Exercise as it relates to Disease/Can smartphone apps increase physical activity?

This paper presents a critical analysis of the journal article: “Effectiveness of a smartphone app in increasing physical activity amongst male adults: a randomised control trial” by Harries et al. (2016)

What is the background to this research?
Physical inactivity is the second highest cause to avoidable death, physical activity has also been proven to have many physical and mental benefits for health. In 2008 the World Health Organisation (WHO) produced internationally comparable estimates of insufficient physical activity. It then updated these estimates in 2010 and published in the Lancet that the global prevalence for insufficient physical activity was 23.3%, which was double what the numbers were in the 1980s. A more recent article found that physical inactivity has been stable at around 27.5% of the population since 20015. It concluded that the WHO’s target of reducing physical inactivity by 10% by 2025 will not be met.

The subject article aims to demonstrate the amount of physical activity engaged in by the majority of the population can be improved when using a feature rich smart phone application. It specifically notes an increased physical activity can be demonstrated in people using the app who otherwise have a very low intrinsic motivation to exercise.

Where is the research from?
This research was funded by the Engineering and Physical Sciences Research Council, the main funding body for physical sciences in the UK. It was conducted in the city of Bristol in the UK in 2011. This organisation partnered with universities, research organisations, businesses, charities, and the government for the widest possible research. Research and analysis by several partner institutions removes bias.

The partner representatives are:
 * Kingston Business School, Kingston University
 * Swansea University
 * Institute of Work Psychology, University of Sheffield
 * Oxford e-research Centre
 * National Health Service Highland, Scotland
 * Centre for Health Sciences, University of the Highlands and Islands.

What kind of research was this?
This research was a randomised control trial. The objective of the research was to measure any change in the number of steps taken per day using longitudinal multilevel regression models. A baseline was established for comparison by participants in test groups.

What did the research involve?
The approach comprised a controlled trial with 165 randomly selected 22-40-year-old males in public areas around shopping malls in Bristol, over an eight week period. Participants were filtered using a questionnaire to determine eligibility to the study, with participants also having to have an existing mobile phone contract. The process captured the daily number of steps taken by participants, which was then automatically uploaded to a secure central server for analysis. The study states that females are usually more attracted to motivational factors for health behaviours than males. Consequently, recruitment of participants was limited to males. The study further claims there is a bias of literature in this area towards females. However, the WHO article, and the more recent global physical inactivity article, states females have been found to be more physically inactive than males. To provide a balanced and sound basis for increasing physical activity with little intrinsic motivation it would be beneficial to include both genders. Claiming women are more attracted to research like this contradicts evidence that males are slightly more physically active than females. Participants were given a smartphone with the appropriate app loaded and given instructions to use the phone as their personal phone with their own SIM card for the next 8 weeks. The phone was to be kept in their pockets at all times. Participants were randomly allocated to three different groups. These groups were: Once the study commenced: if the participant’s phone provided no 3 days, the participant was excluded from the results. Participants were also sent different automated messages based on their group. The frequency and content of these messages was also based on the group the participant was placed in. Based on these groups, the research proposed the following three hypotheses:
 * Control group -No feedback and no access to interactive elements of the app.
 * Individual feedback group - Feedback of the participant’s own steps.
 * Social Feedback group - Feedback on the participant’s own steps and the average steps taken by others in the group.
 * Hypotheses 1 - Those with access to social feedback will have higher step-counts than those receiving no feedback.
 * Hypotheses 2 - Those receiving social norms feedback will have higher step-counts than those that only receive feedback on their own walking.
 * Hypotheses 3 - Those only receiving feedback on their own walking will have higher step counts than those receiving no feedback.

What were the basic results?
Due to a technical malfunction, the first two weeks’ data was unusable. Since this was meant to be the baseline against which all three groups would compare the baseline had to embrace data from weeks 2-4. This is a major limitation of the study and could have altered the results dramatically. H1 and H3 were proven to be true, with the results providing a statistically significant increase in step-count between the control group and the social feedback group. Given no statistically significant difference between the individual feedback group and the social feedback group, the null hypothesis for H2 could not be rejected.

What conclusions can we take from this research?
The research provides an indication that smartphone apps, constantly recording and providing feedback on day-to-day physical activity levels, can generate a substantial increase in activity in young relatively healthy adult males. In addition, using a relatively cheap smartphone as the platform provides a potential solution for future intervention for reducing physical inactivity.

Practical advice
A number of other articles found a strong correlation of physical activity increasing due to recording and feedback apps used on a smartphone. Based on this, it would be beneficial to the public if a meta analyses were to be conducted to establish the best app. The app would need to provide fun for children, such as would be found in a game like Pokémon, and one best suited for sedentary individuals. This research would then further benefit a wider spread population by providing a platform for the World Health Organisation to counter physical inactivity.

Further information/resources
World Health Organisation Engineering and Physical Sciences Research Council
 * Physical activity

Australian Institute of Health and Welfare – Physical inactivity