ACC.16: Mobile health intervention helps participants increase exercise and lose weight

CHICAGO – Participants in a low-cost, workplace-based, physical activity and wellness mobile health intervention program had significant increases in daily step counts, exercise days and weight loss.

Lead researcher Anand N. Ganesan, PhD, associate professor at Flinders University in Adelaide, Australia, presented the results during a late-breaking session at the ACC scientific session on April 3. The findings were simultaneously published online in the Journal of the American College of Cardiology.

“Physical inactivity, sedentary lifestyles and obesity are massive global problems that affect high-, middle- and low-income countries,” Ganesan said in a news release. “We need tools to get people moving that are attractive to consumers, that are affordable and that work on a large scale. Our study suggests that by using technology in a clever way, perhaps we, as a community, can devise solutions to this problem.”

In this study, researchers from Flinders University collaborated with Stepathlon Private Limited, a start-up company based in Mumbai, India. They analyzed data from the Stepathlon, a 100-day annual event that took place in 2012, 2013 and 2014.

Participants were organized into five-person teams, issued inexpensive pedometers and encouraged to increase their daily steps and physical activity around a virtual world and to enter their daily activity into the Stepathlon website. All participants also received daily emails that encouraged them and provided information on physical activity and nutrition. The program was conducted by an interactive, mobile device platform and application.

The cost of the program was modest: $50 for participants in India and $60 for participants outside of India. The fees were generally paid for by the participants’ companies.

The program included adult employees of 481 private and public sector organizations in Asia, Europe, Africa, North America, South America, Australia and New Zealand.

Participants came from 64 countries and 1,481 cities on all seven continents. They completed activity and lifestyle survey questionnaires before and after the 100-day Stepathlon event. Of the 69,219 participants who completed the pre-event questionnaire, 53 percent completed the post-event questionnaire.

“This data set represents the largest published data set in the mobile health literature and exceeds the size of previous meta-analyses by a substantial figure,” Ganesan said at a news conference. “It’s the first study in the mobile health literature to our knowledge that examines outcomes data in patients on all populated continents. It is the first study to examine in any kind of way outcomes data in patients in low to middle income countries.”

At baseline, the mean age of participants was 36 years old, and 76.1 percent were male. In addition, 8 percent of participants were from high-income countries and 92 percent were from lower-middle income countries.

From the beginning to the end of the program, participants increased their step counts by a mean of 3,519 steps per day, including 3,159 steps per day for women and 3,398 steps per day for men. After the Stepathlon event, participants exercised an additional 0.89 days per week and sat for 45 fewer minutes per day.

During the program, participants lost a mean of 1.45 kg, including 0.74 kg in women and 1.63 kg in men.

The improvements occurred in women and men, in all geographic regions, in high and lower-middle income countries and in all of the years (2012, 2013 and 2014) of the study. The researchers said significant predictors of weight loss included step increase, sitting duration decrease and increase in exercise days.

The researchers cited a few limitations of the study, including that it was not randomized and was conducted with relatively short-term follow-up. They also mentioned participants self-reported their outcomes, which may have led to recall and social desirability bias. Participants were also not allowed to receive individual supervision from a health professional, which has been shown to improve adherence.