Multiple Behavior Changes in Diet and Activity

Abstract

Background Many patients exhibit multiple chronic disease risk behaviors. Research provides little information about advice that can maximize simultaneous health behavior changes. Methods To test which combination of diet and activity advice maximizes healthy change, we randomized 204 adults with elevated saturated fat and low fruit/vegetable intakes, high sedentary leisure time and low physical activity to one of four treatments: increase fruit/vegetable and physical activity; decrease fat and sedentary leisure; decrease fat and increase physical activity; increase fruit/vegetable and decrease sedentary leisure. Treatments provided three weeks of remote coaching supported by mobile decision support technology and financial incentives. During treatment, incentives were contingent on using the mobile device to self-monitor and attain behavioral targets; during follow-up they were contingent only on recording. The outcome was standardized, composite improvement on the four diet and activity behaviors at end of treatment and five month follow-up. Results Of those randomized, 200 (98%) completed follow-up. The increase fruit/vegetable and decrease sedentary leisure treatment improved more than the other 3 treatments (p<.001). Specifically, fruit/vegetables increased from 1.2 servings/day to 5.5; sedentary leisure decreased from 219.2 minutes/day to 89.3; saturated fat decreased from 12.0% of calories consumed to 9.5%. Differences between treatment groups were maintained through follow-up. Traditional dieting (decrease fat and increase physical activity) improved less than the other 3 treatments (p<.001). Conclusions Remote coaching supported by mobile technology and financial incentives holds promise to improve diet and activity. Targeting fruits/vegetables and sedentary leisure together maximizes overall adoption and maintenance of multiple healthy behavior changes.

Information Technology and Lifestyle: A Systematic Evaluation of Internet and Mobile Interventions for Improving Diet, Physical Activity, Obesity, Tobacco, and Alcohol Use

“…Two RCTs assessed mobile‐based interventions and fruit/vegetable intake; each found significant improvement (by 2 and 4 servings/day)14, 16 One of these compared a mobile intervention to an established conventional intervention, finding a greater effect in the mobile intervention group 14. In a prior systematic review of 14 mobile trials (2007–2010) focused on text messages and lasting from 2 weeks to 12 months (Table 3), 11 studies reported significant improvements in weight loss–related outcomes, whereas no significant change was reported in calorie intake or consumption of sugar‐sweetened beverages in 4 trials evaluating diet 10…”

Sedentary Behavior and Cardiovascular Morbidity and Mortality: A Science Advisory From the American Heart Association

“…These technologies offer the potential to deliver time-and context-sensitive health information across a broad segment of the population. 150 Smartphone apps can be designed that incorporate behavior change theory strategies (selfmonitoring, goal setting, positive reinforcement) 151 and social networking 152 and provide just-in-time interventions in which prolonged sedentary behavior is detected in real time and participants are then encouraged to engage in brief physical activity breaks of at least light intensity. 153,154 Recently, Bond et al 153 used a smartphone app to monitor and interrupt sedentary behavior in real time in 30 overweight or obese adults.…”

Weight loss intervention for young adults using mobile technology: Design and rationale of a randomized controlled trial — Cell Phone Intervention for You (CITY)

“…As of May 2013, 91% of American adults own a mobile phone and 56% of American adults own a smartphone of some kind [15]. In middle-aged adults, mobile technology has recently been shown to enhance weight loss [16,17] . For example, Ma et al sought to evaluate the effectiveness of two adapted diabetes prevention program lifestyle interventions in overweight or obese adults [16].…”

“…An additional study examined whether a mobile technology system and telephone coaching add to standard treatment improved weight loss outcomes compared to standard treatment alone [17]. Sixty-nine adults with a mean age of 57.7 years (sd 11.9) were randomized to one of the two groups.…”