Physical activity is a central lifestyle component of guidelines for preventing cardiovascular disease, but more than half of adults in the United States do not obtain ideal levels of this activity. “In the clinical setting, new approaches are needed to better promote and objectively track physical activity between the months that go by between patient visits,” says Seth S. Martin, MD, MHS, FACC. One such approach has been to use mobile health (mHealth) technology because it is convenient for patients and can accurately track physical activity through smartphone applications and wearable devices.
Testing an Intervention
For a pilot study published in the Journal of the American Heart Association, Dr. Martin and colleagues tested the effect of using the mActive intervention, which is a fully automated, fully mobile, and physician‐designed mHealth strategy. The mActive intervention utilizes tracking and text messaging to provide individual encouragement and foster feedback loops to increase physical activity. These messages serve as gentle but persistent check-ins to remind patients to fit more exercise into their day.
The trial followed 48 adults aged 18 to 69 who reported low levels of physical activity to their physicians over 1 month. Using a relatively inexpensive activity tracker, researchers measured baseline daily physical activity levels during the first week. Over the following two weeks, one-third of the control group had their activity levels tracked but could not view data on how much they moved. The remaining two-thirds of patients could freely view their daily activity levels, including total step count and aerobic activity levels, on their smartphones. Half of the intervention group also received automated but personalized text messages bearing the names of their cardiologists three times per day.
Patients who were tracked and received text messages took an average of 2,534 more steps per day than those who did not receive texts encouraging them to be more active. Intervention patients also took an average of 3,376 more steps than those in the control group. Overall, 81% of those in the text-message group reached their 10,000-steps-a-day goal, compared with a 44% rate that was observed in the other groups. Patients in the text-message group increased their total activity time by 21 minutes and aerobic time by 13 minutes per day when compared with the other groups.
Although tracking physical activity is not a new concept, the findings suggest that awareness alone may be insufficient to promote physical activity. “We may be able to use the mActive tracking‐texting intervention as a catalyst for behavioral change,” says Dr. Martin. “In turn, this may reduce the risk of heart disease, diabetes, and other chronic conditions while simultaneously improving overall health.”
Dr. Martin and colleagues caution that the study followed participants for just a few weeks, meaning it is still unclear if the observed changes in activity levels will persist over time. The study team plans to address this issue with long-term follow-up of participants involved in the trial. If the mActive tracking‐texting intervention can be sustained, it could become a resource‐efficient strategy that can facilitate more continuous monitoring and feedback between patients and providers.
Martin SS, Feldman DI, Blumenthal RS, et al. mActive: a randomized clinical trial of an automated mHealth intervention for physical activity promotion. J Am Heart Assoc. 2015 Nov 9 [Epub ahead of print]. Available at: http://jaha.ahajournals.org/content/4/11/e002239.full.pdf+html.
Case MA, Burwick HA, Volpp KG, Patel MS. Accuracy of smartphone applications and wearable devices for tracking physical activity data. JAMA. 2015;313:625–626.
Patel MS, Asch DA, Volpp KG. Wearable devices as facilitators, not drivers, of health behavior change. JAMA. 2015;313:459–460.