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Intervention via mobile technology may improve diet, activity
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Remote coaching through mobile devices could improve patients’ food and activity choices, according to data from a randomized study.
“Although healthy lifestyle changes can reduce morbidity and premature mortality, fewer than 25% of US adults meet the dietary guidelines, and 25% report no leisure-time physical activity,” researchers wrote.
Bonnie Spring, PhD, of the department of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago, and colleagues said the Make Better Choices trial was composed of adults aged 21 to 60 years with more than 90 minutes per day of sedentary activity (mean age, 33 years).
Patients with four risk behaviors were randomly assigned to one of four treatments. Risk behaviors included: 1) intake of fewer than five fruits and/or vegetables daily; 2) more than 8% caloric intake from saturated fat; 3) less than 60 minutes per day of moderate or vigorous activity; and 4) more than 90 minutes per day of sedentary activity.
Patients were randomly assigned (n=204; 48 men) to one of four groups: 1) increased fruit/vegetable intake and physical activity; 2) decreased fat and sedentary leisure; 3) decreased fat and increased physical activity, and 4) increased fruit/vegetable intake and decreased sedentary leisure. Each treatment group included 3 weeks of remote coaching backed by mobile decision support technology and financial incentives that were awarded based on use of the mobile device to self-monitor and reach behavioral goals during treatment.
In the 2-week baseline phase and final eligibility screening portion of the study, patients who were randomly assigned wore an accelerometer, recorded diet and activity on the digital hand-held device and uploaded data every day. If patients met behavioral targets during the treatment phase, they were paid $175.
Ninety-eight percent of patients completed follow-up at 5 months. Researchers reported that the group that increased fruits and vegetables and decreased sedentary leisure had more significant improvement compared with patients in other groups (P<.001).
Daily fruit/vegetables intake increased from 1.2 servings to 5.5 servings, sedentary activity decreased from 219.2 minutes to 89.3 minutes, and saturated fat decreased from 12% to 9.5% of calories consumed, researchers wrote.
However, the decreased fat and increased physical activity group experienced less improvements compared with the other three treatments (P<.001).
“Although they were neither asked nor reinforced to maintain eating or activity improvements, 86.5% of the 185 participants from whom exit interviews were obtained said they ‘definitely’ or ‘somewhat’ tried to maintain gains,” the researchers concluded.
In an accompanying editorial, William T. Riley, PhD, researcher in the division of cardiovascular sciences at the National Heart, Lung, and Blood Institute, said the potential for mobile technologies as self-monitoring and feedback resources is promising.
However, Riley said questions remain whether the technology itself reduces costs, improve outcomes, or both.
“Spring et al have contributed to the empirical evidence of the value of these technologies, but many more research contributions such as this are needed to establish that technologically delivered multiple risk factor interventions improve outcomes,” Riley said.
References:
- Riley T. Arch Intern Med. 2012;172:796-798.
- Spring B. Arch Intern Med. 2012;172:789-795.
Disclosures:
- The researchers report no relevant financial disclosures. Dr. Riley reports no relevant financial disclosures.