Effects of Open-Loop Feedback on Physical Activity and Television Viewing in Overweight and Obese Children: A Randomized, Controlled Trial Feasibility and Acceptability of a Wearable Technology Physical Activity Intervention With Telephone Counseling for Mid-Aged and Older Adults: A Randomized Controlled Pilot Trial Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial. Incorporating Novel Mobile Health Technologies Into Management of Knee Osteoarthritis in Patients Treated With Intra-Articular Hyaluronic Acid: Rationale and Protocol of a Randomized Controlled Trial The effect of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women: a systematic review protocol Use of Consumer Wearable Devices to Promote Physical Activity: A Review of Health Intervention Studies Wearable Sensor/Device (Fitbit One) and SMS Text-Messaging Prompts to Increase Physical Activity in Overweight and Obese Adults: A Randomized Controlled Trial. Use of a Computerized Tracking System to Monitor and Provide Feedback on Dietary Goals for Calorie-Restricted Diets: The POUNDS LOST Study An mHealth Intervention Using a Smartphone App to Increase Walking Behavior in Young Adults: A Pilot Study Electronic feedback in a diet- and physical activity-based lifestyle intervention for weight loss: a randomized controlled trial Multidimensional individualised Physical ACTivity (Mi-PACT) – a technology-enabled intervention to promote physical activity in primary care: study protocol for a randomised controlled trial The Effects of Physical Activity Feedback on Behavior and Awareness in Employees: Study Protocol for a Randomized Controlled Trial The effect of ongoing feedback on physical activity levels following an exercise intervention in older adults: a randomised controlled trial protocol Predictive ability of social cognitive theory in exercise research: an integrated literature review. Use of the Fitbit to Measure Adherence to a Physical Activity Intervention Among Overweight or Obese, Postmenopausal Women: Self-Monitoring Trajectory During 16 Weeks The Impact of Different Degrees of Feedback on Physical Activity Levels: A 4-Week Intervention Study Promoting weight loss through diet and exercise in overweight or obese breast cancer survivors (InForma): study protocol for a randomized controlled trial Design and baseline characteristics of participants in the TRial of Economic Incentives to Promote Physical Activity (TRIPPA): a randomized controlled trial of a six month pedometer program with financial incentives. Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults Design and baseline characteristics of participants in the Enhancing Physical Activity and Reducing Obesity through Smartcare and Financial Incentives (EPAROSFI): A pilot randomized controlled trial. Wristband Accelerometers to motiVate arm Exercise after Stroke (WAVES): study protocol for a pilot randomized controlled trial The Development of a Mobile Monitoring and Feedback Tool to Stimulate Physical Activity of People With a Chronic Disease in Primary Care: A User-Centered Design Assessment of the utility of visual feedback in the treatment of early rheumatoid arthritis patients: a pilot study
OBJECTIVES . Television viewing and physical inactivity increase the risk of obesity in youth . Thus , identifying new interventions that increase physical activity and reduce television viewing would be helpful in the prevention and treatment of pediatric obesity . This study evaluated the effects of open-loop feedback plus reinforcement versus open-loop feedback alone on  physical activity , targeted sedentary behavior , body composition , and energy intake in youth . METHODS . Thirty overweight or obese 8- to 12-year-old children were r and omly assigned to an  intervention ( n = 14 ) or control group ( n = 16 ) . Participants wore accelerometers every day for 8 weeks and attended biweekly meetings to download the activity monitors . For children in the open-loop feedback plus reinforcement ( intervention ) group , accumulating 400 counts of physical activity on pedometers earned 1 hour of television/VCR/DVD time , which was controlled by a Token TV electronic device . Open-loop feedback control subjects wore activity monitors but had free access to targeted sedentary behavior . RESULTS . Compared with controls , the open-loop feedback plus reinforcement group demonstrated significantly greater increases in daily physical activity counts ( + 65 % vs + 16 % ) and minutes per day of moderate-to-vigorous physical activity ( + 9.4 vs + 0.3 ) and greater reductions in minutes per day spent in television viewing ( −116.1 vs + 14.3 ) . The intervention group also showed more favorable changes in body composition , dietary fat intake , and energy intake from snacks compared with controls . Reductions in sedentary behavior were directly related to reductions in BMI , fat intake , snack intake , and snack intake while watching television . CONCLUSIONS . Providing feedback of physical activity in combination with reinforcing physical activity with sedentary behavior is a simple method of modifying the home environment that may play an important role in treating and preventing child obesity Background As adults age , their physical activity decreases and sedentary behavior increases , leading to increased risk of negative health outcomes .  Wearable electronic activity monitors have shown promise for delivering effective behavior change techniques . However , little is known about the feasibility and acceptability of non-Fitbit wearables ( Fitbit , Inc , San Francisco , California ) combined with telephone counseling among adults aged more than 55 years . Objective The purpose of our study was to determine the feasibility , acceptability , and effect on physical activity of an intervention combining a wearable physical activity monitor , tablet device , and telephone counseling  among adults aged 55 - 79 years . Methods Adults ( N=40 , aged 55 - 79 years , body mass index=25 - 35 , < 60 min of activity per week ) were r and omized to receive a 12-week intervention or to a wait list control . Intervention participants received a Jawbone Up24 monitor , a tablet with the Jawbone Up app installed , and brief weekly telephone counseling . Participants set daily and weekly step goals and used the monitor ’s idle alert to notify them when they were sedentary for more than 1 h. Interventionists provided brief counseling once per week by telephone .  Feasibility was measured using observation and study records , and acceptability was measured by self-report using vali date d items . Physical activity and sedentary time were measured using ActivPAL monitors following st and ard protocol s. Body composition was measured using dual-energy x-ray absorptiometry scans , and fitness was measured using a 6-min walk test . Results Participants were 61.48 years old ( SD 5.60 ) , 85 % ( 34/40 ) female , 65 % ( 26/40 ) white .  Average activity monitor wear time was 81.85 ( SD 3.73 ) of 90 days . Of the 20 Up24 monitors , 5 were reported broken and 1 lost . No related adverse events were reported . Acceptability items were rated at least 4 on a scale of 1 - 5 . Effect sizes for most outcomes were small , including stepping time per day ( d=0.35 ) , steps per day ( d=0.26 ) , sitting time per day ( d=0.21 ) , body fat ( d=0.17 ) , and weight ( d=0.33 ) . Conclusions The intervention was feasible and acceptable in this population . Effect sizes were similar to the sizes found using other wearable electronic activity monitors , indicating that when combined with telephone counseling , wearable activity monitors are a potentially effective tool for increasing physical activity and decreasing sedentary behavior . Trial registration Clinical trials.gov NCT01869348 ; https:// clinical trials.gov/ct2/show/NCT01869348 ( Archived by WebCite at http://www.webcitation.org/6odlIolqy Importance Effective long-term treatments are needed to address the obesity epidemic . Numerous wearable technologies specific to physical activity and diet are available , but it is unclear if these are effective at improving weight loss . Objective To test the hypothesis that , compared with a st and ard behavioral weight loss intervention ( st and ard intervention ) , a technology-enhanced weight loss intervention ( enhanced intervention ) would result in greater weight loss . Design , Setting , Participants R and omized clinical trial conducted at the University of Pittsburgh and enrolling 471 adult participants between October 2010 and October 2012 , with data collection completed by December 2014 . Interventions Participants were placed on a low-calorie diet , prescribed increases in physical activity , and had group counseling sessions . At 6 months , the interventions added telephone counseling sessions , text message prompts , and access to study material s on a website . At 6 months , participants r and omized to the st and ard intervention group initiated self-monitoring of diet and physical activity using a website , and those r and omized to the enhanced intervention group were provided with a wearable device and accompanying web interface to monitor diet and physical activity . Main Outcomes and Measures The primary outcome of weight was measured over 24 months at 6-month intervals , and the primary hypothesis tested the change in weight between 2 groups at 24 months . Secondary outcomes included body composition , fitness , physical activity , and dietary intake . Results Among the 471 participants r and omized ( body mass index [ BMI ] , 25 to < 40 ; age range , 18 - 35 years ; 28.9 % nonwhite , 77.2 % women ) , 470 ( 233 in the st and ard intervention group , 237 in the enhanced intervention group ) initiated the interventions as r and omized , and 74.5 % completed the study . For the enhanced intervention group , mean base line weight was 96.3 kg ( 95 % CI , 94.2 - 98.5 ) and 24-month weight 92.8 kg ( 95 % CI , 90.6- 95.0 ) [ corrected ] . For the st and ard intervention group , mean baseline weight was 95.2 kg ( 95%CI,93.0 - 97.3 ) and 24-month weight was 89.3 kg ( 95%CI , 87.1 - 91.5 ) [ corrected ] . Weight change at 24 months differed significantly by intervention group ( estimated mean weight loss , 3.5 kg [ 95 % CI , 2.6 - 4.5 } in the enhanced intervention group and 5.9 kg [ 95 % CI , 5.0 - 6.8 ] in the st and ard intervention group ; difference , 2.4 kg [ 95 % CI , 1.0 - 3.7 ] ; P = .002 ) . Both groups had significant improvements in body composition , fitness , physical activity , and diet , with no significant difference between groups . Conclusions and Relevance Among young adults with a BMI between 25 and less than 40 , the addition of a wearable technology device to a st and ard behavioral intervention result ed in less weight loss over 24 months . Devices that monitor and provide feedback on physical activity may not offer an advantage over st and ard behavioral weight loss approaches . Trial Registration clinical trials.gov Identifier : NCT01131871 Background Osteoarthritis ( OA ) of the knee is one of the leading causes of disability in the United States . One relatively new strategy that could be helpful in the management of OA is the use of mHealth technologies , as they can be used to increase physical activity and promote exercise , which are key components of knee OA management . Objective Currently , no published data on the use of a mHealth approach to comprehensively monitor physical activity in patients with OA are available , and similarly , no data on whether mHealth technologies can impact outcomes are available . Our objective is to evaluate the effectiveness of mHealth technology as part of a tailored , comprehensive management strategy for patients with knee OA . Methods The study will assess the impact of a smartphone app that integrates data from a wearable activity monitor ( thereby both encouraging changes in mobility as well as tracking them ) combined with education about the benefits of walking on patient mobility . The results from the intervention group will be compared with data from a control group of individuals who are given the same Arthritis Foundation literature regarding the benefits of walking and wearable activity monitors but who do not have access to the data from those monitors . Activity monitors will capture step count estimates and will compare those with patients ’ step goals , calories burned , and distance walked . Patients using the novel smartphone app will be able to enter information on their daily pain , mood , and sleep quality . The relationships among activity and pain , activity and mood , and sleep will be assessed , as will patient satisfaction with and adherence to the mobile app . Results We present information on an upcoming trial that will prospect ively assess the ability of a mobile app to improve mobility for knee OA patients who are treated with intra-articular hyaluronic acid . Conclusions We anticipate the results of this study will support the concept that mHealth technologies provide continuous , real-time feedback to patients with OA on their overall level of activity for a more proactive , personalized approach to treatment that may help modify behavior and assist with self-management through treatment support in the form of motivational messages and reminders Review question / objective What are the effects of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women ? The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aim ed at limiting gestational weight gain and postpartum weight retention in women . The second objective of this systematic review is to investigate included intervention components with respect to effect on weight‐related outcomes . This may include , but is not limited to : length of intervention , use of face‐to‐face counselling , group or individual consultations , use of other interventions components including exercise , use of goals and use of support tools like food diaries , coaching , including email or text message support . Background Around half of all women of reproductive age are either overweight or obese,1,2,3 with women aged 25‐34 years having a greater risk of substantial weight gain compared with men of all ages.1,4 Excessive gestational weight gain ( GWG ) and postpartum weight retention ( PPWR ) may play a significant role in long term obesity . Having one child doubles the five‐ and 10‐year obesity incidence for women , with many women who gain excessive weight during pregnancy remaining obese permanently.5 Excessive GWG and /or PPWR can also significantly contribute to short‐ and long‐term adverse health outcomes for mother , baby and future pregnancies.6,7 Maternal obesity increases the risk of pregnancy related complications such as pre‐eclampsia , gestational diabetes mellitus , stillbirth and the rate of caesarean section.8 Childhood obesity is a further long term complication of maternal obesity for offspring , which may persist in to adulthood.9 Excess GWG is also a risk factor for PPWR both in the short and long‐term.10,11 Nehring et al. conducted a meta‐ analysis with over 65,000 women showing that , compared to women who gained weight within recommendations during pregnancy , women with GWG above Institute of Medicine weight gain recommendations , 12 retained an additional 3.1 kg and 4.7 kg after three and greater than or equal to 15 years postpartum , respectively.13 The health risk associated with PPWR is highlighted in a study of 151,025 Swedish women followed between 1992 and 2001.The study identified the risk of adverse pregnancy outcomes for those who gained three or more units of Body Mass Index ( kg/m2 ) between consecutive pregnancies ( an average of two years ) was much higher compared with women whose BMI changed from ‐1.0 and 0.9 units.14 Long‐term chronic disease risk may also be affected by PPWR as weight retention at the end of the first year post‐partum has been found to be a predictor of maternal overweight 15 years later.15With around 14‐20 % of women retaining 5 kg or more 12 months postpartum,16,5 the risk of developing conditions like diabetes , metabolic syndrome and cardiovascular disease may be increased.17 It becomes evident that interventions which aim to support attainment of healthy weight both in the antenatal and postpartum periods are key health priorities for women during this life stage . Lifestyle factors of overweight , having poor diet quality , and not undertaking enough moderate‐to‐vigorous physical activity are amongst the top five predictors of mortality in women.18 Additionally it is noted that , for many women , pregnancy and the postpartum period are associated with a reduction in physical activity.19 It is known that a combination of poor dietary choices , an increase in sedentary time and reduction in physical activity are all contributors to the development of overweight and obesity . With this in mind , current research has focused on lifestyle interventions to limit GWG and PPWR . Thangaratinam et al. review ed 44 r and omized controlled trials ( 7278 women ) where interventions including diet , physical activity or both were evaluated for their influence on maternal weight during  pregnancy.20 Results indicate that all were significantly effective in reducing GWG compared with the control group . More specifically , dietary interventions were the most effective in reducing weight gain , with a mean weight loss of ‐3.84 kg compared with ‐0.72 kg and ‐1.06 kg for physical activity and the mixed ( diet plus physical activity ) approach , respectively.20 This finding is supported by Hill and colleagues ' recent systematic review of theory based interventions to limit GWG.21 Included studies in this review reported an underpinning theory base and were classified as adopting a dietary , physical activity or mixed approach . Hill et al. concluded that studies which included a diet intervention were significantly more effective at limiting GWG.21 In 2011 Tanentsapf et al. review ed the effect of dietary interventions alone for reducing GWG in normal weight , overweight and obese pregnant women.22 This review analysed 13 r and omized controlled trials and quasi‐r and omized controlled trials with a dietary intervention to prevent excessive GWG in women . The review concluded that dietary interventions during pregnancy were effective in reducing GWG with an effect of ‐1.92 kg ( n=1434 ) compared with the control group.22 Tanentsapf et al. identified that trials differed in the conduct of the interventions with various diet and non‐diet related components utilised . Dietary approaches were highly variable with some trials focusing only on calorie restriction and others included additional target macronutrient distribution for intake . Some trials further provided feedback based on maternal weight gain guidelines .12 Interventions also varied in delivery method with a variety of modes used , including face‐to‐face , individual or group consultations and /or written correspondence . The frequency of communication , despite the type or mix , also changed from trial to trial with additional methods via telephone , posted material s , feedback or food diaries utilised . The inclusion of physical activity in addition to diet intervention was also common . Whilst the recent review by Tanentsapf et al.22 identified that dietary interventions are effective in reducing GWG , the review did not investigate the impact that different intervention components , delivery methods or dietary counselling approaches had on gestational weight management . It remains unclear as to which intervention components optimize GWG in women . The impact of lifestyle interventions has also been investigated in the postpartum period . The recent systematic review from van der Pligt et al. reported seven of 11 studies review ed were successful in limiting PPWR.23 As with studies aim ed at limiting GWG , interventions included in van der Pligt et al. 's review differed greatly in their conduct . Six of these seven studies included both dietary and physical activity components for the intervention , with the final successful study including a diet only intervention . Five of the successful studies recruited overweight or obese women only . Intervention time varied considerably in successful studies with some running for as little at ten days , and others up to six months . Bertz et al. demonstrated that their 12‐week behavior modification intervention which targeted diet alone or diet and exercise , including two individual sessions with a dietitian and physical therapist , provision of scales for weight self‐monitoring and bi‐weekly text messages was successful in achieving significant weight loss following the intervention , and sustained at one year.24 The diet intervention and the diet and exercise intervention  yielded significant weight loss compared to the control . Following 12 weeks a reduction of ‐8.3 + /‐ 4.2 kg for diet intervention and ‐6.9 + /‐ 3.0 kg for diet and exercise was observed . Additionally after one year , the diet intervention showed ‐10.2 + /‐ 5.7 kg reduction and ‐7.3 + /‐ 6.3 kg for the diet and exercise intervention (p<0.001).24 Colleran et al. also found significant weight change results by implementing a 16‐week intervention which consisted of weekly individual sessions with a dietitian regarding calorie restriction , two additional home visits regarding exercise , weekly food diary completion and email support.25 The intervention group had greater weight loss compared to the control group ( ‐5.8 kg + /‐ 3.5 kg vs ‐1.6 kg + /‐ 5.4 kg ) . It can be seen that various methods have been utilized in investigating the impact of diet and physical activity interventions on PPWR . The review by van der Pligt et al.23 highlights the impact successful lifestyle interventions can have on postpartum weight change . However , this review did not investigate the different intervention strategies utilized . It remains unclear as to the optimal setting , delivery method , diet strategy , contact frequency or intervention length to limit PPWR . Previous systematic review s for both GWG and PPWR have focused on the effectiveness of lifestyle interventions as a whole for weight management in pregnant and postpartum women.20,23 And despite Tanentsapf et al. 's focus on dietary interventions for GWG,22 much is still unknown about the effectiveness of differing diet interventions over the antenatal and postpartum period . Specifically , the impact of differing diet intervention strategies on maternal weight gain is not known . Firstly , this systematic review will focus on whether  weight management interventions which include a dietary component  are effective in pregnant and postpartum women . In addition to this , this review will investigate the different intervention strategies utilized and their effectiveness in maternal weight management . A search of systematic review protocol data bases has shown that there is no current review underway for this topic Background Although many wearable devices for monitoring and tracking physical activity are available to consumers , relatively few research studies have been conducted to determine their efficacy in promoting health . Methods In this article , data on the use of consumer wearable devices in promoting healthy behaviors  are summarized based upon bibliographic search es in PubMed and Psychology and Behavioral Sciences Collection with relevant search terms through September 2016 . Results A total of 274 articles were identified in the bibliographic search es . By screening abstract s or full-text articles , six pre/post test trials and seven r and omized controlled trials were identified . In initial trials , consumer wearable devices have been shown to increase physical activity and help users lose weight . However , the number of studies completed to date is small and limited by small sample sizes , short study duration s , and uncertain generalizability of the findings . Conclusions Future studies should utilize r and omized controlled trial research design s , larger sample sizes , and longer study periods to better establish the efficacy of wearable devices in promoting physical activity . Additional research is needed to determine the feasibility and effectiveness of wearable devices in promoting physical activity and weight loss in community setting s including communities affected by health disparities . Studies focusing on children and adolescents are also needed BACKGROUND Studies have shown self-monitoring can modify health behaviors , including physical activity ( PA ) . This study tested the utility of a wearable sensor/device ( Fitbit ( ® ) One ™ ; Fitbit Inc. , San Francisco , CA ) and short message service ( SMS ) text-messaging prompts to  increase PA  in overweight and obese adults . MATERIAL S AND METHODS Sixty-seven adults wore a Fitbit One tracker for 6 weeks ; half were r and omized to also receive three daily SMS-based PA prompts . The Fitbit One consisted of a wearable tracker for instant feedback on performance and a Web site/mobile application ( app ) for detailed summaries . Outcome measures were objective ly measured steps and minutes of PA by intensity using two accelerometers : Actigraph ™ ( Pensacola , FL ) GT3X+ ( primary measure ) at baseline and Week 6 and Fitbit One ( secondary measure ) at baseline and Weeks 1 , 2 , 3 , 4 , 5 , and 6 . RESULTS Mixed-model repeated- measures analysis of primary measures indicated a significant within-group increase of + 4.3 ( st and ard error [SE]=2.0 ) min/week of moderate- to vigorous-intensity PA ( MVPA ) at 6-week follow-up ( p=0.04 ) in the comparison group ( Fitbit only ) , but no study group differences across PA levels . Secondary measures indicated the SMS text-messaging effect lasted for only 1 week : the intervention group increased by + 1,266 steps ( SE=491 ; p=0.01 ) , + 17.8 min/week MVPA ( SE=8.5 ; p=0.04 ) , and + 38.3 min/week total PA ( SE=15.9 ; p=0.02 ) compared with no changes in the comparison group , and these between-group differences were significant for steps ( p=0.01 ) , fairly/very active minutes ( p<0.01 ) , and total active minutes ( p=0.02 ) . CONCLUSIONS These data suggest that the Fitbit One achieved a small increase in MVPA at follow-up and that the SMS-based PA prompts were insufficient in increasing PA beyond 1 week . Future studies can test this intervention in those requiring less help and /or test strategies to increase participants ' engagement levels The use of self-monitoring as a tool to facilitate behavioral modification is common in many lifestyle-based weight loss interventions . Electronic tracking programs , including computer-based systems and smart phone applications , have been developed to allow individuals to self-monitor their behavior digitally . These programs offer an advantage over traditional self-report modalities in that they can provide users with direct feedback about dietary and /or physical activity adherence levels and thereby assist them in real-time decision making . This article describes the use of an Internet-based computerized tracking system ( CTS ) that was developed specifically for the POUNDS LOST study , a 2-year r and omized controlled trial design ed to test the efficacy of four macronutrient diets for weight and fat reduction in healthy , overweight men and women ( body mass index range = 25.0–39.9 kg/m2 ) . The CTS served many functions in this study , including data collection , dietary and exercise assessment and feedback , messaging system , and report generation . Across all groups , participants with high usage of the CTS during the initial 8 weeks lost greater amounts of weight than participants with low usage ( 8.7 % versus 5.5 % of initial body weight , respectively ; p < .001 ) at week 32 . Rates of CTS utilization were highest during the first year of this 2-year intervention , and utilization of the CTS declined steadily over time . The unique features of the CTS combined with technological developments , such as smart phone applications , offer significant potential to improve the user 's self-monitoring experience and adherence to health promotion programs design ed specifically for individuals with obesity and type 2 diabetes Background Physical inactivity is a growing concern for society and is a risk factor for cardiovascular disease , obesity , and other chronic diseases . Objective This study aim ed to determine the efficacy of the Accupedo-Pro Pedometer mobile phone app intervention , with the goal of increasing daily step counts in young adults . Methods Mobile phone users ( n=58 ) between 17 - 26 years of age were r and omized to one of two conditions ( experimental and control ) . Both groups downloaded an app that recorded their  daily step counts .  Baseline data were recorded and followed-up at 5 weeks . Both groups were given a daily walking goal of 30 minutes , but the experimental group participants were told the equivalent goal in steps taken , via feedback from the app . The primary outcome was daily step count between baseline and follow-up . Results A significant time x group interaction effect was observed for daily step counts ( P=.04 ) . Both the experimental ( P<.001 ) and control group ( P=.03 ) demonstrated a significant increase in daily step counts , with the experimental group walking an additional 2000 steps per day . Conclusions The results of this study demonstrate that a mobile phone app can significantly increase physical activity in a young adult sample by setting specific goals , using self-monitoring , and feedback Background The SenseWear ™ Armb and ( SWA ) ( BodyMedia , Inc. Pittsburgh , PA ) is a physical activity and lifestyle monitor that objective ly and accurately measures free-living energy balance and sleep and includes software for self-monitoring of daily energy expenditure and energy intake . The real-time feedback of the SWA can improve individual self-monitoring and , therefore , enhance weight loss outcomes . Methods We recruited 197 sedentary overweight or obese adults ( age , 46.8 ± 10.8 y ; body mass index ( BMI ) , 33.3 ± 5.2 kg/m2 ; 81 % women , 32 % African-American ) from the greater Columbia , South Carolina area . Participants were r and omized into 1 of 4 groups , a self-directed weight loss program via an evidence -based weight loss manual ( St and ard Care , n = 50 ) , a group-based behavioral weight loss program ( GWL , n = 49 ) , the armb and alone ( SWA-alone , n = 49 ) , or the GWL plus the armb and ( GWL+SWA , n = 49 ) , during the 9-month intervention . The primary outcome was change in body weight and waist circumference . A mixed-model repeated- measures analysis compared change in the intervention groups to the st and ard care group on weight and waist circumference status after adjusting for age , sex , race , education , energy expenditure , and recruitment wave . Results Body weight was available for 62 % of participants at 9 months ( 52 % st and ard care , 70 % intervention ) . There was significant weight loss in all 3 intervention groups ( GWL , 1.86 kg , P = 0.05 ; SWA-alone , 3.55 kg , P = 0.0002 ; GWL+SWA , 6.59 kg , P < 0.0001 ) but not in the St and ard Care group ( 0.89 kg , P = 0.39 ) at month 9 . Only the GWL+SWA group achieved significant weight loss at month 9 compared to the St and ard Care group ( P = 0.04 ) . Significant waist circumference reductions were achieved in all 4 groups at month 9 ( St and ard Care , 3.49 cm , P = 0.0004 ; GWL , 2.42 cm , P = 0.008 ; SWA-alone , 3.59 cm , P < 0.0001 ; GWL+SWA , 6.77 cm , P < 0.0001 ) , but no intervention group had significantly reduced waist circumference compared to the St and ard Care group . Conclusions Continuous self-monitoring from wearable technology with real-time feedback may be particularly useful to enhance lifestyle changes that promote weight loss in sedentary overweight or obese adults . This strategy , combined with a group-based behavioral intervention , may yield optimal weight loss . Trial Registration Clinical Trials.gov : Background Low physical activity is a major public health problem . New cost-effective approaches that stimulate meaningful long-term changes in physical activity are required , especially within primary care setting s. It is becoming clear that there are various dimensions to physical activity with independent health benefits . Advances in technology mean that it is now possible to generate multidimensional physical activity ‘ profiles ’ that provide a more complete representation of physical activity and offer a variety of options that can be tailored to the individual . Mi-PACT is a r and omised controlled trial design ed to examine whether personalised multidimensional physical activity feedback and self-monitoring alongside trainer-supportive sessions increases physical activity and improves health outcomes in at-risk men and women . Methods / Design We aim to recruit 216 patients from within primary care aged 40 to 70 years and at medium or high risk of cardiovascular disease and /or type II diabetes mellitus . Adopting an unequal allocation ratio ( intervention : control ) of 2:1 , participants will be r and omised to one of two groups , usual care or the intervention . The control group will receive usual care from their general practitioner ( GP ) and st and ardised messages about physical activity for health . The intervention group will receive physical activity monitors and access to a web-based platform for a 3-month period to enable self-monitoring and the provision of personalised feedback regarding the multidimensional nature of physical activity . In addition , this technology-enabled feedback will be discussed with participants on 5 occasions during supportive one-to-one coaching sessions across the 3-month intervention . The primary outcome measure is physical activity , which will be directly assessed using activity monitors for a 7-day period at baseline , post intervention and at 12 months . Secondary measures ( at these time-points ) include weight loss , fat mass , and markers of metabolic control , motivation and well-being . Discussion Results from this study will provide insight into the effects of integrated physical activity profiling and self-monitoring combined with in-person support on physical activity and health outcomes in patients at risk of future chronic disease . Trial registration IS RCT N18008011 Trial registration date : 31 July Purpose . The SenseWear Armb and ( SWA ) is a multisensor activity monitor that can be used in daily life to assess an individual 's physical activity level ( PAL ) . The primary goal of this study was to analyze the impact of different types of feedback on the PAL of Flemish employees . Methods / Design . We recruited 320 sedentary employees ( age , 41.0 ± 10.7 years ; BMI , 26.2 ± 4.2 kg/m2 ) to participate in the 12-month study . Participants were r and omized into one of four intervention groups after being measured for 7 days and nights by means of the SWA : ( 1 ) a minimal intervention group received no feedback ( MIG , n = 56 ) ; ( 2 ) a pedometer group was provided only information on their daily step count ( PG , n = 57 ) ; ( 3 ) a display group received feedback on calories burned , steps taken , and minutes of physical activity by means of the SWA display ( DG , n = 57 ) ; ( 4 ) a coaching group also received the display and had weekly meetings with a Personal Coach ( CoachG , n = 57 ) . We hypothesize that participants receiving feedback ( SG , DG , and CoachG ) will have a greater increase in physical activity outcome variables compared to participants of the minimal intervention group Background Physical inactivity ranks as a major contributing factor in the development and progression of chronic disease . Lifestyle interventions reduce the progression of chronic disease , however , compliance decreases over time and health effects only persist as long as the new lifestyle is maintained . Telephone counselling ( TC ) is an effective way to provide individuals with ongoing support to maintain lifestyle changes . Remote physical activity monitoring and feedback ( RAMF ) via interactive technologies such as activity trackers and smartphones may be a cost-effective alternative to TC , however , this comparison has not been made . This study , therefore , aims to determine the effect of ongoing feedback ( TC vs. RAMF ) on the maintenance of physical activity following a 12-week individualised lifestyle program , and the effect of this on health risk factors and health services usage . Methods and design A r and omised controlled trial with a parallel groups design . A total of 150 adults ( ≥60 years ) who participate in a 12-week face-to-face individualised lifestyle program will be r and omised to twelve months of RAMF ( n = 50 ) , TC ( n = 50 ) , or usual care ( n = 50 ) . Participants r and omised to RAMF will use a smartphone activity tracker app , synced to a wrist worn activity tracker , to provide them with automated feedback regarding compliance to prescribed activity targets . Telephone counselling involves a follow-up phone call every fortnight for the first three months and a monthly call for the remaining nine months of the follow-up period . The primary outcome measures are physical activity compliance ( accelerometry and Active Australia survey ) . Secondary outcome measures include cardiorespiratory fitness , muscle strength , dynamic balance , quality of life , blood pressure , body composition , and health services usage . Measures will be made before and after the individualised lifestyle program , and at three , six and twelve months during the intervention . Discussion The results of this study will help to determine the efficacy of RAMF devices on compliance to prescribed physical activity compared to the current gold st and ard of TC . If the remote monitoring proves effective , it may provide a cost efficient alternative method of assisting maintenance of behaviour change from lifestyle interventions .Trial registration ACTRN12615001104549 . Retrospectively Registered 20/10/2015 The mechanisms that underlie successful initiation and adherence to physical activity regimens are not well understood . Few theoretical models have used consistent explanatory variables that are theory-driven and many findings that use extant models are equivocal . Social Cognitive Theory ( SCT ) as presented by B and ura ( 1986 , 1997 ) appears to have strong promise as a guide to underst and ing physical activity behaviors and developing clinical ly relevant interventions to promote the initiation and maintenance of physical activity . This critical systematic review of research using SCT was completed to determine the predictive ability of model constructs in explaining physical activity behavior and in identifying key intervention components found to enhance physical activity initiation and maintenance . Following review for quality and adequacy , published research during the years 1990 - 1998 contained 27 studies that examined the relationship between the construct of SCT , self-efficacy  , and physical activity .  All of the descriptive studies found a statistically significant relationship between self-efficacy and exercise behavior . Intervention studies demonstrated that participation in an exercise program promoted self-efficacy , and that programs design ed to increase outcome expectations and self-efficacy significantly increased exercise behavior . Due to the central ity of self-efficacy in many of the social psychological theories that help explain the attitude-intention-behavior triad , a strong need remains to design interventions to maximize its usefulness . Clear , generalizable , systematic and theoretically comprehensive , r and omized , controlled studies are needed to underst and the usefulness of the construct Background Direct-to-consumer trackers and devices have potential to enhance theory-based physical activity interventions by offering a simple and pleasant way to help participants self-monitor their behavior . A secondary benefit of these devices is the opportunity for investigators to objective ly track adherence to physical activity goals across weeks or even months , rather than relying on self-report or a small number of accelerometry wear periods . The use of consumer trackers for continuous monitoring of adherence has considerable potential to enhance physical activity research , but few studies have been published in this rapidly developing area . Objective The objective of the study was to assess the trajectory of physical activity adherence across a 16-week self-monitoring intervention , as measured by the Fitbit tracker . Methods Participants were 25 overweight or obese , postmenopausal women enrolled in the intervention arm of a r and omized controlled physical activity intervention trial . Each participant received a 16-week technology-based intervention that used the Fitbit physical activity tracker and website . The overall study goal was 150 minutes/week of moderate to vigorous intensity physical activity ( MVPA ) and 10,000 steps/day ; however , goals were set individually for each participant and up date d at Week 4 based on progress . Adherence data were collected by the Fitbit and aggregated by Fitabase . Participants also wore an ActiGraph GT3X+ accelerometer for 7 days prior to the intervention and again during Week 16 . Results The median participant logged 10 hours or more/day of Fitbit  wear on 95 % of the 112 intervention days , with no significant decline in wear over the study period . Participants averaged 7540 ( SD 2373 ) steps/day and 82 minutes/week ( SD 43 ) of accumulated “ fairly active ” and “ very active ” minutes during the intervention . At Week 4 , 80 % ( 20/25 ) of women chose to maintain/increase their individual MVPA goal and 72 % ( 18/25 ) of participants chose to maintain/increase their step goal . Physical activity levels were relatively stable after peaking at 3 weeks , with only small declines of 8 % for steps ( P=.06 ) and 14 % for MVPA ( P=.05 ) by 16 weeks . Conclusions These data indicate that a sophisticated , direct-to-consumer activity tracker encouraged high levels of self-monitoring that were sustained over 16 weeks . Further study is needed to determine how to motivate additional gains in physical activity and evaluate the long-term utility of the Fitbit tracker as part of a strategy for chronic disease prevention . Trial Registration Clinical trials.gov NCT01837147 ; http:// clinical trials.gov/ct2/show/NCT01837147 ( Archived by WebCite at http://www.webcitation.org/6d0VeQpvB Assessing levels of  physical activity ( PA ) and providing feedback about these levels might have an effect on participant ’s PA behavior . This study discusses the effect of different levels of feedback — from minimal to use of a feedback display and coach — on PA over a 4-week intervention period . PA was measured at baseline , during and immediately after the intervention . Participants ( n = 227 ) were r and omly assigned to a Minimal Intervention Group ( MIG-no feedback ) , Pedometer Group ( PG-feedback on steps taken ) , Display Group ( DG-feedback on steps , minutes of moderate to vigorous physical activity and energy expenditure ) or Coaching Group ( CoachG-same as DG with need-supportive coaching ) . Two-way ANCOVA showed no significant Group × Time interaction effect for the different PA variables between the MIG and PG . Also no differences emerged between PG and DG . As hypothesized , CoachG had higher PA values throughout the intervention compared with DG . Self-monitoring using a pedometer result ed in more steps compared with a no-feedback condition at the start of the intervention . However , adding individualized coaching seems necessary to increase the PA level until the end of the intervention Background Most women with breast cancer experience a progressive weight gain during and after treatment . Obesity is associated with an increased risk of recurrence , contralateral breast cancer , and death . Physical activity after cancer diagnosis has been reported to have positive effects on body composition and quality of life . We present the protocol of the InForma study , a trial testing the efficacy of an intervention on weight loss ( ≥5 % of the baseline body weight ) in a group of overweight or obese breast cancer survivors . Methods / design This is a four-arm r and omized controlled trial . Patients will receive a 6-month intervention and be followed for a further 18 months . Intervention is design ed to improve adherence to a healthy diet and /or to increase physical activity , taking advantage of a wrist-based activity monitor .  Participants will be recruited among overweight or obese breast cancer patients treated at the European Institute of Oncology , after completion of eventual adjuvant chemotherapy and /or radiotherapy . It is envisaged that 260 patients will be r and omized into four arms : Dietary Intervention ; Physical Activity Intervention ; Physical Activity and Dietary Intervention ; and Less Intensive Intervention . Women will be offered individualized counseling consisting of face-to face discussion and phone calls in addition to group meetings . A motivational interviewing approach will be used to encourage health behavior change . All participants will be given a pedometer device to monitor their physical activity . Participants ’ dietary intake will be repeatedly assessed using a vali date d food frequency question naire . Participants ’ quality of life and anxiety will be assessed with the Functional Assessment of Cancer Therapy-Breast and the State-Trait Anxiety Inventory question naires . Blood sample s will be collected at baseline and follow-up visits to assess lipid and hormone profiles . Body composition will be repeatedly assessed using bioelectrical impedance vector analysis for identifying changes of fat and fat-free mass . Women allocated to the less intensive intervention arm will be considered as the control group . Discussion While there is a rising concern about the role of obesity in cancer recurrence and survival , this trial with its multi-arm design , motivational approach and use of a pedometer device will provide important insights regarding the most effective approach in promoting weight control in breast cancer survivors . Trial registration IS RCT N53325751 ( registration date : 16 October 2015 ) ; Clinical Trials.gov NCT02622711 ( registration date : 2 December 2015 ) Non-communicable diseases ( NCDs ) are emerging as the predominant global health challenge of this century . Physical inactivity is one of the primary risk factors for NCDs . Therefore , increasing physical activity levels is a public health imperative . The arrival of affordable wearable technologies , such as wireless pedometers , provides one strategy for encouraging walking . However , the effectiveness of these technologies in promoting sustained behavior change has not been established . Insights from economics suggest that incentives may be a useful strategy for increasing maintenance and effectiveness of behavior change interventions , including physical activity interventions that rely on wearable technologies . The aim of this trial is to test the effectiveness of a common wireless pedometer with or without one of two types of incentives ( cash or donations to charity ) for reaching weekly physical activity goals . We present here the design and baseline characteristics of participants of this four arm r and omized controlled trial . 800 full-time employees ( desk-bound office workers ) belonging to 15 different worksites ( on average , 53 ( sd : 37 ) employees at each worksite ) were successfully r and omized to one of four study arms . If shown to be effective , wearable technologies in concert with financial incentives may provide a scalable and affordable health promotion strategy for governments and employers seeking to increase the physical activity levels of their constituents Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors . Despite an explosion of mobile phone applications aim ed at physical activity and other health behaviors , few have been based on theoretically derived constructs and empirical evidence . Eighty adults ages 45 years and older who were insufficiently physically active , engaged in prolonged daily sitting , and were new to smartphone technology , participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence . An “ analytically ” framed custom application focused on personalized goal setting , self-monitoring , and active problem solving around barriers to behavior change . A “ socially ” framed custom application focused on social comparisons , norms , and support . An “ affectively ” framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar , whose movements and behaviors reflected the physical activity and sedentary levels of the user . To explore the applications ' initial efficacy in changing regular physical activity and leisure-time sitting , behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity question naire and the Australian sedentary behavior question naire . User acceptability of and satisfaction with the applications was explored via a post-intervention user survey . The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period . Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology . Preliminary data exploring sustained use of the applications across a longer time period yielded promising results . The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors BACKGROUND An activity tracker combined with a smartphone application ( smartcare ) may help people track and receive feedback on their own activities . However , activity trackers themselves generally fail to drive long-term sustained engagement for a majority of users . One potential strategy for increasing the effectiveness of smartcare is through the use of incentives . The purpose of this pilot r and omized trial is to test the feasibility of our intervention and to assess the extent to which smartcare with or without financial incentives can increase physical activity levels and reduce weight over a 12-week period . METHODS / DESIGN This study employs a three-arm , open-label r and omized controlled trial design : control ( st and ard basic education ) , smartcare , and smartcare plus financial incentives .  Male university students with body mass index ≥ 27 are enrolled . Our primary and secondary endpoints are the amount of weight loss and the level of physical activity respectively . The weight loss goal is 3 % of baseline at week 4 , 5 % at week 8 , and 7 % at week 12 . The daily physical activity goal was individualized according to the participants ' weight . Process incentives are accumulated when participants met daily physical activity goals , and outcome incentives are provided when they met weight reduction goals . DISCUSSION Given the global increase in physical inactivity and obesity , there is a growing need for effective , scalable , and affordable health promotion strategies . Our proof-of-concept study will provide the evidence for the combination of rising health promotion technology of activity trackers and smartphone applications with the modern concept of behavioral economics using financial incentives Background Loss of upper limb function affects up to 85 % of acute stroke patients . Recovery of upper limb function requires regular intensive practise of specific upper limb tasks . To enhance intensity of practice interventions are being developed to encourage patients to undertake self-directed exercise practice . Most interventions do not translate well into everyday activities and stroke patients continue to find it difficult remembering integration of upper limb movements into daily activities . A wrist-worn device has been developed that monitors and provides ‘ live ’ upper limb activity feedback to remind patients to use their stroke arm in daily activities ( The CueS wristb and ) . The aim of this trial is to assess the feasibility of a multi-centre , observer blind , pilot r and omised controlled trial of the CueS wristb and in clinical stroke services . Methods / design This pilot r and omised controlled feasibility trial aims to recruit 60 participants over 15 months from North East Engl and . Participants will be within 3 months of stroke which has caused new reduced upper limb function and will still be receiving therapy . Each participant will be r and omised to an intervention or control group . Intervention participants will wear a CueS wristb and ( between 8 am and 8 pm ) providing “ live ” feedback towards pre-set movement goals through a simple visual display and vibration prompts whilst undertaking a 4-week upper limb therapy programme ( review ed twice weekly by an occupational/physiotherapist ) . Control participants will also complete the 4-week upper limb therapy programme but will wear a ‘ sham ’ CueS wristb and that monitors upper limb activity but provides no feedback . Outcomes will determine study feasibility in terms of recruitment , retention , adverse events , adherence and collection of descriptive clinical and accelerometer motor performance data at baseline , 4 weeks and 8 weeks . Discussion The WAVES study will address an important gap in the evidence base by reporting the feasibility of undertaking an evaluation of emerging and affordable technology to encourage impaired upper limb activity after stroke . The study will establish whether the study protocol can be supported by clinical stroke services , thereby informing the design of a future multi-centre r and omised controlled trial of clinical and cost-effectiveness . Trial registration IS RCT N:82306027 . Registered 12 July 2016 Background  Physical activity  is an important aspect in the treatment of patients with chronic obstructive pulmonary disease or type-2 diabetes . A monitoring and feedback tool combined with guidance by a primary care provider might be a successful method to enhance the level of physical activity in these patients . As a prerequisite for useful technology , it is important to involve the end-users in the design process from an early stage . Objective The aim of this study was to investigate the user requirements for a tool to stimulate physical activity  , embedded in primary care practice . The leading principle of this tool is to change behavior by self-monitoring , goal - setting , and feedback . Methods The research team collected qualitative data among 15 patients , 16 care professionals , and several experts . A prototype was developed in three stages . In stage 1 , the literature was search ed to identify end-users and context . In stage 2 , the literature , experts and patient representatives were consulted to set up a use case with the general idea of the innovation . In stage 3 , individual interviews and focus groups were held to identify the end-user requirements . Based on these requirements a prototype was built by the engineering team . Results The development process has led to a tool that generally meets the requirements of the end-users . A tri-axial activity sensor  , worn on the hip , is connected by Bluetooth to a smartphone . In an app , quantitative feedback is given about the amount of activity and goals reached by means of graphical visualization , and an image shows a sun when the goal is reached . Overviews about activity per half an hour , per day , week , and month are provided . In the menu of the app and on a secured website , patients can enter information in individual sessions or read feedback messages generated by the system . The practice nurse can see the results of all patients on a secure webpage and can then discuss the results and set personalized goals in consultation with the patient . Conclusions This study demonstrates that a user-centered approach brings in valuable details ( such as the requirements for feedback in activity minutes per day ) to improve the fit between the user , technology , and the organization of care , which is important for the usability and acceptability of the tool . The tool embedded in primary care will be evaluated in a r and omized controlled trial Earlier studies revealed that visual feedback has contributed in the management of neuromuscular as well as psychiatric disorders ; however , it has not yet been applied in rheumatology . Visual feedback is a relatively new tool that enables the patient to visualize as well as monitor a real-time change of their disease activity parameters as well as the patient ’s reported outcome measures . Integrating electronic data recording in the st and ard rheumatology clinical practice made visual feedback possible . To evaluate the feasibility of using the visual feedback in patients with early inflammatory arthritis ( EA ) and how ubiquitous computing technology can improve the patients ’ compliance and adherence to therapy , this was a double-blind r and omized controlled study , which included 111 patients diagnosed to have EA according to the new ACR/EULAR criteria . All patients received disease-modifying antirheumatic drugs ( DMARDs ) therapy and monitored regularly over the period of 1 year . By the 6th month of treatment , the patients were r and omly allocated to an active group ( 55 patients ) to whom the visual feedback ( visualization of charts showing the progression of disease activity parameters ) was added to their management protocol , and a control group ( 56 patients )  who continued their st and ard management protocol s. The patients were monitored for another 6-months period . All the patient ’s disease activity parameters , patient reported outcome measures ( PROMs ) , medications , scores of falls , and cardiovascular risks were recorded electronically . Primary outcome was the change in the patients ’ adherence to their medications , disease activity score ( DAS-28 ) , and PROMs : pain score , patient global assessment , functional disability , and quality of life . Secondary outcome was the answers to a question naire completed by every patient in both the active group and control group ( using Visual Analogue Scale ) by the end of 1 year of management , to rate from the patient ’s perspective the impact of the management protocol , whether using the st and ard or visual feedback approach , on them and their disease . The visual feedback provided a significant greater reduction in disease activity parameters as well as improvement of the patients ’ adherence to antirheumatic therapy ( P < 0.01 ) . Also stopping the DMARDs therapy because of intolerance was significantly less in the active group . Concerns about the future was significantly less in the active group whereas inability to coup with daily life and disease stress were significantly more among the control group . The improvement of disease activity parameters was associated with improvement in functional disability and quality of life scores . Mean changes in disease parameters showed no significant differences at 3–6 months of therapy but differences were statistically significant at 12-months follow-up ( P < 0.01 ) . Medication compliance was significantly correlated with changes in all measured disease parameters . By recording and monitoring disease activity parameters electronically and incorporating the visual feedback approach into clinical practice , a new experience can be created . Visual feedback enabled the patients to see how they are doing regarding their disease activity and helps to optimize their adherence to their treatment . Visual feedback had a positive and significant impact on the disease activity control
Conclusion These studies provide preliminary evidence suggesting that EAMS can increase physical activity and decrease weight significantly , but their efficacy compared to other interventions has not yet been demonstrated .
Background Obesity is a growing global health concern that may lead to cardiovascular disease , type II diabetes , and cancer .
Several systematic review s have shown that technology is successful in combating obesity through increased physical activity , but there is no known review on interventions that use an electronic activity monitor system ( EAMS ) .
EAMSs are defined as a wearable device that objective ly measures lifestyle physical activity and can provide feedback , beyond the display of basic activity count information , via the monitor display or through a partnering application to elicit continual self-monitoring of activity behavior .
These devices improve upon st and ard pedometers because they have the ability to provide visual feedback on activity progression , verbal encouragement , and social comparison .
This systematic review aim ed to synthesize the efficacy and feasibility results of EAMSs within published physical activity interventions .