Is a smartphone app more successful in increasing physical activity than setting goals? Step up and check out this edition's critically appraised topic (CAT).
CLINICAL BOTTOM LINE:
Users of a smartphone pedometer app achieved a modest, but significant, increase in daily walking distance, compared with those only given basic exercise advice and goal setting.
During a routine GP visit, you confess your rather sedentary lifestyle to the practice nurse. Never one to miss a teachable moment, she pulls out her smartphone and demonstrates her ‘walking app’. With expectations of a readily available ‘gym buddy’, you decide to review the evidence around smartphone technology and exercise promotion.
In generally healthy adults, does a smartphone app increase physical activity, compared with basic physical activity goals and exercise advice only?
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Glynn, L. G., Hayes, P. S., Casey, M., Glynn, F., Alvarez-Iglesias, A., Newell, J., Murphy, A. W. (2014). Effectiveness of a smartphone application to promote physical activity in primary care: the SMART MOVE randomised controlled trial. Br J Gen Pract, 64(624), e384-391. doi: 10.3399/bjgp14X680461.
The Smart Move study is a two-arm, open-label, randomised controlled trial conducted in a single, rural primary care setting in Ireland in 2012. It evaluates the effectiveness of a smartphone app – Accupedo-Pro Pedometer –as an intervention for promoting physical activity. Participants were recruited from an economically diverse, predominantly white population via referral from primary healthcare professionals or self-referral in response to community advertisements. Eligible participants were active android smartphone users over 16 years of age. Exclusion criteria were acute psychiatric illness, pregnancy, inability to undertake moderate exercise (for any reason, including being overweight). Of the 139 screened for eligibility, 49 were excluded (mainly because of phone device); 90 were randomised. At study commencement, the app was downloaded onto each participant’s phone to enable step count measurement. At the end of week 1, all participants were given physical activity goals and information on the benefits of exercise. Study duration was eight weeks.
Intervention: (n=45) At the end of week 1, participants were able to access the smartphone app features. These included live feedback of daily step count, a graphic display of step count history, goal-setting functions, and goal achievement feedback. These features were explained and interaction with the app was encouraged. A physical activity goal of 10,000 steps per day was set.
Control: (n= 45) At the end of week 1, participants were given a physical activity goal of walking for 30 minutes per day (equivalent to 10,000 steps) in addition to their normal activity. The app features were not activated.
Outcomes: Primary outcome measure was the difference in daily step count between week 1 (baseline measurement), and follow-up (weeks 2-8). Participants’ daily step count data was automatically recorded and stored in the app prior to downloading via the ‘share data’ function. Secondary outcome measures were blood pressure, heart rate, weight, body mass index (BMI), mental health, and quality of life at eight weeks.
Random allocation to study groups occurred via the Research Randomizer computer software programme. A centrally located, independent investigator ensured allocation concealment. Participants and investigators were blinded until end of study week 1 for screening, baseline assessment of physical activity and phone calibration. There was complete follow-up of 86 per cent of study participants (82 per cent in smartphone group and 89 per cent in control). Most loss of follow-up data was phone-related and reported to have occurred during baseline week 1 (pre-intervention). Analyses used on-treatment data. Loss of data after week 2 appears to have been managed via appropriate statistical methods. Baseline group differences (gender and quality of life) were adjusted for, as per the published protocol. Groups were treated equally. Overall study quality was good.
The mean age of participants was 44 years, mean BMI was 28.2, and mean step count at baseline was 4771 (3.6kms), although some participants were quite sedentary. All had prior experience with smartphone apps. A significant and sustained improvement in physical activity between week 1 and week 8 was seen in the intervention group, compared with control (Table) and this effect remained after adjustment for possible explanatory variables (including age, BMI, socioeconomic status, mental health, and quality of life). These results provide evidence of an increased level of physical activity by, on average, 0.8 km or around half a mile (1029 steps) per day in the app user group compared with the control group (Table). There was no significant difference in any secondary outcomes measures.
- Short follow-up and small numbers limited the detection of changes in secondary outcomes. However, if sustained, even the modest increase in physical activity seen in app users is likely to promote clinically meaningful health benefits.
- A concurrent qualitative evaluation of participants’ experiences suggests that, despite technological challenges, app users viewed this intervention as a positive motivator for physical activity.
- Low cost app, easy to download, available in
- New Zealand. No conflict of interest with app developer reported.
- Not known whether similar or free smartphone pedometer apps would have the same motivational benefits
Cynthia Wensley RN MHSc is a PhD candidate at Deakin University. She also works at the School of Nursing, University of Auckland as an Honorary Professional Teaching Fellow.