Long-Term Effectiveness of a Smartphone App for Improving Healthy Lifestyles in General Population in Primary Care: Randomized Controlled Trial (Evident II Study)

Abstract

BackgroundInformation and communication technologies are currently among the supporting elements that may contribute to improving health and changing lifestyles.ObjectiveThe aim of this study was to evaluate the long-term effectiveness of adding an app to standardized counseling in order to increase physical activity (PA) and adherence to the Mediterranean diet and to analyze the effects of app adherence in lifestyle changes.MethodsA randomized, multicenter clinical trial with a 12 month-follow up was conducted, involving 833 participants recruited by random sampling in 6 primary Spanish care centers (415 vs 418). Counseling on PA and the Mediterranean diet was given to both groups by a research nurse; however, the counseling + app group (intervention group) received additional training in the use of an app that was designed to promote the Mediterranean diet and PA over a 3-month period. Main outcomes and measures included PA by accelerometer and the 7-day Physical Activity Recall (PAR) questionnaire and adherence to the Mediterranean diet by an adherence screener questionnaire. We considered adherence to the app to be high when it was used for more than 60 days.ResultsThe mean age was 51 years (SD 12) in the intervention group and 52.3 years (SD 12.0) in the counseling-only group; females predominated in both groups (60.0%, 249/415 and 64.1%, 268/418, respectively). PA by accelerometer declined in both groups at 12 months (P value for tendency in moderate to vigorous PA, [MVPA]=.15). The intervention subgroup with high app adherence had better behavior than the low adherence subgroup (P value for tendency in MVPA=.001). PA analyzed by 7-day PAR did not show changes at 12 months in any of the groups (P value for tendency=.25). In the Mediterranean diet, an increase in adherence was observed in both groups at 12 months with no differences between them (P value for tendency=.46). In these two cases, the group with high app adherence also had better behavior, although without reaching significance for the tendency (P>.05).ConclusionsThe participants with strongest app adherence showed better outcomes in terms of maintenance of healthy lifestyles at 12 months than those with weaker adherence. Overall, however, we found no differences between intervention group and counseling-only group in PA increase and adherence to the Mediterranean diet in the long term.Trial RegistrationClinicaltrials.gov NCT02016014; https://clinicaltrials.gov/ct2/show/NCT02016014 (Archived by WebCite at http://www.webcitation.org/6ymEXH6W4)

Your Personal Motivator is with You: A Systematic Review of Mobile Phone Applications Aiming at Increasing Physical Activity

“…For a small number of users in Lin et al [59], feedback decreased PA because of emotional connections to the avatar (fish), which backfired because users stopped checking when they saw their fish was sad. Feedback in Duncan et al [19] and Garcia-Ortiz et al [134] was non-significant, but unfortunately, no explanation for the absence of effects was provided.…”

“…From a vote counting perspective, of 14 quantitative studies, 12 versus 2 [19,134] studies showed significant, positive effects of feedback on PA [17,55,77,86,89,120,122,123,127,129,133,135]. The remaining 18 studies reported qualitative, supporting results.…”

“…Of the studies, 78.0% (n = 32/41) analyzed feedback, considered in a multitude of forms, with some studies using more than one form. Feedback was represented as bar graphs and a virtual map [98,[116][117][118][119][120]; audio feedback from virtual trainers [77]; illustrations through avatars [17,55,59,75,121,[123][124][125]127]; tailored text and email messages [94,[128][129][130]; real time, self-monitoring, receiving reminders, GPS tracking, tempo of music, and biofeedback [18,19,54,77,86,89,98,119,120,122,123,126,128,[131][132][133][134][135].…”

Usability and utility of eHealth for physical activity counselling in primary health care: a scoping review

“…Of 17 articles published from 2014 to 2019, more than half ( n = 10) obviously presented the use of mobile technologies (e.g. smartphone, tablet) [ 21 , 28 , 30 , 31 , 34 , 39 , 40 , 42 , 51 , 52 ], while some programmes were potential to access by mobile devices (Table 2 and Additional file 2 ) [ 20 , 32 ].…”

“…The research group in the Netherlands produced ‘It’s LiFe!’ as an intervention for promoting PA in PHC [ 31 , 34 , 39 ]. The Spanish team introduced a randomised controlled trial to investigate the short- and long-term effects on utilisation of a mobile phone app [ 40 , 42 ]. The online programme, MyPlan 1.0, developed in Belgium was presented in two articles (Table 2 and Additional file 2 ) [ 20 , 32 ].…”