Effect of a Multicomponent mHealth Intervention on the Composition of Diet in a Population with Overweight and Obesity—Randomized Clinical Trial EVIDENT 3

A balanced diet can help in the prevention of chronic diseases. The aim of this study was to evaluate the effect of an mHealth intervention on the distribution of macronutrients and the intake of food groups. A total of 650 participants were included in this multi-center, clinical, randomized, controlled trial (Evident 3 study). All participants were given brief advice about diet and exercise. The intervention group received, in addition, an app (Evident 3) for the self-recording of their diet and an activity tracker wristband for 3 months. Follow-up visits were performed at 3 and 12 months to collect the diet composition using the Food Frequency Questionnaire. There were decreases in the intake of total calories, fat, protein and carbohydrates in both groups throughout the study, without significant differences between them. The intervention group reduced the intake of cholesterol (−30.8; 95% CI −59.9, −1.7) and full-fat dairies (−23.3; 95% CI −42.8, −3.8) and increased the intake of wholemeal bread (3.3; 95% CI −6.7, 13.3) and whole-grain cereals (3.4; 95% CI −6.8, 13.7) with respect to the control group. No differences were found in the rest of the nutritional parameters. The brief advice is useful to promote a healthier diet, and the app can be a support tool to obtain changes in relevant foods, such as integral foods, and the intake of cholesterol. Trial registration: ClinicalTrials.gov with identifier NCT03175614.

Associations of COVID-19 lockdown restrictions with longer-term activity levels of working adults with type 2 diabetes (Preprint)

BACKGROUND Lockdown restrictions reduce COVID-19 community transmission; however, they may pose challenges for non-communicable disease management. A 112-day hard lockdown in Victoria, Australia (commencing March 23, 2020), which affected an intervention trial of reducing and breaking up sitting time in desk workers with type 2 diabetes who were using a provided consumer grade activity tracker (Fitbit). OBJECTIVE To compare continuously recorded activity levels preceding and during COVID-19 lockdown restrictions among working adults with type 2 diabetes participating in a sitting less and moving more intervention. METHODS Eleven participants (8/11 male; mean [SD] age 52.8 [5.0] years) in Melbourne, Australia had Fitbit activity tracked before (mean [SD]: 122.7 [47.9] days) and during (99.7 [62.5] days) city-wide COVID-19 lockdown restrictions. Regression models compared device (Fitbit Inspire HR)-derived activity (steps; METs [metabolic equivalents], mean time in sedentary, lightly, fairly, and very active minutes, and usual bout durations) during restrictions, to pre-restriction. Relative rates (RR) <1.00 indicated a decline in activity levels following restrictions. RESULTS Total wear days were 2447. There was a decrease in steps (-1,584 steps; RR: 0.91; 95%CI: 0.89, 0.93), METs (-83 METs; RR: 0.95; 95%CI: 0.94, 0.95), lightly active (RR: 0.96; 95%CI: 0.92, 0.99), fairly active (RR: 0.82; 95%CI: 0.79, 0.85), very active (RR: 0.92; 95%CI: 0.89, 0.95) intensity minutes, and increases in sedentary minutes (RR: 1.03; 95%CI: 1.01, 1.06). Only very active (+5.1mins) and sedentary (+4.3mins) bout durations changed significantly. CONCLUSIONS In adults with type 2 diabetes, COVID-19 lockdown restrictions were associated with decreases in overall activity levels and increases in very active and sedentary bout durations. A Fitbit monitor provided meaningful continuous long term data in this context. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ANZCTRN12618001159246

Social Mobile Approaches to Reducing Weight (SMART) 2.0: protocol of a randomized controlled trial among young adults in university settings

Background Excess weight gain in young adulthood is associated with future weight gain and increased risk of chronic disease. Although multimodal, technology-based weight-loss interventions have the potential to promote weight loss among young adults, many interventions have limited personalization, and few have been deployed and evaluated for longer than a year. We aim to assess the effects of a highly personalized, 2-year intervention that uses popular mobile and social technologies to promote weight loss among young adults. Methods The Social Mobile Approaches to Reducing Weight (SMART) 2.0 Study is a 24-month parallel-group randomized controlled trial that will include 642 overweight or obese participants, aged 18–35 years, from universities and community colleges in San Diego, CA. All participants receive a wearable activity tracker, connected scale, and corresponding app. Participants randomized to one intervention group receive evidence-based information about weight loss and behavior change techniques via personalized daily text messaging (i.e., SMS/MMS), posts on social media platforms, and online groups. Participants in a second intervention group receive the aforementioned elements in addition to brief, technology-mediated health coaching. Participants in the control group receive a wearable activity tracker, connected scale, and corresponding app alone. The primary outcome is objectively measured weight in kilograms over 24 months. Secondary outcomes include anthropometric measurements; physiological measures; physical activity, diet, sleep, and psychosocial measures; and engagement with intervention modalities. Outcomes are assessed at baseline and 6, 12, 18, and 24 months. Differences between the randomized groups will be analyzed using a mixed model of repeated measures and will be based on the intent-to-treat principle. Discussion We hypothesize that both SMART 2.0 intervention groups will significantly improve weight loss compared to the control group, and the group receiving health coaching will experience the greatest improvement. We further hypothesize that differences in secondary outcomes will favor the intervention groups. There is a critical need to advance understanding of the effectiveness of multimodal, technology-based weight-loss interventions that have the potential for long-term effects and widespread dissemination among young adults. Our findings should inform the implementation of low-cost and scalable interventions for weight loss and risk-reducing health behaviors. Trial registration ClinicalTrials.govNCT03907462. Registered on April 9, 2019

A Wearable Activity Tracker Intervention With and Without Weekly Behavioral Support Emails to Promote Physical Activity Among Women Who Are Overweight or Obese: Randomized Controlled Trial

Background Physical activity (PA) plays a fundamental role in combating the current obesity epidemic; however, most women who are overweight or obese are generally physically inactive. Wearable activity tracker interventions can help increase the PA levels in this population. Supplementing such interventions with behavioral support emails may further improve their effectiveness, but this remains to be confirmed. Objective This study aims to determine if adding behavioral support emails to a wearable activity tracker intervention can further increase PA levels among women who are overweight or obese in comparison to a wearable activity tracker–only intervention and a control condition. Methods Women with a BMI ≥25 kg/m2 who were not meeting the Canadian PA guidelines for aerobic and strength training were randomized into 1 of 3 groups. Group 1 received 6 weekly behavioral support emails, a wearable activity tracker, and a copy of the Canadian PA guidelines. Group 2 received a wearable activity tracker and a copy of the Canadian PA guidelines, and group 3 (control condition) received a copy of the Canadian PA guidelines. Self-reported data for walking and moderate to vigorous intensity PA were collected preintervention (week 0; prerandomization), postintervention (7 weeks postrandomization), and at follow-up (21 weeks postrandomization) and analyzed as metabolic equivalent of task minutes per week. In addition, potential mechanisms of behavior change (ie, basic psychological needs satisfaction and motivational regulations) were assessed for within- and between-group differences at all 3 time points. Data were analyzed using nonparametric statistical tests. Results A total of 49 women were recruited; data from 47 women (mean age 37.57 years, SD 11.78 years; mean BMI 31.69 kg/m2, SD 5.97 kg/m2) were available for analysis. Group 1 reported a significant increase in walking from preintervention to postintervention (χ22=7.5; P=.02) but not in moderate to vigorous intensity PA (P=.24). Group 1 also reported significant increases in perceptions of competence from preintervention to follow-up (χ22=7.6; P=.02) and relatedness from preintervention to follow-up (χ22=8.7; P=.005). Increases in perceived autonomy were observed for group 2 (χ22=7.0) and group 3 (χ22=10.6). There were no significant changes in the motivational regulations within the groups. The difference between the groups was not significant for any outcome variable. Conclusions The results suggest that adding behavioral support emails to a wearable activity tracker intervention may help to increase time spent walking and perceptions of competence and relatedness for PA among women who are overweight or obese. Trial Registration ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663

Active Women over 50. Promoting Physical Activity in Women Over 50: A Randomized Trial

Purpose This study aims to test the effect of an information and support intervention on physical activity (PA) in women aged 50+ years. Design Randomized wait-list controlled trial. Setting Sydney, Australia. Sample 126 female university and health service employees, aged 50+. Intervention Information session, activity tracker, regular motivational emails. Measures Proportion achieving ≥ 10,000 steps/day (primary outcome), daily step count, proportion meeting 150 mins/week of moderate to vigorous PA (MVPA), self-reported PA. Analysis Odds-ratios and general linear regression models. Results At 3 months, the intervention group reported significantly more vigorous PA (1.04 hours, 95% CI 0.24 to 1.85, P = .01, measured by IPAQ), were more likely to achieve 300 mins/week of MVPA (OR = 1.98, 95% CI 0.89 to 4.36, P = .09, measured by Actigraph) than the control wait-list group, and reported adopting PA promotion strategies (technology = 31/58% or goal-setting = 39/74%). No significant between-group differences in the primary outcome were detected (1.39, 95% CI 0.61 to 3.18, P = .44). Conclusions This low-dose intervention significantly increased self-reported vigorous PA time and non-significantly increased the proportion of people achieving 300 mins/week of MVPA but did not significantly increase the proportion of participants achieving 10,000 steps/day. Relatively small effects may be important at a population level given the minimal resources needed to deliver this intervention.

The Unquantifiable Self: An exploration into the relationship between users and their activity trackers

<p>Digital self-tracking generates ever increasing amounts of personal data on anything from mood and relationships to health and finance. This thesis aims to explore the relationship between the consumer and their personal data, it seeks to discover how self-tracking changes the user’s experience and understanding of the world and themselves. The background research firstly discusses the usefulness and availability of self-tracking data to the consumer in comparison to other stakeholders. Secondly, it explores the services and cultural systems that guide how self-tracking might be used as a tool for self-expression. Thirdly, it outlines the ways that quantification can change how an experience is perceived and the meaning that people find in analysing their data.Finally, it discusses the impact of potential surveillance on consumers. Interviews and analysis concluded that activity trackers help users make day to day decisions, that personal data is both meaningful and useful to the user and can act as a way to express or represent their experiences and that the act of using an activity tracker also changes and often enhances the experiences of the user. These ideas were then explored in a series of design works that both critiqued self-tracking and used it as a creative medium.</p>

The Unquantifiable Self: An exploration into the relationship between users and their activity trackers

<p>Digital self-tracking generates ever increasing amounts of personal data on anything from mood and relationships to health and finance. This thesis aims to explore the relationship between the consumer and their personal data, it seeks to discover how self-tracking changes the user’s experience and understanding of the world and themselves. The background research firstly discusses the usefulness and availability of self-tracking data to the consumer in comparison to other stakeholders. Secondly, it explores the services and cultural systems that guide how self-tracking might be used as a tool for self-expression. Thirdly, it outlines the ways that quantification can change how an experience is perceived and the meaning that people find in analysing their data.Finally, it discusses the impact of potential surveillance on consumers. Interviews and analysis concluded that activity trackers help users make day to day decisions, that personal data is both meaningful and useful to the user and can act as a way to express or represent their experiences and that the act of using an activity tracker also changes and often enhances the experiences of the user. These ideas were then explored in a series of design works that both critiqued self-tracking and used it as a creative medium.</p>

Home-Based Exercise Program for Patients With Combined Advanced Chronic Cardiac and Pulmonary Diseases: Exploratory Study

Background As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. Objective The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for patients with advanced cardiopulmonary disease. The secondary end points include patient satisfaction; adverse events; and program efficacy in terms of change in functional capacity, level of dyspnea, and health-related quality of life. Methods The participants received a goal-oriented, home-based exercise program, and they used a wrist-worn activity tracker to record their exercise sessions. Activity tracker data were made visible on a digital platform, which was also equipped with several other features such as short instruction videos on how to perform specific exercises. The participants received weekly coaching by a physiotherapist and an occupational therapist through video communication. Results In all, 10 patients with advanced combined cardiopulmonary disease participated (median age 71, IQR 63-75 years), and 50% (5/10) were men. Of the 10 participants, 9 (90%) completed the 8-week program. Median adherence to the exercise prescription was 75% (IQR 37%-88%), but it declined significantly when the program was divided into 2-week periods (first 2 weeks: 86%, IQR 51%-100%, and final 2 weeks: 57%, IQR 8%-75%; P=.03). The participants were highly satisfied with the program (Client Satisfaction Questionnaire: median score 29, IQR 26-32, and Purpose-Designed Questionnaire: median score 103, IQR 92-108); however, of the 9 participants, 4 (44%) experienced technical issues. The Patient-Specific Complaints Instrument scores declined, indicating functional improvement (from median 7.5, IQR 6.1-8.9, to median 5.7, IQR 3.8-6.7; P=.01). Other program efficacy metrics showed a trend toward improvement. Conclusions Home-based cardiopulmonary telerehabilitation for patients with severe combined cardiopulmonary disease is feasible in terms of high completion and satisfaction rates. Nevertheless, a decrease in adherence during the program was observed, and some of the participants reported difficulties with the technology, indicating the importance of the integration of behavior change techniques, using appropriate technology. Trial Registration Netherlands Trial Register NL9182; https://www.trialregister.nl/trial/9182