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31-05-2012 | Article

Mobile devices stimulate healthy lifestyle changes


Free abstract

MedWire News: Research suggests that simply eating more fruit and vegetables and moving around more results in greater health benefits than adopting other diet and exercise strategies.

In a randomized clinical trial, 204 adults who were largely sedentary in their leisure time and had poor diets had the most success with an intervention that combined an increase in fruit and vegetable consumption with a decline in sedentary activities such as TV watching, video gaming, or recreational internet use. Participants received remote coaching from trained assistants, and diet and exercise information and support from handheld electronic devices.

"This study demonstrates the feasibility of changing multiple unhealthy diet and activity behaviors simultaneously, efficiently, and with minimal face-to-face contact by using mobile technology, remote coaching, and incentives," write Bonnie Spring (Northwestern University, Chicago, Illinois) and colleagues in the Archives of Internal Medicine.

Many practitioners lack the time or resources to coach patients on the most effective diet and exercise strategies, the authors acknowledge, noting that one in four US residents report having no leisure-time physical activity.

To determine whether increasingly common mobile devices could be used to motivate patients to make lasting changes for the better, Spring et al devised a study in which a targeted population was given handheld devices to provide decision support and record data, with remote coaching provided by trained paraprofessionals. Participants who met their targeted goals during treatment and maintained record-keeping during follow-up were rewarded with cash.

A total of 48 men and 156 women with a mean age of 32.8 years were enrolled and randomly assigned to one of four interventions: decrease saturated fat and increase physical activity; eat more fruits and vegetables and get more physical activity; eat more fruits and vegetables and decrease sedentary leisure time; or decrease both saturated fat and sedentary leisure time.

The participants used a personal digital assistant (PDA) to record their targeted behaviors and uploaded the data daily. They could also communicate by email or telephone with their assigned coaches (research assistants). The intervention lasted 3 weeks and the participants were followed up for 20 weeks.

The increase fruits/vegetables and decrease sedentary leisure intervention group had significantly greater improvements in a composite diet-activity improvement score than the other three interventions at 1 week, at the end of the intervention, and at the end of follow-up.

In contrast, the group that followed the "traditional diet" route, with decreased fat intake and increased physical activity, showed a reduction in diet-activity improvement scores compared with the other groups, and this disadvantage persisted throughout treatment and follow-up.

In an accompany commentary, William Riley (National Heart, Lung, and Blood Institute, Bethesda, Maryland) writes: "Via technology, we will soon be able to deliver fully automated and configurable multiple risk factor interventions that monitor progress continuously and can be delivered throughout the day every day. It remains an empirical question, however, whether these technological advances improve outcomes, reduce costs, 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."

By Neil Osterweil