Effect of Smartphone-Based Lifestyle Coaching App on Community-Dwelling Population With Moderate Metabolic Abnormalities: Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND Metabolic disorders are established precursors to cardiovascular diseases; yet, they can be readily prevented with sustained lifestyle modifications. OBJECTIVE We assessed the effectiveness of a smartphone-based weight management application on metabolic parameters in adults at high-risk yet without physician diagnosis nor pharmacological treatment for metabolic syndrome in community settings. METHODS In this three-arm parallel-group, single-blind, randomised controlled trial, we recruited participants aged 30 to 59 years with at least two conditions among abdominal obesity, high blood pressure, high triglycerides, low high-density lipoprotein cholesterol and high fasting glucose defined by the third report of the National Cholesterol Education Program expert panel. Participants were randomly assigned (1:1:1) by block randomisation to either non-users, application-based diet and exercise self-logging or application-based self-logging and personalised coaching from professional dieticians and exercise coordinators. Assessments were done at baseline, week 6, 12 and 24. The primary outcome was changes in systolic blood pressure. Secondary outcomes were changes in diastolic blood pressure, body weight, body fat mass, waist circumference, homeostatic model of assessment of insulin resistance, triglyceride and high-density lipoprotein cholesterol between the baseline and three follow-up occasions after 6, 12 and 24 weeks. Analysis was performed via intention-to-treat approach. RESULTS Between October 28th, 2017 and May 28th, 2018, 160 participants have participated in the baseline screening examination. Among, 129 (80.63%), who satisfied the study eligibility criteria, were assigned to control (CO; n=41), self-logging (AO; n=45) or self-logging with personalised coaching (APC; n=43). Overall, systolic blood pressure showed decreasing trend from baseline yet without significantly greater reduction across the three groups at any follow-up examinations (CO: -10.95±2.09 mmHg; AO: -7.29±1.83 mmHg; APC: -7.19±1.66 mmHg). Instead, the APC group underwent significantly greater body weight reduction (CO: -0.12±0.30 kg; AO: -0.35±0.36 kg; APC: -0.96±0.37 kg), specifically by body fat mass reduction (CO: -0.13±0.34 kg; AO: -0.64±0.38 kg; APC: -0.79±0.38 kg). CONCLUSIONS Simultaneous diet and exercise self-logging and persistent lifestyle modification coaching was ineffective in systolic blood pressure lowering but meaningful in weight and body fat mass reduction. These results warrant future implementation of similar models of care on a broader scale in the context of primary prevention. CLINICALTRIAL This study was registered with the ClinicalTrials.gov (NCT03300271, https://clinicaltrials.gov/ct2/show/NCT03300271).