, Johnson & Wales University, Providence, Rhode Island, USA. Basil H. Aboul-Enein is with the Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth Dodge
- Nada Benajiba is with the Department of Health Basic Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. Elizabeth Dodge is with the College of Graduate & Professional Studies, University of New England, Portland, Maine, USA. Meghit Boumédiène Khaled is with the Faculty of Life and Natural Science, Department of Biology, Laboratory of Nutrition, Pathology, Biotechnology and Health, Djillali Liabes University of Sidi-Bel-Abbes, Sidi-Bel-Abbes, Algeria. Enmanuel A. Chavarria is with the Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA. Cara J. Sammartino is with the College of Health & Wellness, Department of Health Science, Johnson & Wales University, Providence, Rhode Island, USA. Basil H. Aboul-Enein is with the Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Meghit Boumédiène Khaled
- Nada Benajiba is with the Department of Health Basic Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. Elizabeth Dodge is with the College of Graduate & Professional Studies, University of New England, Portland, Maine, USA. Meghit Boumédiène Khaled is with the Faculty of Life and Natural Science, Department of Biology, Laboratory of Nutrition, Pathology, Biotechnology and Health, Djillali Liabes University of Sidi-Bel-Abbes, Sidi-Bel-Abbes, Algeria. Enmanuel A. Chavarria is with the Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA. Cara J. Sammartino is with the College of Health & Wellness, Department of Health Science, Johnson & Wales University, Providence, Rhode Island, USA. Basil H. Aboul-Enein is with the Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Enmanuel A Chavarria
- Nada Benajiba is with the Department of Health Basic Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. Elizabeth Dodge is with the College of Graduate & Professional Studies, University of New England, Portland, Maine, USA. Meghit Boumédiène Khaled is with the Faculty of Life and Natural Science, Department of Biology, Laboratory of Nutrition, Pathology, Biotechnology and Health, Djillali Liabes University of Sidi-Bel-Abbes, Sidi-Bel-Abbes, Algeria. Enmanuel A. Chavarria is with the Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA. Cara J. Sammartino is with the College of Health & Wellness, Department of Health Science, Johnson & Wales University, Providence, Rhode Island, USA. Basil H. Aboul-Enein is with the Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Cara J Sammartino
- Nada Benajiba is with the Department of Health Basic Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. Elizabeth Dodge is with the College of Graduate & Professional Studies, University of New England, Portland, Maine, USA. Meghit Boumédiène Khaled is with the Faculty of Life and Natural Science, Department of Biology, Laboratory of Nutrition, Pathology, Biotechnology and Health, Djillali Liabes University of Sidi-Bel-Abbes, Sidi-Bel-Abbes, Algeria. Enmanuel A. Chavarria is with the Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA. Cara J. Sammartino is with the College of Health & Wellness, Department of Health Science, Johnson & Wales University, Providence, Rhode Island, USA. Basil H. Aboul-Enein is with the Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Basil H Aboul-Enein
- Nada Benajiba is with the Department of Health Basic Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. Elizabeth Dodge is with the College of Graduate & Professional Studies, University of New England, Portland, Maine, USA. Meghit Boumédiène Khaled is with the Faculty of Life and Natural Science, Department of Biology, Laboratory of Nutrition, Pathology, Biotechnology and Health, Djillali Liabes University of Sidi-Bel-Abbes, Sidi-Bel-Abbes, Algeria. Enmanuel A. Chavarria is with the Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA. Cara J. Sammartino is with the College of Health & Wellness, Department of Health Science, Johnson & Wales University, Providence, Rhode Island, USA. Basil H. Aboul-Enein is with the Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Delaney T, Mclaughlin M, Hall A, Yoong SL, Brown A, O’Brien K, Dray J, Barnes C, Hollis J, Wyse R, Wiggers J, Sutherland R, Wolfenden L. Associations between Digital Health Intervention Engagement and Dietary Intake: A Systematic Review. Nutrients 2021; 13:nu13093281. [PMID: 34579158 PMCID: PMC8470016 DOI: 10.3390/nu13093281] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
There has been a proliferation of digital health interventions (DHIs) targeting dietary intake. Despite their potential, the effectiveness of DHIs are thought to be dependent, in part, on user engagement. However, the relationship between engagement and the effectiveness of dietary DHIs is not well understood. The aim of this review is to describe the association between DHI engagement and dietary intake. A systematic search of four electronic databases and grey literature for records published before December 2019 was conducted. Studies were eligible if they examined a quantitative association between objective measures of engagement with a DHI (subjective experience or usage) and measures of dietary intake in adults (aged ≥18 years). From 10,653 citations, seven studies were included. Five studies included usage measures of engagement and two examined subjective experiences. Narrative synthesis, using vote counting, found mixed evidence of an association with usage measures (5 of 12 associations indicated a positive relationship, 7 were inconclusive) and no evidence regarding an association with subjective experience (both studies were inconclusive). The findings provide early evidence supporting an association between measures of usage and dietary intake; however, this was inconsistent. Further research examining the association between DHI engagement and dietary intake is warranted.
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Affiliation(s)
- Tessa Delaney
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
- Correspondence: ; Tel.: +612-49246-499
| | - Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Alison Brown
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kate O’Brien
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Julia Dray
- School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Courtney Barnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jenna Hollis
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
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Effectiveness of Smartphone-Based Physical Activity Interventions on Individuals' Health Outcomes: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6296896. [PMID: 34409104 PMCID: PMC8367594 DOI: 10.1155/2021/6296896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/01/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022]
Abstract
Design A systematic review. Data Sources. 114 studies were gathered using the following search descriptors: (“mobile phone” OR “smartphone” OR “cell phone” OR “mobile device” OR “mobile apps” OR “mHealth”) AND (“exercise” OR “physical activity” OR “physical fitness” OR “motor activity”) AND (“physiological outcomes” OR “weight outcomes” OR “psychological outcomes” OR “health” OR “health behavior”). Seven databases were used including databases such as Academic Search Premier and PubMed. PRISMA guidelines were followed in this review. Eligibility Criteria for Selecting Studies. The 20 articles included in this review met the following inclusion criteria: (1) randomized and controlled trials, (2) involving an outcome variable measured by accelerometer, and (3) intervention enforced by a smartphone application. Results Overall, 56% of the studies reviewed in this paper resulted in successful interventions. Of the 19 articles that examined the first individual health outcome of physical and physiological outcomes, 11 interventions resulted in a positive effect on one of the following parameters: MVPA/step count, sedentary behavior, cardiorespiratory fitness, and blood pressure. Six interventions examined the effects on the second individual health outcome, weight-related outcomes. Five of these interventions observed significant positive effects from mobile application interventions on weight and waist circumference. Six articles evaluated the effectiveness of smartphone-based physical activity interventions on the third and final individual health outcome, psychological outcomes, with four resulting in significant positive outcomes in self-efficacy, life enjoyment/satisfaction, and intrinsic PA motivation. Conclusion The findings in this review suggest that mobile application physical activity interventions, compared to unguided exercise activities, can effectively improve certain health outcomes for individuals such as physical/physiological and weight-related outcomes. It was found that research in the area of effectiveness of mobile application interventions on specific psychosocial health outcomes such as self-efficacy, life enjoyment, and intrinsic PA motivation is limited. Thus, the effect of mobile health applications remains unclear for psychosocial outcomes. Due to this limitation, more research is warranted to confirm the findings of this review.
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Goncalves MD, Maddocks OD. Engineered diets to improve cancer outcomes. Curr Opin Biotechnol 2021; 70:29-35. [PMID: 33232844 PMCID: PMC8702371 DOI: 10.1016/j.copbio.2020.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/22/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
Cancer cells acquire a diverse range of metabolic adaptations that support their enhanced rates of growth and proliferation. While these adaptations help tune metabolism to support higher anabolic output and bolster antioxidant defenses, they can also decrease metabolic flexibility and increase dependence on nutrient uptake versus de novo synthesis. Diet is the major source of nutrients that ultimately support tumor growth, yet the potential impact of diet is currently underutilized during the treatment of cancer. Here, we review several forms of dietary augmentation therapy including those that alter the content of food, such as energy or macronutrient restriction, and those that alter the timing of food consumption, like intermittent fasting regimens. We discuss how these dietary strategies can be combined with pharmacologic therapies to exaggerate the metabolic liabilities of different cancer types.
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Affiliation(s)
- Marcus D Goncalves
- Division of Endocrinology, Weill Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA; Meyer Cancer Center, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Oliver Dk Maddocks
- Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, UK
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Gómez Marcos MA, Ortiz LG. Response to: Reporting the results of a clinical trial across multiple papers, does it matter? Eur J Cardiovasc Nurs 2021; 20:620-621. [PMID: 34263325 DOI: 10.1093/eurjcn/zvab051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Manuel A Gómez Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL). Health Service of Castilla y León (SACyL), Salamanca, Spain.,Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Luis García Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL). Health Service of Castilla y León (SACyL), Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
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15
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Gray R, Mackay B, Waters A, Brown E. Reporting the results of a clinical trial across multiple papers, does it matter? Eur J Cardiovasc Nurs 2021; 20:618-619. [PMID: 34263324 DOI: 10.1093/eurjcn/zvaa010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | | | - Amanda Waters
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Ellie Brown
- Orygen, The University of Melbourne, Melbourne, Australia
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Ding EY, Pathiravasan CH, Schramm E, Borrelli B, Liu C, Trinquart L, Kornej J, Benjamin EJ, Murabito JM, McManus DD. Design, deployment, and usability of a mobile system for cardiovascular health monitoring within the electronic Framingham Heart Study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 2:171-178. [PMID: 35265906 PMCID: PMC8890046 DOI: 10.1016/j.cvdhj.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background The electronic Framingham Heart Study (eFHS) is an ongoing nested study, which includes FHS study participants, examining associations between health data from mobile devices with cardiovascular risk factors and disease. Objective To describe application (app) design, report user characteristics, and describe usability and survey response rates. Methods Eligible FHS participants were consented and offered a smartwatch (Apple Watch), a digital blood pressure (BP) cuff, and the eFHS smartphone app for administering surveys remotely. We assessed usability of the new app using 2 domains (functionality, aesthetics) of the Mobile App Rating Scale (MARS) and assessed survey completion rates at baseline and 3 months. Results A total of 196 participants were recruited using the enhanced eFHS app. Of these, 97 (49.5%) completed the MARS instrument. Average age of participants was 53 ± 9 years, 51.5% were women, and 93.8% were white. Eighty-six percent of participants completed at least 1 measure on the baseline survey, and 50% completed the 3-month assessment. Overall subjective score of the app was 4.2 ± 0.7 on a scale from 1 to 5 stars. Of those who shared their health data with others, 46% shared their BP and 7.7% shared their physical activity with a health care provider. Conclusion Participants rated the new, enhanced eFHS app positively overall. Mobile app survey completion rates were high, consistent with positive in-app ratings from participants. These mobile data collection modalities offer clinicians new opportunities to engage in conversations about health behaviors.
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Affiliation(s)
- Eric Y. Ding
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
- Address reprint requests and correspondence: Mr Eric Ding, Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA 01655.
| | | | | | - Belinda Borrelli
- Department of Health Policy & Health Services Research, Boston University School of Dental Medicine, Boston, Massachusetts
| | - Chunyu Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Jelena Kornej
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Emelia J. Benjamin
- Boston University and National Heart, Lung, and Blood Institute, Framingham Heart Study, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Joanne M. Murabito
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Boston University and National Heart, Lung, and Blood Institute, Framingham Heart Study, Boston, Massachusetts
| | - David D. McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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Nutrition and physical activity interventions for the general population with and without cardiometabolic risk: a scoping review. Public Health Nutr 2021; 24:4718-4736. [PMID: 34030758 DOI: 10.1017/s1368980021002184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this scoping review was to examine the research question: In the adults with or without cardiometabolic risk, what is the availability of literature examining interventions to improve or maintain nutrition and physical activity-related outcomes? Sub-topics included: (1) behaviour counseling or coaching from a dietitian/nutritionist or exercise practitioner, (2) mobile applications to improve nutrition and physical activity and (3) nutritional ergogenic aids. DESIGN The current study is a scoping review. A literature search of the Medline Complete, CINAHL Complete, Cochrane Database of Systematic Reviews and other databases was conducted to identify articles published in the English language from January 2005 until May 2020. Data were synthesised using bubble charts and heat maps. SETTING Out-patient, community and workplace. PARTICIPANTS Adults with or without cardiometabolic risk factors living in economically developed countries. RESULTS Searches resulted in 19 474 unique articles and 170 articles were included in this scoping review, including one guideline, thirty systematic reviews (SR), 134 randomised controlled trials and five non-randomised trials. Mobile applications (n 37) as well as ergogenic aids (n 87) have been addressed in several recent studies, including SR. While primary research has examined the effect of individual-level nutrition and physical activity counseling or coaching from a dietitian/nutritionist and/or exercise practitioner (n 48), interventions provided by these practitioners have not been recently synthesised in SR. CONCLUSION SR of behaviour counseling or coaching provided by a dietitian/nutritionist and/or exercise practitioner are needed and can inform practice for practitioners working with individuals who are healthy or have cardiometabolic risk.
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Shah LM, Ding J, Spaulding EM, Yang WE, Lee MA, Demo R, Marvel FA, Martin SS. Sociodemographic Characteristics Predicting Digital Health Intervention Use After Acute Myocardial Infarction. J Cardiovasc Transl Res 2021; 14:951-961. [PMID: 33999374 PMCID: PMC8127845 DOI: 10.1007/s12265-021-10098-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
Increasing evidence suggests that digital health interventions (DHIs) are an effective tool to reduce hospital readmissions by improving adherence to guideline-directed therapy. We investigated whether sociodemographic characteristics influence use of a DHI targeting 30-day readmission reduction after acute myocardial infarction (AMI). Covariates included age, sex, race, native versus loaner iPhone, access to a Bluetooth-enabled blood pressure monitor, and disease severity as marked by treatment with CABG. Age, sex, and race were not significantly associated with DHI use before or after covariate adjustment (fully adjusted OR 0.98 (95%CI: 0.95-1.01), 0.6 (95%CI: 0.29-1.25), and 1.22 (95% CI: 0.60-2.48), respectively). Being married was associated with high DHI use (OR 2.12; 95% CI 1.02-4.39). Our findings suggest that DHIs may have a role in achieving equity in cardiovascular health given similar use by age, sex, and race. The presence of a spouse, perhaps a proxy for enhanced caregiver support, may encourage DHI use.
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Affiliation(s)
- Lochan M Shah
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jie Ding
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin M Spaulding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH), an AHA SFRN Center for Health Technology and Innovation, Baltimore, MD, USA
| | - William E Yang
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthias A Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Ryan Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Francoise A Marvel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Seth S Martin
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Johns Hopkins Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH), an AHA SFRN Center for Health Technology and Innovation, Baltimore, MD, USA.
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA.
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19
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Wattanapisit A, Wattanapisit S, Tuangratananon T, Amaek W, Wongsiri S, Petchuay P. Primary Health Care Providers' Perspectives on Developing an eHealth Tool for Physical Activity Counselling: A Qualitative Study. J Multidiscip Healthc 2021; 14:321-333. [PMID: 33603391 PMCID: PMC7882433 DOI: 10.2147/jmdh.s298390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose Physical inactivity is a global health concern. Physical activity (PA) counselling is an effective intervention for promoting PA in primary health care (PHC) settings. The use of electronic health (eHealth) technology has the potential to support PA counselling. This study aimed to explore PHC providers’ perspectives on the development of an eHealth tool to aid PA counselling in the resource-limited settings. Methods This qualitative study employed interpretive phenomenology. The study was conducted at hospital-based PHC clinics among physicians and registered nurses. Data collection involved in-depth interviews (IDIs) and focus group discussions (FGDs). An inductive thematic approach was used to analyze the data. Results Three physicians participated in three IDIs and 12 nurses participated in four FGDs at three hospitals. The median age of the participants was 43 years. Participants saw 15–100 patients/day (median 40) and spent 2–20 min with each patient (median 5). Three themes emerged. Theme 1: requirements for PA counselling: the participants reflected the needs and characteristics of eHealth tool that may support PA counselling. Theme 2: enabling an eHealth tool for PA counselling: the eHealth should be easy to use, provide PA prescription function, and support follow-up PA counselling. Theme 3: reducing barriers to PA counselling: the eHealth tool was expected to help reduce service and workforce barriers and patients’ limitations. Conclusion A well-designed and practical eHealth tool has the potential to improve PA counselling practice in PHC settings. The eHealth tool may affect an indirect mechanism to reduce barriers to PA counselling. Future research should focus on the usability and utility as well as the process evaluation of the PA counselling eHealth tool that will be implemented in resource-limited settings.
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Affiliation(s)
- Apichai Wattanapisit
- Department of Clinical Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand.,Family Medicine Clinic, Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | | | | | - Waluka Amaek
- College of Graduate Studies, Walailak University, Nakhon Si Thammarat, Thailand
| | - Sunton Wongsiri
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Prachyapan Petchuay
- Department of Clinical Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
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20
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Spaulding EM, Marvel FA, Piasecki RJ, Martin SS, Allen JK. User Engagement With Smartphone Apps and Cardiovascular Disease Risk Factor Outcomes: Systematic Review. JMIR Cardio 2021; 5:e18834. [PMID: 33533730 PMCID: PMC8411427 DOI: 10.2196/18834] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 01/14/2023] Open
Abstract
Background The use of mobile health (mHealth) interventions, including smartphone apps, for the prevention of cardiovascular disease (CVD) has demonstrated mixed results for obesity, hypercholesterolemia, diabetes, and hypertension management. A major factor attributing to the variation in mHealth study results may be mHealth user engagement. Objective This systematic review aims to determine if user engagement with smartphone apps for the prevention and management of CVD is associated with improved CVD health behavior change and risk factor outcomes. Methods We conducted a comprehensive search of PubMed, CINAHL, and Embase databases from 2007 to 2020. Studies were eligible if they assessed whether user engagement with a smartphone app used by an individual to manage his or her CVD risk factors was associated with the CVD health behavior change or risk factor outcomes. For eligible studies, data were extracted on study and sample characteristics, intervention description, app user engagement measures, and the relationship between app user engagement and the CVD risk factor outcomes. App user engagement was operationalized as general usage (eg, number of log-ins or usage days per week) or self-monitoring within the app (eg, total number of entries made in the app). The quality of the studies was assessed. Results Of the 24 included studies, 17 used a randomized controlled trial design, 4 used a retrospective analysis, and 3 used a single-arm pre- and posttest design. Sample sizes ranged from 55 to 324,649 adults, with 19 studies recruiting participants from a community setting. Most of the studies assessed weight loss interventions, with 6 addressing additional CVD risk factors, including diabetes, sleep, stress, and alcohol consumption. Most of the studies that assessed the relationship between user engagement and reduction in weight (9/13, 69%), BMI (3/4, 75%), body fat percentage (1/2, 50%), waist circumference (2/3, 67%), and hemoglobin A1c (3/5, 60%) found statistically significant results, indicating that greater app user engagement was associated with better outcomes. Of 5 studies, 3 (60%) found a statistically significant relationship between higher user engagement and an increase in objectively measured physical activity. The studies assessing the relationship between user engagement and dietary and diabetes self-care behaviors, blood pressure, and lipid panel components did not find statistically significant results. Conclusions Increased app user engagement for prevention and management of CVD may be associated with improved weight and BMI; however, only a few studies assessed other outcomes, limiting the evidence beyond this. Additional studies are needed to assess user engagement with smartphone apps targeting other important CVD risk factors, including dietary behaviors, hypercholesterolemia, diabetes, and hypertension. Further research is needed to assess mHealth user engagement in both inpatient and outpatient settings to determine the effect of integrating mHealth interventions into the existing clinical workflow and on CVD outcomes.
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Affiliation(s)
- Erin M Spaulding
- Johns Hopkins University School of Nursing, Baltimore, MD, United States.,The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Francoise A Marvel
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rebecca J Piasecki
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
| | - Seth S Martin
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.,Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Johns Hopkins University Whiting School of Engineering, Baltimore, MD, United States.,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jerilyn K Allen
- Johns Hopkins University School of Nursing, Baltimore, MD, United States.,Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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21
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Wattanapisit A, Tuangratananon T, Wattanapisit S. Usability and utility of eHealth for physical activity counselling in primary health care: a scoping review. BMC FAMILY PRACTICE 2020; 21:229. [PMID: 33158430 PMCID: PMC7648312 DOI: 10.1186/s12875-020-01304-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/29/2020] [Indexed: 02/09/2023]
Abstract
Background Physical activity (PA) counselling is an effective approach to promote PA in primary health care (PHC). Barriers to PA counselling in PHC include time constraints, lack of knowledge and skills of providers, and systemic barriers. Using electronic health (eHealth) has the potential to promote PA. This scoping review aimed to identify usability and utility of eHealth for tailored PA counselling introduced in PHC settings. Methods A scoping review included primary research articles. The authors systematically searched six databases (Cochrane Library, CINAHL Complete, Embase, PubMed, Scopus and Web of Science) from the inception of the databases. The search terms consisted of three search components: intervention (PA counselling), platform (eHealth), and setting (PHC). Additional articles were included through reference lists. The inclusion criteria were research or original articles with any study designs in adult participants. Results Of 2501 articles after duplicate removal, 2471 articles were excluded based on the title and abstract screening and full text review. A total of 30 articles were included for synthesis. The eHealth tools had a wide range of counselling domains as a stand-alone PA domain and multiple health behaviours. The included articles presented mixed findings of usability and utility of eHealth for PA counselling among patients and providers in PHC settings. Technical problems and the complexity of the programmes were highlighted as barriers to usability. The majority of articles reported effective utility, however, several articles stated unfavourable outcomes. Conclusions eHealth has the potential to support PA counselling in PHC. Facilitators and barriers to eHealth usability should be considered and adapted to particular settings and contexts. The utility of eHealth for promoting PA among patients should be based on the pragmatic basis to optimise resources. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01304-9.
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Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, Thailand. .,Walailak University Hospital, Thasala, Nakhon Si Thammarat, Thailand.
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22
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Chaudhry UAR, Wahlich C, Fortescue R, Cook DG, Knightly R, Harris T. The effects of step-count monitoring interventions on physical activity: systematic review and meta-analysis of community-based randomised controlled trials in adults. Int J Behav Nutr Phys Act 2020; 17:129. [PMID: 33036635 PMCID: PMC7545847 DOI: 10.1186/s12966-020-01020-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background Step-count monitors (pedometers, body-worn trackers and smartphone applications) can increase walking, helping to tackle physical inactivity. We aimed to assess the effect of step-count monitors on physical activity (PA) in randomised controlled trials (RCTs) amongst community-dwelling adults; including longer-term effects, differences between step-count monitors, and between intervention components. Methods Systematic literature searches in seven databases identified RCTs in healthy adults, or those at risk of disease, published between January 2000–April 2020. Two reviewers independently selected studies, extracted data and assessed risk of bias. Outcome was mean differences (MD) with 95% confidence intervals (CI) in steps at follow-up between treatment and control groups. Our preferred outcome measure was from studies with follow-up steps adjusted for baseline steps (change studies); but we also included studies reporting follow-up differences only (end-point studies). Multivariate-meta-analysis used random-effect estimates at different time-points for change studies only. Meta-regression compared effects of different step-count monitors and intervention components amongst all studies at ≤4 months. Results Of 12,491 records identified, 70 RCTs (at generally low risk of bias) were included, with 57 trials (16,355 participants) included in meta-analyses: 32 provided change from baseline data; 25 provided end-point only. Multivariate meta-analysis of the 32 change studies demonstrated step-counts favoured intervention groups: MD of 1126 steps/day 95%CI [787, 1466] at ≤4 months, 1050 steps/day [602, 1498] at 6 months, 464 steps/day [301, 626] at 1 year, 121 steps/day [− 64, 306] at 2 years and 434 steps/day [191, 676] at 3–4 years. Meta-regression of the 57 trials at ≤4 months demonstrated in mutually-adjusted analyses that: end-point were similar to change studies (+ 257 steps/day [− 417, 931]); body-worn trackers/smartphone applications were less effective than pedometers (− 834 steps/day [− 1542, − 126]); and interventions providing additional counselling/incentives were not better than those without (− 812 steps/day [− 1503, − 122]). Conclusions Step-count monitoring leads to short and long-term step-count increases, with no evidence that either body-worn trackers/smartphone applications, or additional counselling/incentives offer further benefit over simpler pedometer-based interventions. Simple step-count monitoring interventions should be prioritised to address the public health physical inactivity challenge. Systematic review registration PROSPERO number CRD42017075810.
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Affiliation(s)
- Umar A R Chaudhry
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Charlotte Wahlich
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Rebecca Fortescue
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Rachel Knightly
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Tess Harris
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
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23
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Milne-Ives M, Lam C, De Cock C, Van Velthoven MH, Meinert E. Mobile Apps for Health Behavior Change in Physical Activity, Diet, Drug and Alcohol Use, and Mental Health: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e17046. [PMID: 32186518 PMCID: PMC7113799 DOI: 10.2196/17046] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/03/2019] [Accepted: 01/26/2020] [Indexed: 01/16/2023] Open
Abstract
Background With a growing focus on patient interaction with health management, mobile apps are increasingly used to deliver behavioral health interventions. The large variation in these mobile health apps—their target patient group, health behavior, and behavioral change strategies—has resulted in a large but incohesive body of literature. Objective This systematic review aimed to assess the effectiveness of mobile apps in improving health behaviors and outcomes and to examine the inclusion and effectiveness of behavior change techniques (BCTs) in mobile health apps. Methods PubMed, EMBASE, CINAHL, and Web of Science were systematically searched for articles published between 2014 and 2019 that evaluated mobile apps for health behavior change. Two authors independently screened and selected studies according to the eligibility criteria. Data were extracted and the risk of bias was assessed by one reviewer and validated by a second reviewer. Results A total of 52 randomized controlled trials met the inclusion criteria and were included in the analysis—37 studies focused on physical activity, diet, or a combination of both, 11 on drug and alcohol use, and 4 on mental health. Participant perceptions were generally positive—only one app was rated as less helpful and satisfactory than the control—and the studies that measured engagement and usability found relatively high study completion rates (mean 83%; n=18, N=39) and ease-of-use ratings (3 significantly better than control, 9/15 rated >70%). However, there was little evidence of changed behavior or health outcomes. Conclusions There was no strong evidence in support of the effectiveness of mobile apps in improving health behaviors or outcomes because few studies found significant differences between the app and control groups. Further research is needed to identify the BCTs that are most effective at promoting behavior change. Improved reporting is necessary to accurately evaluate the mobile health app effectiveness and risk of bias.
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Affiliation(s)
- Madison Milne-Ives
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Ching Lam
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Caroline De Cock
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Michelle Helena Van Velthoven
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Edward Meinert
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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24
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Yang X, Ma L, Zhao X, Kankanhalli A. Factors influencing user's adherence to physical activity applications: A scoping literature review and future directions. Int J Med Inform 2019; 134:104039. [PMID: 31865054 DOI: 10.1016/j.ijmedinf.2019.104039] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/12/2019] [Accepted: 11/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although mobile app-delivered physical activity (PA) interventions have the potential to promote exercise, poor adherence to these apps is a common issue impeding their effectiveness. Gaining insights into the factors that influence PA app adherence is an important priority for app developers and intervention designers. OBJECTIVE The objective of this study is to perform a literature review to synthesize the factors influencing PA app adherence and to identify directions for future research in this area. METHODS A scoping review of prior research was conducted to uncover the factors influencing PA app adherence. Seven online journal databases were searched for relevant articles published from January 1, 2014, to December 31, 2018. The initial search identified 5,572 articles. After a screening and eligibility check based on inclusion criteria, 24 articles were finally selected. The definition of PA app adherence in this review could be categorized along four dimensions derived from previous studies: i.e., frequency of PA app usage, intention/motivation to sustain use of the PA app, degree of function use within the PA app, and the duration of PA app usage. RESULTS Of the 24 included studies (both qualitative and quantitative), 12 studies were conducted in the U.S. The methods and study designs varied considerably, with the study durations ranging from 2 weeks to 24 months. The synthesized evidence indicates that 89 distinct factors influenced PA app adherence, and these could be classified into three categories: Personal Factors (n = 28), Technology Features (n = 53), and Contextual Factors (n = 8). Nine more detailed sub-categories were also compiled. Factors in sub-categories, such as psychological factors, health-related factors and predefined goals, are essential for physical activity behavior change experts to implement interventions. Factors in technology features, including PA tracking, PA goal setting and customization of exercise, are specifically useful for PA app developers or PA intervention designers. Overall, evidence of causal factors was limited. Only 5 of the 24 articles explored causal factors that affect PA app adherence. Furthermore, longitudinal studies with long durations were also limited. CONCLUSIONS Uncovering the factors influencing PA app adherence is critical as it can expand our current knowledge and provide guidance for app-delivered PA interventions, as well as the design of PA apps. This scoping review identified and categorized factors that influence PA app adherence in prior studies. Based on the evidence synthesized, users are paying more attention to the "playfulness" and personalized features of PA apps, in addition to basic functional requirements. Also, app glitches are the most common factors found to negatively influence app adherence. Several important directions for future research are highlighted in this review, especially the design of studies to explore causality.
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Affiliation(s)
- Xiaotian Yang
- School of Management, Xi'an Jiaotong University, Xi'an 710049, China.
| | - Lin Ma
- School of Management, Xi'an Jiaotong University, Xi'an 710049, China.
| | - Xi Zhao
- School of Management, Xi'an Jiaotong University, Xi'an 710049, China; The Key Lab of the Ministry of Education for process control & Efficiency Engineering, Xi'an 710049, China.
| | - Atreyi Kankanhalli
- Department of Information Systems and Analytics, National University of Singapore, Singapore.
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25
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Puigdomenech Puig E, Robles N, Saigí-Rubió F, Zamora A, Moharra M, Paluzie G, Balfegó M, Cuatrecasas Cambra G, Garcia-Lorda P, Carrion C. Assessment of the Efficacy, Safety, and Effectiveness of Weight Control and Obesity Management Mobile Health Interventions: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e12612. [PMID: 31654566 PMCID: PMC6913727 DOI: 10.2196/12612] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/29/2019] [Accepted: 08/19/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The use of apps to tackle overweight and obesity by tracking physical and dietary patterns and providing recommendations and motivation strategies to achieve personalized goals has increased over recent years. However, evidence of the efficacy, effectiveness, and safety of these apps is severely lacking. OBJECTIVE The aim of this study was to identify efficacy, safety, and effectiveness criteria used to assess weight control, overweight, and obesity management in mobile health (mHealth) interventions through a systematic review. METHODS PubMed, PsycINFO, Scopus, UK Trial Database, ClinicalTrials.gov, and the Cochrane Library were surveyed up to May 2018. All types of clinical studies were considered. A total of 2 independent reviewers assessed quality using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Ratings were used to provide an overall score for each study (low, moderate, or high). Data were synthesized in evidence tables. RESULTS From 233 potentially relevant publications, only 28 studies were included. Of these, 13 (46%) were randomized control trials, 11 were single-arm studies (39%), 3 were nonrandomized controlled trials (11%), and 1 study was a cluster randomized trial (4%). The studies were classified as low (15), high (7), and moderate (6) quality according to SIGN criteria. All studies focused on efficacy, with only 1 trial mentioning safety and another 1 effectiveness. In 11 studies, the apps were used as stand-alone interventions, the others were multicomponent studies that included other tools for support such as sensors or websites. The main management tool included in the apps was feedback messaging (24), followed by goal-setting mechanisms (20) and self-monitoring (19). The majority of studies took weight or body mass index loss as the main outcome (22) followed by changes in physical activity (14) and diet (12). Regarding outputs, usability, adherence, and engagement (17) were the most reported, followed by satisfaction (7) and acceptability (4). CONCLUSIONS There is a remarkable heterogeneity among these studies and the majority have methodological limitations that leave considerable room for improvement. Further research is required to identify all relevant criteria for assessing the efficacy of mHealth interventions in the management of overweight and obesity. TRIAL REGISTRATION PROSPERO CRD42017056761; https://tinyurl.com/y2zhxtjx.
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Affiliation(s)
- Elisa Puigdomenech Puig
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Barcelona, Spain.,eHealth Lab, Barcelona, Spain
| | - Noemí Robles
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Barcelona, Spain.,eHealth Lab, Barcelona, Spain.,eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Interdisciplinary Research Group on ICTs, Barcelona, Spain
| | - Alberto Zamora
- Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Blanes, Spain.,Grup de Medicina Traslacional i Ciències de la Decisió, Departament de Ciències Mèdiques, Facultat de Medicina, Universitat de Girona, Girona, Spain
| | - Montse Moharra
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Guillermo Paluzie
- Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Blanes, Spain
| | - Mariona Balfegó
- Clínica Sagrada Família, CPEN SL Servei d'Endocrinologia i Nutrició, Barcelona, Spain
| | | | - Pilar Garcia-Lorda
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Carme Carrion
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Barcelona, Spain.,eHealth Lab, Barcelona, Spain.,eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain.,Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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26
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Hosseinpour M, Terlutter R. Your Personal Motivator is with You: A Systematic Review of Mobile Phone Applications Aiming at Increasing Physical Activity. Sports Med 2019; 49:1425-1447. [PMID: 31144235 PMCID: PMC6684571 DOI: 10.1007/s40279-019-01128-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Literature shows mixed evidence about the power of mobile phone applications to foster physical activity. A systematic integration that offers insights into which mobile phone application techniques can or cannot foster physical activity is lacking, as is a theoretical integration of current research. OBJECTIVES We performed a systematic review guided by a theoretical framework focusing on effects that certain mobile phone application techniques have on physical activity, to improve our understanding of what techniques are more or less effective. METHODS We identified articles by searching EBSCO Business Source Complete, Science Direct, PsycINFO, Springer, PLoS ONE, Taylor and Francis, IEEE, Social Science Citation Index, Science Citation Index Expanded, PUBMED, MEDLINE, and Google Scholar. We considered articles if (1) they referred to the use of mobile phone applications to promote physical activity; (2) their methodological approach allowed one to derive appropriate results (e.g., intervention-based approach, observational study); (3) they were published in peer-reviewed journals or conference proceedings; and (4) they were written in English. The literature search resulted in 41 usable studies. Meta-synthesis and vote counting were applied to analyze these studies. RESULTS Based on the ratio of supportive versus non-supportive evidence in both the qualitative and the quantitative studies, we propose the following descending rank order for the effectiveness of application techniques to foster physical activity. This is tentative in nature because the current overall small body of literature made coming to definite conclusions difficult: (1) feedback, (2) goal setting and its sub-forms, (3) competition, social sharing with familiar users in both segregated and social network groups, and (4) social sharing with strangers in segregated groups, reward, and social sharing with strangers in social network groups. Rewards in particular provided mixed results, and social sharing with strangers in segregated and social network groups seemed rather ineffective but may work under special conditions that need to be identified in additional research. One limitation of our study was that our results are mostly derived from qualitative studies, since quantitative studies are underrepresented in the field. CONCLUSION Several mobile phone application techniques were identified that have the potential to foster physical activity, whereas others were identified that are unlikely to increase physical activity. Major avenues for future research include more theoretical development and more quantitative studies, among others.
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Affiliation(s)
- Masoumeh Hosseinpour
- Department of Marketing and International Management, Alpen-Adria-Universität, Klagenfurt, Universitätsstrasse 65-67, 9020 Klagenfurt, Austria
| | - Ralf Terlutter
- Department of Marketing and International Management, Alpen-Adria-Universität, Klagenfurt, Universitätsstrasse 65-67, 9020 Klagenfurt, Austria
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Fukuoka Y, Haskell W, Lin F, Vittinghoff E. Short- and Long-term Effects of a Mobile Phone App in Conjunction With Brief In-Person Counseling on Physical Activity Among Physically Inactive Women: The mPED Randomized Clinical Trial. JAMA Netw Open 2019; 2:e194281. [PMID: 31125101 PMCID: PMC6632135 DOI: 10.1001/jamanetworkopen.2019.4281] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
IMPORTANCE Mobile phone applications (apps) and activity trackers allow researchers to remotely deliver an intervention and monitor physical activity but have not been rigorously evaluated for longer periods. OBJECTIVE To determine whether a mobile phone-based physical activity education app, in conjunction with brief in-person counseling, increases and then maintains levels of physical activity. DESIGN, SETTING, AND PARTICIPANTS In this parallel randomized clinical trial, community-dwelling physically inactive women recruited between May 2011 and April 2014 were randomized in equal proportions into the control (n = 69), regular (n = 71), and plus (n = 70) groups. Data were analyzed using intention to treat from September 16, 2016, through June 30, 2018. INTERVENTIONS The regular and plus groups were instructed to use the app on their mobile phone and an accelerometer every day for 3 months and attend brief in-person counseling. During the 6-month maintenance period, the plus group continued to use the app and accelerometer, while the regular group stopped using the app but continued using the accelerometer. The control group used the accelerometer throughout. MAIN OUTCOMES AND MEASURES The primary and secondary outcomes were daily accelerometer-measured total steps and time spent in moderate to vigorous physical activity (MVPA). RESULTS The 210 participants had a mean (SD) age of 52.4 (11.0) years. At baseline, the mean (SD) daily total steps by accelerometer in the control, regular, and plus groups were 5384 (2920), 5063 (2526), and 5837 (3235), respectively. During the 3-month intervention period, daily steps and MVPA increased in the combined regular and plus groups compared with the control group (between-group differences, 2060 steps per day; 95% CI, 1296-2825 steps per day; P < .001 and 18.2 min/d MVPA; 95% CI, 10.9-25.4 min/d MVPA; P < .001). During the subsequent 6-month maintenance period, mean activity level remained higher in the combined plus and regular groups than among controls (between-group difference, 1360 steps per day; 95% CI, 694-2026 steps per day; P <. 001), but trends in total daily steps and MVPA were similar in the plus and regular groups. CONCLUSIONS AND RELEVANCE In this trial, the intervention groups substantially increased their physical activity. However, use of both the app and accelerometer for an additional 6 months after the initial 3-month intervention did not help to maintain increases in physical activity compared with continued use of the accelerometer alone. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01280812.
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Affiliation(s)
- Yoshimi Fukuoka
- Department of Physiological Nursing, Institute for Health & Aging, School of Nursing, University of California, San Francisco
| | - William Haskell
- Stanford Prevention Research Center, Stanford University, Palo Alto, California
| | - Feng Lin
- Department of Epidemiology & Biostatistics, University of California, San Francisco
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California, San Francisco
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Gonzalez-Sanchez J, Recio-Rodriguez JI, Fernandez-delRio A, Sanchez-Perez A, Magdalena-Belio JF, Gomez-Marcos MA, Garcia-Ortiz L. Using a smartphone app in changing cardiovascular risk factors: A randomized controlled trial (EVIDENT II study). Int J Med Inform 2019; 125:13-21. [DOI: 10.1016/j.ijmedinf.2019.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/11/2019] [Accepted: 02/11/2019] [Indexed: 01/01/2023]
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Feter N, Dos Santos TS, Caputo EL, da Silva MC. What is the role of smartphones on physical activity promotion? A systematic review and meta-analysis. Int J Public Health 2019; 64:679-690. [PMID: 30758514 DOI: 10.1007/s00038-019-01210-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify and evaluate the effect of interventions that used cell phones as a means to promote physical activity (PA). METHODS The databases searched were MedLine/PubMed, Scopus, SPORTDiscus, PsycINFO, Science Direct, Lilacs, and SciELO. After removing duplicates, applying exclusion criteria, and checking the reference lists, 45 studies were reviewed. The Downs and Black (D&B) scale measured methodological quality, and a random effect model was used to compute the meta-analysis of PA by the reported unit (minutes per day or steps per day), delivery agent (application (APP), SMS, or other), and PA measurement (questionnaire, accelerometer, pedometer). RESULTS Mobile phone-based PA interventions were efficient in increasing both minutes [10.49; CI (3.37-17.60); p = 0.004] and steps per day [735.17; CI (227.72-1242.61); p = 0.005] in adults when compared to baseline. Furthermore, APP-based interventions were able to increase the number of steps (p = 0.04) and minutes per day of PA (p = 0.04) in adults. Also, 85% of included manuscripts were classified as moderate- to high-quality articles. CONCLUSIONS Mobile phone-based PA interventions, inclusive those delivery by APP, were effective to increase minutes and steps per day in adults.
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Affiliation(s)
- Natan Feter
- Federal University of Pelotas, Pelotas, Brazil.
| | | | - Eduardo Lucia Caputo
- Federal University of Pelotas, Pelotas, Brazil.,University of Sydney, Sydney, Australia
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Recio-Rodríguez JI, Lugones-Sanchez C, Agudo-Conde C, González-Sánchez J, Tamayo-Morales O, Gonzalez-Sanchez S, Fernandez-Alonso C, Maderuelo-Fernandez JA, Mora-Simon S, Gómez-Marcos MA, Rodriguez-Sanchez E, Garcia-Ortiz L. Combined use of smartphone and smartband technology in the improvement of lifestyles in the adult population over 65 years: study protocol for a randomized clinical trial (EVIDENT-Age study). BMC Geriatr 2019; 19:19. [PMID: 30674284 PMCID: PMC6343313 DOI: 10.1186/s12877-019-1037-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/16/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The increasing use of smartphones by older adults also increases their potential for improving different aspects of health in this population. Some studies have shown promising results in the improvement of cognitive performance through lifestyle modification. All this may have a broad impact on the quality of life and carrying out daily living activities. The objective of this study is to evaluate the effectiveness of combining the use of smartphone and smartband technology for 3 months with brief counseling on life habits, as opposed to providing counseling only, in increasing physical activity and improving adherence to the Mediterranean diet. Secondary objectives are to assess the effect of the intervention on body composition, quality of life, independence in daily living activities and cognitive performance. METHODS This study is a two-arm cluster-randomized trial that will be carried out in urban health centers in Spain. We will recruit 160 people aged between 65 and 80 without cardiovascular disease or cognitive impairment (score in the Mini-mental State Examination ≥24). On a visit to their center, intervention group participants will be instructed to use a smartphone application for a period of 3 months. This application integrates information on physical activity received from a fitness bracelet and self-reported information on the patient's daily nutritional composition. The primary outcome will be the change in the number of steps measured by accelerometer. Secondary variables will be adherence to the Mediterranean diet, sitting time, body composition, quality of life, independence in daily living activities and cognitive performance. All variables will be measured at baseline and on the assessment visit after 3 months. A telephone follow-up will be carried out at 6 months to collect self-reported data regarding physical activity and adherence to the Mediterranean diet. DISCUSSION Preventive healthy aging programs should include health education with training in nutrition and lifestyles, while stressing the importance of and enhancing physical activity; the inclusion of new technologies can facilitate these goals. The EVIDENT-AGE study will incorporate a simple, accessible intervention with potential implementation in the care of older adults. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03574480 . Date of trial Registration July 2, 2018.
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Affiliation(s)
- José I Recio-Rodríguez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain. .,Faculty of Health Sciences, University of Burgos, Burgos, Spain.
| | - Cristina Lugones-Sanchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain
| | - Cristina Agudo-Conde
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain
| | - Jesús González-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain.,Department of Nursing, University of Extremadura, Plasencia, Cáceres, Spain
| | - Olaya Tamayo-Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain
| | - Susana Gonzalez-Sanchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain
| | | | - Jose A Maderuelo-Fernandez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain
| | - Sara Mora-Simon
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain.,Department of Basic Psychology, Psychobiology and Behavioral Sciences Methodology, University of Salamanca, Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain.,Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Emiliano Rodriguez-Sanchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain
| | - Luis Garcia-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
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Katzman WB, Gladin A, Lane NE, Wong S, Liu F, Jin C, Fukuoka Y. Feasibility and Acceptability of Technology-Based Exercise and Posture Training in Older Adults With Age-Related Hyperkyphosis: Pre-Post Study. JMIR Aging 2019; 2:e12199. [PMID: 31363712 PMCID: PMC6664796 DOI: 10.2196/12199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Hyperkyphosis is common among older adults and is associated with multiple adverse health outcomes. Kyphosis-specific exercise and posture training programs improve hyperkyphosis, but in-person programs are expensive to implement and maintain over long periods. It is unclear if a technology-based posture training program disseminated through a mobile phone is a feasible or acceptable alternative to in-person training among older adults with hyperkyphosis. Objective The primary purpose was to assess the feasibility of subject recruitment, short-term retention and adherence, and acceptability of a technology-based exercise and posture training program disseminated as video clip links and text messaging prompts via a mobile phone. The secondary purpose was to explore the potential efficacy of this program for kyphosis, physical function, and health-related quality of life in older adults with hyperkyphosis. Methods In this 6-week pre-post design pilot trial, we recruited community-dwelling adults aged ≥65 years with hyperkyphosis ≥40° (±5°) and access to a mobile phone. The intervention had two parts: (1) exercise and posture training via video clips sent to participants daily via text messaging, including 6 weekly video clip links to be viewed on the participant’s mobile phone, and (2) text messaging prompts to practice good posture. We analyzed the subject recruitment, adherence, retention, and acceptability of the intervention. Outcomes included change in kyphometer-measured kyphosis, occiput-to-wall (OTW) distance, Short Physical Performance Battery score, Scoliosis Research Society (SRS-30) score, Center for Epidemiological Studies Depression score, and Physical Activity Scale for the Elderly (PASE) score. Results A total of 64 potential participants were recruited, 17 were enrolled, and 12 completed postintervention testing at 6 weeks. The average age was 71.6 (SD 4.9) years, and 50% were women. The median adherence to daily video viewing was 100% (range, 14%-100%) and to practicing good posture at least three times per day was 71% (range, 0%-100%). Qualitative evaluation of intervention acceptability revealed that the mobile phone screen was too small for participants to view the videos well and daily prompts to practice posture were too frequent. Kyphosis, OTW distance, and physical activity significantly improved after the 6-week intervention. Kyphosis decreased by 8° (95% CI –12 to –5; P<.001), OTW decreased by 1.9 cm (95% CI –3.3 to –0.7; P=.007), and physical activity measured by PASE increased by 29 points (95% CI 3 to 54; P=.03). The health-related quality of life SRS-30 score increased by 0.11 point (SD 0.19), but this increase was not statistically significant (P=.09). Conclusions Technology-based exercise and posture training using video clip viewing and text messaging reminders is feasible and acceptable for a small cohort of older adults with hyperkyphosis. Technology-based exercise and posture training warrants further study as a potential self-management program for age-related hyperkyphosis, which may be more easily disseminated than in-person training.
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Affiliation(s)
- Wendy B Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
| | - Amy Gladin
- Rehabilitation Services, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Nancy E Lane
- Department of Medicine, University of California, Davis CA, USA
| | - Shirley Wong
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
| | - Felix Liu
- Department of Biostatistics and Epidemiology, University of California, San Francisco, CA, USA
| | - Chengshi Jin
- Department of Biostatistics and Epidemiology, University of California, San Francisco, CA, USA
| | - Yoshimi Fukuoka
- Department of Physiological Nursing, School of Nursing/ Institute for Health & Aging, University of California, San Francisco CA, USA
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Combined use of a healthy lifestyle smartphone application and usual primary care counseling to improve arterial stiffness, blood pressure and wave reflections: a Randomized Controlled Trial (EVIDENT II Study). Hypertens Res 2018; 42:852-862. [DOI: 10.1038/s41440-018-0182-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/21/2018] [Accepted: 11/05/2018] [Indexed: 12/17/2022]
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