Exercise as it relates to Disease/Use of smartphone apps to increase physical activity

This is an analysis of the journal article "Effectiveness of a smartphone application to promote physical activity in primary care: the SMART MOVE randomised controlled trial" by Glynn et al (2014)

What is the background to this research?
Physical inactivity and sedentary behaviours have been linked to the development of lifestyle diseases, including obesity, diabetes, cancer and cardiovascular disease. Hence physical inactivity has emerged as a major global health concern, particularly as the incidence of these disease states and associated mortality continues to increase. The World Health Organisation (WHO) reports that since 1980 obesity rates have doubled, whilst rates of physical activity have plummeted. There are a plethora of studies that show that modest increases in physical activity are associated with reduced risk of lifestyle disease and mortality and consequently there is a growing need for sustainable interventions that can effectively increase rates of physical activity in these populations. Sustainable interventions should: Smart phone applications are centered on these criteria, and are therefore offered in this study by Glynn et al (2014) as a potential intervention for increasing physical activity in sedentary populations.
 * Motivate individuals to change behaviour
 * Offer realistic goal setting
 * And provide live feedback on activity rates

Where is the research from?
This research was conducted in a few rural primary care facilities in Western Ireland by a team of researchers from the School of Medicine at the National University of Ireland.

What kind of research was this?
This was an eight-week, randomised controlled trial.

What did the research involve?
This research utilized 90 participants, aged >16 years who used an android smartphone, which were either referred by their primary health care professional or self-referred. The study investigated the effect of using a smartphone app (Accupedo-pro pedometer) on daily level of physical activity by measuring the participants daily step count. This SMART MOVE intervention shares the basic features and accuracy of pedometer-based interventions, which are associated with increases in physical activity of approximately 500–3500 steps per day, as well as significant decreases in BMI and blood pressure.

The participants were divided into two groups, an intervention group and a control group.The intervention group was able to interact with the smartphone app and keep track of progress and had a goal of 10,000 steps per day were as the control group could not see their progress at all on the app and were told to walk for 30 minutes per day in addition to normal activity. The data was collected at the end of weeks 1 and 8 and compared to baseline measures to get a result.

What were the basic results?
The primary findings were the differences in mean daily step count between baseline (week 1) and follow-up (weeks 8).
 * Week 1 – Participants in control and intervention group had an estimated mean daily step count of 4700
 * Week 8 – The unadjusted mean difference in improvement in step count between week 1 and week 8 was:
 * Control = −386 steps, an approximate 8% decrease in physical activity.
 * Intervention = 1631 steps, an approximate 35% increase in physical activity.

Hence, there is evidence to suggest that the treatment effect was maintained at 8 weeks in the intervention group only.

How did the researchers interpret the results?
The researcher’s interpretation was that a positive correlation exists between use of smart phone apps and increased physical activity within a sedentary population. They believe that the magnitude of behavioural change (over 1000 step increase daily) is clinically significant and predict that if continued, would result in long-term health benefits.

What conclusions should be taken away from this research?
Novel technologies such as smart phone apps can have positive impacts on lifestyle change, in particular physical activity.However, other studies   have shown that there was no significant improvement in physical activity; however these studies did not include a step goal. Hence, goal setting seems to be a key predictor in increased physical activity.

This study by Glynn et al highlights the importance of having a daily physical activity goal as well as being able to track progress and interact with data. These factors are important in increasing physical activity as they make the individual aware of their current state of physical activity and allow them to make conscious adjustments in effort in order to improve it to reach their goal. The authors also performed a qualitative study on this research and termed this the know-check –move effect whereby participants in the intervention group knew the target goal and were able to check their progress and if they hadn’t done enough could do more to reach their goal.

The control group were totally blind to this effect and had no target goal for physical activity other than the 30mins they had to complete daily. The decrease in mean daily step count shown in the results for this group further indicates the importance of this effect in interventions aiming to increase physical activity.

What are the implications of this research?
The results of this study suggest that novel technologies, such as smartphone apps, may become an important driver for health related behavioural changes, including increased daily physical activity. However larger randomised controlled trials are needed to study the long-term sustainability of such improvements.

Other studies have also shown the positive association pedometer- based interventions have in increasing physical activity, however the advantage of using a smartphone app is that  they don’t just count steps, there are hundreds of  free applications out there specific for increasing physical activity in almost any way you can think of and there are no additional instruments associated other than a mobile phone which people in this day and age carry around continuously. This in itself may not be sufficient to guarantee ongoing engagement with the app; however additional features such as feedback on sleep, heart rate, activity time, running speed, and energy consumption metrics, accompanied by attractive user-friendly graphic displays and a system of rewards for goals achieved may help to keep the individual committed to behaviour change. These features provide smartphone apps with significant potential as tailored interventions that can be used to promote physical activity in almost any demographic. Therefore, rather than just providing more evidence that progress tracking supports behaviour change, this intervention represents an important step forward in the challenging issue of promoting physical activity.

The rapid infiltration of smartphones throughout society and the availability of hundreds of apps promoting physical activity should be a shining beacon of opportunity to use these technologies to explore, understand, and positively change human behavior and should therefore be considered a component of any future intervention to promote physical activity.