The effect of ongoing feedback on physical activity levels following an exercise intervention in older adults: a randomised controlled trial protocol 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 influence of a consumer-wearable activity tracker on sedentary time and prolonged sedentary bouts: secondary analysis of a randomized controlled trial Wearable Activity Technology And Action-Planning (WATAAP) to promote physical activity in cancer survivors: Randomised controlled trial protocol A Community-Based Physical Activity Counselling Program for People With Knee Osteoarthritis: Feasibility and Preliminary Efficacy of the Track-OA Study Organizational-Level Strategies With or Without an Activity Tracker to Reduce Office Workers’ Sitting Time: Rationale and Study Design of a Pilot Cluster-Randomized Trial Effect and Process Evaluation of a Smartphone App to Promote an Active Lifestyle in Lower Educated Working Young Adults: Cluster Randomized Controlled Trial 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. 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Effects of a 12‐week mHealth program on peak VO2 and physical activity patterns after completing cardiac rehabilitation: A randomized controlled trial Promoting physical activity using an activity monitor and a tailored web-based advice: design of a randomized controlled trial [ISRCTN93896459] Loss‐Framed Financial Incentives and Personalized Goal‐Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial Continuous glucose monitoring counseling improves physical activity behaviors of individuals with type 2 diabetes: A randomized clinical trial. Daily physical activity in adults with mild and moderate learning disabilities: is there enough? Physical activity social support and middle- and older-aged minority women: results from a US survey. Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical 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. Physical activity, sedentary behavior and total wellness changes among sedentary adults: a 4-week randomized controlled trial The mPED randomized controlled clinical trial: applying mobile persuasive technologies to increase physical activity in sedentary women protocol Use of a Computerized Tracking System to Monitor and Provide Feedback on Dietary Goals for Calorie-Restricted Diets: The POUNDS LOST Study Implementation and effectiveness of a primary care based physical activity counselling scheme. Can Exergaming Contribute to Improving Physical Activity Levels and Health Outcomes in Children? Effect of a Web-Based Intervention to Promote Physical Activity and Improve Health Among Physically Inactive Adults: A Population-Based Randomized Controlled Trial What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol Relationships of physical activity with dietary behaviors among adults. Chronic obstructive pulmonary disease self-management activation research trial (COPD-SMART): design and methods. Cost-effectiveness of alternative approaches for motivating activity in sedentary adults: results of Project STRIDE. Older women and physical activity: using the telephone to walk. Impact of a nurse-directed, coordinated school health program to enhance physical activity behaviors and reduce body mass index among minority children: a parallel-group, randomized control trial. 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Trial protocol Prevalence of Physical Activity in the United States: Behavioral Risk Factor Surveillance System, 2001 A 30‐month worksite‐based lifestyle program to promote cardiovascular health in middle‐aged bank employees: Design of the TANSNIP‐PESA randomized controlled trial The Effect of Tailored Web-Based Feedback and Optional Telephone Coaching on Health Improvements: A Randomized Intervention Among Employees in the Transport Service Industry Cost-effectiveness of lifestyle and structured exercise interventions in sedentary adults: results of project ACTIVE. Building a multiple modality, theory-based physical activity intervention: The development of CardiACTION! An overview and process evaluation of TeleWalk: a telephone-based counseling intervention to encourage walking in older adults. 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 Multidimensional individualised Physical ACTivity (Mi-PACT) – a technology-enabled intervention to promote physical activity in primary care: study protocol for a randomised controlled trial
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 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 Objective A recent meta- analysis surmised pedometers were a useful panacea to independently reduce sedentary time ( ST ) . To further test and exp and on this deduction , we analyzed the ability of a consumer-wearable activity tracker to reduce ST and prolonged sedentary bouts ( PSB ) . We originally conducted a 12-month r and omized control trial where 800 employees from 13 organizations were assigned to control , activity tracker  , or one of two activity tracker plus incentive groups design ed to increase step count . The primary outcome was accelerometer measured moderate-to-vigorous physical activity . Results We conducted a secondary analysis on accelerometer measured daily ST and PSB bouts . A general linear mixed model was used to examine changes in ST and prolonged sedentary bouts , followed by between-group pairwise comparisons . Regression analyses were conducted to examine the association of changes in step counts with ST and PSB . The changes in ST and PSB were not statistically significant and not different between the groups ( P < 0.05 ) . Increases in step counts were concomitantly associated with decreases in ST and PSB , regardless of intervention ( P < 0.05 ) . Caution should be taken when considering consumer-wearable activity trackers as a means to reduce sedentary behavior . Trial registration NCT01855776 Registered : August 8 , Background / Objective : Colorectal and gynecologic cancer survivors are at cardiovascular risk due to comorbidities and sedentary behaviour , warranting a feasible intervention to increase physical activity . The Health Action Process Approach ( HAPA ) is a promising theoretical framework for health behaviour change , and wearable physical activity trackers offer a novel means of self-monitoring physical activity for cancer survivors . Method : Sixty-eight survivors of colorectal and gynecologic cancer will be r and omised into 12-week intervention and control groups . Intervention group participants will receive : a Fitbit Alta ™ to monitor physical activity , HAPA-based group sessions , booklet , and support phone-call . Participants in the control group will only receive the HAPA-based booklet . Physical activity ( using accelerometers ) , blood pressure , BMI , and HAPA constructs will be assessed at baseline , 12-weeks ( post-intervention ) and 24-weeks ( follow-up ) . Data analysis will use the Group x Time interaction from a General Linear Mixed Model analysis . Conclusions : Physical activity interventions that are acceptable and have robust theoretical underpinnings show promise for improving the health of cancer survivors Background Physical activity can improve health outcomes in people with knee osteoarthritis ( OA ) ; however , participation in physical activity is very low in this population . Objective The objective of our study was to assess the feasibility and preliminary efficacy of the use of wearables ( Fitbit Flex ) and telephone counselling by a physical therapist ( PT ) for improving physical activity in people with a physician-confirmed diagnosis of knee OA , or who have passed 2 vali date d criteria for early OA . Methods We conducted a community-based feasibility r and omized controlled trial . The immediate group ( n=17 ) received a brief education session by a physical therapist , a Fitbit Flex activity tracker , and a weekly telephone call for activity counselling with the physical therapist . The delayed group ( n=17 ) received the same intervention 1 month later . All participants were assessed at baseline ( T0 ) , and the end of 1 month ( T1 ) and 2 months ( T2 ) . Outcomes were ( 1 ) mean moderate to vigorous physical activity time , ( 2 ) mean time spent on sedentary behavior , ( 3 ) Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , and ( 4 ) Partners in Health Scale . Feasibility data were summarized with descriptive statistics . We used analysis of covariance to evaluate the effect of the group type on the outcome measures at T1 and T2 , after adjusting for blocking and T0 . We assessed planned contrasts of changes in outcome measures over measurement periods . Results We identified 46 eligible individuals ; of those , 34 ( 74 % ) enrolled and no one dropped out . All but 1 participant adhered to the intervention protocol . We found a significant effect , with the immediate intervention group having improved in the moderate to vigorous physical activity time and in the Partners in Health Scale at T0 to T1 compared with the delayed intervention group . The planned contrast of the immediate intervention group at T0 to T1 versus the delayed group at T1 to T2 showed a significant effect in the sedentary time and the KOOS symptoms subscale , favoring the delayed group . Conclusions This study demonstrated the feasibility of a behavioral intervention , supported by the use of a wearable device , to promote physical activity among people with knee OA . Trial Registration Clinical Trials.gov NCT02313506 ; https:// clinical trials.gov/ct2/show/NCT02313506 ( Archived by WebCite at http://www.webcitation.org/6r4P3Bub0 Background The office workplace is a key setting in which to address excessive sitting time and inadequate physical activity . One major influence on workplace sitting is the organizational environment . However , the impact of organizational-level strategies on individual level activity change is unknown . Further , the emergence of sophisticated , consumer-targeted wearable activity trackers that facilitate real-time self-monitoring of activity , may be a useful adjunct to support organizational-level strategies , but to date have received little evaluation in this workplace setting . Objective The aim of this study is to evaluate the feasibility , acceptability , and effectiveness of organizational-level strategies with or without an activity tracker on sitting , st and ing , and stepping in office workers in the short ( 3 months , primary aim ) and long-term ( 12 months , secondary aim ) . Methods This study is a pilot , cluster-r and omized trial ( with work teams as the unit of clustering ) of two interventions in office workers : organizational-level support strategies ( eg , visible management support , emails ) or organizational-level strategies plus the use of a waist-worn activity tracker ( the LUMOback ) that enables self-monitoring of sitting , st and ing , and stepping time and enables users to set sitting and posture alerts . The key intervention message is to ‘ St and Up , Sit Less , and Move More . ’ Intervention elements will be implemented from within the organization by the Head of Workplace Wellbeing . Participants will be recruited via email and enrolled face-to-face . Assessment s will occur at baseline , 3 , and 12 months . Time spent sitting , sitting in prolonged ( ≥30 minute ) bouts , st and ing , and stepping during work hours and across the day will be measured with activPAL3 activity monitors ( 7 days , 24 hours/day protocol ) , with total sitting time and sitting time during work hours the primary outcomes . Web-based question naires , LUMOback recorded data , telephone interviews , and focus groups will measure the feasibility and acceptability of both interventions and potential predictors of behavior change . Results Baseline and follow-up data collection has finished . Results are expected in 2016 . Conclusions This pilot , cluster-r and omized trial will evaluate the feasibility , acceptability , and effectiveness of two interventions targeting reductions in sitting and increases in st and ing and stepping in office workers . Few studies have evaluated these intervention strategies and this study has the potential to contribute both short and long-term findings Background Mobile technologies have great potential to promote an active lifestyle in lower educated working young adults , an under research ed target group at a high risk of low activity levels . Objective The objective of our study was to examine the effect and process evaluation of the newly developed evidence - and theory-based smartphone app “ Active Coach ” on the objective ly measured total daily physical activity ; self-reported , context -specific physical activity ; and self-reported psychosocial variables among lower educated working young adults . Methods We recruited 130 lower educated working young adults in this 2-group cluster r and omized controlled trial and assessed outcomes at baseline , posttest ( baseline+9 weeks ) , and follow-up ( posttest+3 months ) . Intervention participants ( n=60 ) used the Active Coach app ( for 9 weeks ) combined with a Fitbit activity tracker . Personal goals , practical tips , and educational facts were provided to encourage physical activity . The control group received print-based generic physical activity information . Both groups wore accelerometers for objective measurement of physical activity , and individual interviews were conducted to assess the psychosocial variables and context -specific physical activity . Furthermore , intervention participants were asked process evaluation questions and generalized linear mixed models and descriptive statistics were applied . Results No significant intervention effects were found for objective ly measured physical activity , self-reported physical activity , and self-reported psychosocial variables ( all P>.05 ) . Intervention participants evaluated the Active Coach app and the combined use with the Fitbit wearable as self-explanatory ( 36/51 , 70.6 % ) , user friendly ( 40/51 , 78.4 % ) , and interesting ( 34/51 , 66.7 % ) . Throughout the intervention , we observed a decrease in the frequency of viewing graphical displays in the app ( P<.001 ) ; reading the tips , facts , and goals ( P<.05 ) ; and wearing the Fitbit wearable ( P<.001 ) . Few intervention participants found the tips and facts motivating ( 10/41 , 24.4 % ) , used them to be physically active ( 8/41 , 19.6 % ) , and thought they were tailored to their lifestyle ( 7/41 , 17.1 % ) . Conclusions The lack of significant intervention effects might be due to low continuous user engagement . Advice or feedback that was not perceived as adequately tailored and the difficulty to compete with many popular commercial apps on young people ’s smartphones may be responsible for a decrease in the engagement . A st and -alone app does not seem sufficient to promote an active lifestyle among lower educated working young adults ; therefore , multicomponent interventions ( using both technological and human support ) , as well as context -specific sensing to provide tailored advice , might be needed in this population . Trial Registration Clinical Trials.gov NCT02948803 ; https:// clinical trials.gov/ct2/show/ results /NCT02948803 ( Archived by WebCite at http://www.webcitation.org/71OPFwaoA 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 INTRODUCTION Direct-to-consumer mHealth devices are a potential asset to behavioral research but rarely tested as intervention tools . This trial examined the accelerometer-based Fitbit tracker and website as a low-touch physical activity intervention . The purpose of this study is to evaluate , within an RCT , the feasibility and preliminary efficacy of integrating the Fitbit tracker and website into a physical activity intervention for postmenopausal women . METHODS Fifty-one inactive , postmenopausal women with BMI ≥25.0 were r and omized to a 16-week web-based self-monitoring intervention ( n=25 ) or comparison group ( n=26 ) . The Web-Based Tracking Group received a Fitbit , instructional session , and follow-up call at 4 weeks . The comparison group received a st and ard pedometer . All were asked to perform 150 minutes/week of moderate to vigorous physical activity ( MVPA ) . Physical activity outcomes were measured by the ActiGraph GT3X+ accelerometer . RESULTS Data were collected and analyzed in 2013 - 2014 . Participants were aged 60 ( SD=7 ) years with BMI of 29.2 ( 3.5 ) kg/m(2 ) . Relative to baseline , the Web-Based Tracking Group increased MVPA by 62 ( 108 ) minutes/week ( p<0.01 ) ; 10-minute MVPA bouts by 38 ( 83 ) minutes/week ( p=0.008 ) ; and steps by 789 ( 1,979 ) ( p=0.01 ) , compared to non-significant increases in the Pedometer Group ( between-group p=0.11 , 0.28 , and 0.30 , respectively ) . The Web-Based Tracking Group wore the tracker on 95 % of intervention days ; 96 % reported liking the website and 100 % liked the tracker . CONCLUSIONS The Fitbit was well accepted in this sample of women and associated with increased physical activity at 16 weeks . Leveraging direct-to-consumer mHealth technologies aligned with behavior change theories can strengthen physical activity interventions Background Physical activity ( PA ) reduces pain and improves functioning in people with knee osteoarthritis ( OA ) , but few people with the condition meet recommended PA guidelines . Successful intervention strategies to increase PA include goal setting , action planning , self-monitoring , and follow-up feedback from a healthcare professional . Recently developed consumer wearable activity trackers allow users to set activity goals , self-monitor daily goal -progress , and provide feedback on goal attainment . It is hypothesized that a multi-component physiotherapist-led intervention that includes a short ( 40-min ) education module , guided goal - setting and action planning , the use of a wristb and activity tracker , and weekly follow-up phone calls will lead to increased PA outcomes . Methods / design Thirty-six participants will be recruited from the community for a two-group pilot r and omized controlled trial with a stepped-wedge design using an intention-to-treat analysis . Computer-generated block r and omization will be performed using varying block sizes and a 1:1 allocation ratio . The 4-week intervention will be delivered immediately ( immediate-intervention group ) or after a 5-week delay ( delayed-intervention group ) . Outcome measures of pain and disability ( Knee Injury and OA Outcome Score ) , disease self-management ability ( Partners in Health Scale ) , and objective bouted moderate-to-vigorous PA and sedentary time ( BodyMedia SenseWear Mini Armb and ) will be collected at baseline ( week 0 ) and two follow-ups ( weeks 5 and 10 ) , for a total study duration of 11 weeks . Feasibility data relating to process , re source , management , and scientific elements of the trial will be collected . Outcome measure and feasibility data will be summarized , and an estimate of intervention efficacy will be obtained by regression model with planned comparisons . The trial began recruiting in February 2015 . To date , 34 subjects have been recruited . Discussion This study will evaluate the feasibility and preliminary efficacy of a novel intervention to promote  PA in people living with knee OA . The results will provide valuable information to inform a larger r and omized trial to assess intervention effectiveness . Trial registration Clinical Trials.gov Identifier : NCT02313506 ( registration date 8 December 2014 ) . First participant r and omized 20 February 2015 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 As wearable sensors/devices become increasingly popular to promote physical activity ( PA ) , research is needed to examine how and which components of these devices people use to increase their PA levels . AIMS ( 1 ) To assess usability and level of engagement with the Fitbit One and daily SMS-based prompts in a 6-week PA intervention , and ( 2 ) to examine whether use/ level of engagement with specific intervention components were associated with PA change . METHODS Data were analyzed from a r and omized controlled trial that compared ( 1 ) a wearable sensor/ device ( Fitbit One ) plus SMS-based PA prompts , and ( 2 ) Fitbit One only , among overweight/ obese adults ( N = 67 ) . We calculated average scores from Likert-type response items that assessed usability and level of engagement with device features ( e.g. , tracker , website , mobile app , and SMS-based prompts ) , and assessed whether such factors were associated with change in steps/day ( using Actigraph GT3X+ ) . RESULTS Participants reported the Fitbit One was easy to use and the tracker helped to be more active . Those who used the Fitbit mobile app ( 36 % ) vs. those who did not ( 64 % ) had an increase in steps at 6-week follow-up , even after adjusting for previous web/app use : + 545 steps/ day ( SE = 265 ) vs. -28 steps/ day ( SE = 242 ) ( p = .04 ) . CONCLUSIONS Level of engagement with the Fitbit One , particularly the mobile app , was associated with increased steps . Mobile apps can instantly display summaries of PA performance and could optimize self-regulation to activate change . More research is needed to determine whether such modalities might be cost-effective in future intervention research and practice 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 Background Many adults are insufficiently physically active , have prolonged sedentary behaviour and report poor sleep . These behaviours can be improved by interventions that include education , goal setting , self-monitoring , and feedback strategies . Few interventions have explicitly targeted these behaviours simultaneously or examined the relative efficacy of different self-monitoring methods . Methods / Design This study aims to compare the efficacy of two self-monitoring methods in an app-based multi-behaviour intervention to improve objective ly measured physical activity , sedentary , and sleep behaviours , in a 9 week 2–arm r and omised trial . Participants will be adults ( n = 64 ) who report being physically inactive , sitting > 8 h/day and frequent insufficient sleep ( ≥14 days out of last 30 ) . The “ Balanced ” intervention is delivered via a smartphone ‘ app ’ , and includes education material s ( guidelines , strategies to promote change in behaviour ) , goal setting , self-monitoring and feedback support . Participants will be r and omly allocated to either a device-entered or user-entered self-monitoring method . The device-entered group will be provided with a activity tracker to self-monitor behaviours . The user-entered group will recall and manually record behaviours . Assessment s will be conducted at 0 , 3 , 6 , and 9 weeks . Physical activity , sedentary behaviour and sleep-wake behaviours will be measured using the wrist worn Geneactiv accelerometer . Linear mixed models will be used to examine differences between groups and over time using an alpha of 0.01 . Discussion This study will evaluate an app-based multi-behavioural intervention to improve physical activity , sedentary behaviour and sleep ; and the relative efficacy of two different approaches to self-monitoring these behaviours . Outcomes will provide information to inform future interventions and self-monitoring targeting these behaviours . Trial registration ACTRN12615000182594 ( Australian New Zeal and Clinical Trials Registry . Registry URL : www.anzctr.org.au ; registered prospect ively on 25 February 2015 ) 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 BACKGROUND Physical activity is positively associated with survival and quality of life among breast cancer survivors . Despite these benefits , the majority of breast cancer survivors are insufficiently active . The potential health benefits of reducing sedentary behaviour ( sitting time ) in this population have not been extensively investigated . The ACTIVATE Trial will evaluate the efficacy of an intervention that combines wearable technology ( the Garmin Vivofit2 ® ) with traditional behavioural change approaches to increase physical activity and reduce sedentary behaviour performed by breast cancer survivors . METHODS / DESIGN This r and omised controlled trial includes inactive , postmenopausal women diagnosed with stage I-III breast cancer who have completed their primary treatment . Participants are r and omly assigned to the primary intervention group ( Garmin Vivofit2 ® ; behavioural feedback and goal setting session ; and , five telephone-delivered health coaching sessions ) or to the wait-list control group . The primary intervention is delivered over a 12-week period . The second 12-week period comprises a maintenance phase for the primary intervention group , and an abridged intervention ( Garmin Vivofit2 ® only ) for the wait-list control group . Moderate- to vigorous-intensity physical activity ( MVPA ) and sedentary behaviour are assessed by accelerometry at baseline ( T1 ) , end of intervention ( T2 ) , and end of maintenance phase ( T3 ) . DISCUSSION The ACTIVATE Trial is one of the first studies to incorporate wearable technology into an intervention for cancer survivors . If the use of wearable technology ( in combination with behaviour change strategies , or alone ) proves efficacious , it may become an inexpensive and sustainable addition to the health promotion strategies available to health care providers in the cancer survivorship context . TRIAL REGISTRATION ACTRN12616000175471 Background The benefits of physical activity are well documented , but scalable programs to promote activity are needed . Interventions that assign tailored and dynamically adjusting goals could effect significant increases in physical activity but have not yet been implemented at scale . Objective Our aim was to examine the effectiveness of an open access , Internet-based walking program that assigns daily step goals tailored to each participant . Methods A two-arm , pragmatic r and omized controlled trial compared the intervention to no treatment .  Participants were recruited from a workplace setting and r and omized to a no-treatment control ( n=133 ) or to treatment ( n=132 ) . Treatment participants received a free wireless activity tracker and enrolled in the walking program , Walkadoo .  Assessment s were fully automated : activity tracker recorded primary outcomes ( steps ) without intervention by the participant or investigators . The two arms were compared on change in steps per day from baseline to follow-up ( after 6 weeks of treatment ) using a two-tailed independent sample s t test . Results Participants ( N=265 ) were 66.0 % ( 175/265 ) female with an average age of 39.9 years . Over half of the participants ( 142/265 , 53.6 % ) were sedentary ( < 5000 steps/day ) and 44.9 % ( 119/265 ) were low to somewhat active ( 5000 - 9999 steps/day ) . The intervention group significantly increased their steps by 970 steps/day over control ( P<.001 ) , with treatment effects observed in sedentary ( P=.04 ) and low-to-somewhat active ( P=.004 ) participants alike . Conclusions The program is effective in increasing daily steps .  Participants benefited from the program regardless of their initial activity level . A tailored , adaptive approach using wireless activity trackers is realistically implementable and scalable . Trial Registration Clinical trials.gov NCT02229409 , https:// clinical trials.gov/ct2/show/NCT02229409 ( Archived by WebCite at http://www.webcitation.org/6eiWCvBYe This study examined the use of activity trackers alone or combined with weekly communication through email to improve activity and body composition over one academic year in medical students . This r and omized clinical trial conducted at the New York Institute of Technology from July 7 , 2016 through June 4 , 2017 enrolled 120 medical students . The first group ( Fitbit-Plus ) wore activity trackers and received weekly emails offering fitness challenges and lifestyle modification challenges . The second group ( Fitbit-Only ) received only activity trackers and did not receive weekly emails . The third group ( Control ) was asked not to purchase an activity tracker of any kind throughout the study . All groups had a body composition analysis prior to the start of the academic year and at the end of the first academic year . Outcome measures included step count and body composition ( body fat percentage and lean body mass ) . The results showed the overall mean daily steps were greater in the Fitbit-Plus group than the Fitbit-Only group for the academic year ( 7429 ± 2833 vs. 6483 ± 2359 ) with only months April and May showing a significant difference between the groups ( p = 0.011 ; p = 0.044 ) . Body fat percentage decreased in the Fitbit-Plus overweight women ( 2.1 ± 1.6 % ) lean body mass increased in the Fitbit-Plus group in overweight men ( 2.4 ± 4.6 lbs . ) . A subsequent finding of this study showed improved body composition in a small sub-group of over-weight students . Weekly behavioral challenges combined with an activity tracker  increased step count in medical students compared to an activity tracker alone . Clinical trials.gov Identifier : NCT02778009 BACKGROUND Activity tracking devices can reinforce physical fitness and may be beneficial to resident physicians . To date , their use has not been evaluated . OBJECTIVE To determine if use of an activity tracking device increases residents ' activity  , measured as steps per day . METHODS A prospect i ve , crossover study involved residents at 1 academic hospital system . Participants were weighed and completed a baseline survey . All participants were asked to wear an activity tracking device for 8 weeks . Residents were blinded to feedback from the device on activity level during the first 4 weeks . During the second 4-week period , participants were given access to data on activity level and were invited to join a voluntary activity tracking group . RESULTS Of 104 residents invited to participate , 86 enrolled . The majority of participants were female and did not have experience using activity trackers . Almost half ( 49 % , 51 of 104 ) had a body mass index greater than 25 kg/m2 . The median steps per day of all participants during the blinded period was 7260 . This increased to 8266 steps per day during the unblinded period . Surgical residents recorded significantly more steps than nonsurgical specialties ( 7938 versus 6724 , P = .018 ) . The 26 residents who joined the voluntary activity tracking group registered higher median steps per day , and wore their activity tracker more consistently . CONCLUSIONS Providing residents with activity trackers , increasing feedback , and providing comparisons to peers may enhance residents '  physical activity levels Background : Site‐based cardiac rehabilitation  ( CR ) provides supervised exercise , education and motivation for patients . Graduates of CR have improved exercise tolerance . However , when participation in CR ceases , adherence to regular physical activity often declines , consequently leading to worsening risk factors and clinical events . Therefore , the purpose of this pilot study was to evaluate if a mHealth program could sustain the fitness and physical activity levels gained during CR . Methods and Results : A 12‐week mHealth program was implemented using physical activity trackers and health coaching .  Twenty‐five patients were r and omized into mHealth or usual care after completing CR . The combination of a 4.7 ± 13.8 % increase in the mHealth and a 8.5 ± 11.5 % decrease in the usual care group result ed in a difference between groups ( P ≤ .05 ) for absolute peak VO2 . Usual care decreased the amount of moderate‐low physical activity minutes per week ( 117 ± 78 vs 50 ± 53 ; P < .05 ) as well as moderate‐high ( 111 ± 87 vs 65 ± 64 ; P < .05 ) . mHealth increased moderate‐high physical activity ( 138 ± 113 vs 159 ± 156 ; NS ) . The divergent changes between mHealth and usual care in moderate‐high physical activity minutes/week result ed in a difference between groups ( 21 ± 103 vs – 46 ± 36 ; P < .05 ) . Conclusions : A 12‐week mHealth program of physical activity trackers and health coaching following CR graduation can sustain the gains in peak VO2 and physical activity achieved by site‐based CR Background Ageing is associated with a decrease in physical activity . This decrease particularly occurs during specific transitional life stages . Especially during adolescence and young adulthood a steep decrease in physical activity is observed . Inactive people are often not aware of their inactivity . Providing feedback on the actual physical activity level by an activity monitor can increase awareness and may in combination with an individually tailored physical activity advice stimulate a physically active lifestyle . Methods In a r and omized controlled trial the effectiveness of providing an activity monitor in combination with a personal physical activity advice through the Internet will be examined . Outcome measures are level of physical activity , determinants of physical activity , quality of life , empowerment , aerobic fitness and body composition .  Participants are relatively inactive adolescents and young adults who are measured at baseline , after 3 months intervention and 5 months after the end of the intervention . In addition , facilitating and hindering factors for implementation of the intervention will be investigated . Discussion The use of a personal activity monitor in combination with web-based assisted individually tailored health promotion offers a good opportunity to work interactively with large groups of adolescents and young adults and provide them with advice based on their actual activity level . It has great potential to motivate people to change their behaviour and to our knowledge has not been evaluated before Background Regular physical activity reduces the risk of cardiovascular events , but most ischemic heart disease ( IHD ) patients do not obtain enough . Methods and Results ACTIVE REWARD ( A Clinical Trial Investigating Effects of a R and omized Evaluation of Wearable Activity Trackers with Financial Rewards ) was a 24‐week home‐based , remotely monitored , r and omized trial with a 16‐week intervention ( 8‐week ramp‐up incentive phase and 8‐week maintenance incentive phase ) and an 8‐week follow‐up . Patients used wearable devices to track step counts and establish a baseline . Patients in control received no other interventions . Patients in the incentive arm received personalized step goals and daily feedback for all 24 weeks . In the ramp‐up incentive phase , daily step goals increased weekly by 15 % from baseline with a maximum of 10 000 steps and then remained fixed . Each week , $ 14 was allocated to a virtual account ; $ 2 could be lost per day for not achieving step goals . The primary outcome was change in mean daily steps from baseline to the maintenance incentive phase . Ischemic heart disease patients had a mean ( SD ) age of 60 ( 11 ) years and 70 % were male . Compared with control , patients in the incentive arm had a significantly greater increase in mean daily steps from baseline during ramp‐up ( 1388 versus 385 ; adjusted difference , 1061 [ 95 % confidence interval , 386–1736 ] ; P<0.01 ) , maintenance ( 1501 versus 264 ; adjusted difference , 1368 [ 95 % confidence interval , 571–2164 ] ; P<0.001 ) , and follow‐up ( 1066 versus 92 ; adjusted difference , 1154 [ 95 % confidence interval , 282–2027 ] ; P<0.01 ) . Conclusions Loss‐framed financial incentives with personalized goal setting significantly increased physical activity among ischemic heart disease patients using wearable devices during the 16‐week intervention , and effects were sustained during the 8‐week follow‐up . Clinical Trial Registration URL : https://www . clinical trials.gov . Unique identifier : NCT02531022 AIMS Despite the known benefits , 60 % of individuals with diabetes do not engage in regular physical activity ( PA ) . This pilot study tested the effects of a counseling intervention using continuous glucose monitoring system ( CGMS ) feedback on PA self-efficacy , PA levels , and physiological variables . METHODS Adults ( N=52 ) with type 2 diabetes ( non-insulin requiring , inactive ) were r and omized to intervention ( n=27 ) or control ( n=25 ) groups . Both groups received 90min of diabetes education with a follow-up phone call 4 weeks later . The intervention group also received counseling derived from self-efficacy theory . This intervention included feedback on each participant 's CGMS graph and used role model CGMS graphs to clearly depict glucose reductions in response to PA . Outcomes were assessed at baseline and 8 weeks . RESULTS Participants receiving the intervention had higher self-efficacy scores than the control group for sticking to activity/resisting relapse at 8 weeks ( p<0.05 ) , indicating more confidence in maintaining a PA program . Intervention group participants light/sedentary activity minutes decreased significantly ( p<0.05 ) , moderate activity minutes increased significantly ( p<0.05 ) , and , HbA1c and BMI decreased significantly ( p<0.05 ) . CONCLUSIONS These data suggest that PA counseling interventions using CGMS feedback for individuals with type 2 diabetes may improve PA levels and reduce risk factors for diabetes-related complications PURPOSE Whilst the health benefits associated with regular physical activity are well known , little objective evidence exists regarding the activity profiles of adults with mild and moderate learning disabilities . The aims of the present study were to establish 7 day physical activity profiles for 24 adults with mild and moderate learning disabilities and to compare them with the general population and current Department of Health recommendations for physical activity . METHOD A descriptive study was used , based on interviews with 24 adults with learning disabilities ( mean age 34 years ) triangulated by daytime and residential care workers . Participants volunteered from two residential homes and one social education centre ( SEC ) in a city in the North of Engl and . RESULTS The physical activity profiles show that the participants led sedentary lifestyles that were more exaggerated than those of the general population . Twenty-two participants ( 93 % ) performed significantly less than the minimum daily levels of physical activity recommended by the Department of Health . CONCLUSIONS Few adults with learning disabilities can choose to walk to work , go for a run or visit the local swimming pool without adequate support . This study suggests that there may not be enough moderate or vigorous physical activity choices available in day and residential care setting s to empower adults with mild and moderate learning disabilities to meet the minimum recommendations of the Department of Health . Hence some people with learning disabilities have no alternatives to a sedentary lifestyle and the health risks associated with physical inactivity BACKGROUND Many American adults remain sedentary despite many known health benefits . Research on the determinants of physical activity have indicated that social support is one of the strongest correlates , but little is known about this relation in important subgroups of middle and older-aged women . OBJECTIVE The purpose of this study was to assess the association of physical activity-related social support on several measures of physical activity in a national sample of minority women . A unique aspect of these measures is the inclusion of vigorous household tasks and occupational physical activities . METHODS The US Women 's Determinants Study was conducted in 1996 - 1997 . The survey was a modified-r and om sample , telephone survey of 2912 Black , Hispanic , American Indian/Alaskan Native , and White women age 40 and older . A composite score of  physical activity social support ( PASS ) was analyzed as the independent variable in logistic regression analyses . Four measures of physical activity levels served as the dependent variables . A separate analysis was done to distinguish PASS from friends versus PASS from relatives . The potential confounding effect of race/ethnicity , marital status , age , income and education were evaluated and adjusted in the models . RESULTS Hispanic women were more likely to have high PASS scores than the other racial/ethnic groups . Odds ratios indicate that subjects with high levels of PASS were significantly less likely to be sedentary than those with low support , even after adjusting for race/ethnicity . While there were significant associations among levels of social support and physical activity , this was not true for the measure of " regular exercise .  " There was no significant difference between the contribution of " friend " support versus " family " support on all four measures on physical activity . DISCUSSION Based on our results , enhancing social support may be an important aspect of interventions aim ed at increasing physical activity in a population of sedentary women of various racial/ethnic background s. Also , " regular exercisers " in this population appear to be less reliant social support to maintain their behavior 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 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 Background The construct of total wellness includes a holistic approach to the body , mind and spirit components of life . While the health benefits of reducing sedentary behavior and increasing physical activity are well documented , little is known about the influence on total wellness of an internet-based physical activity monitor design ed to help people to achieve higher physical activity levels . Purpose The purpose of this four-week , personal activity monitor-based intervention program was to reduce sedentary behavior and increase physical activity levels in daily living for sedentary adults and to determine if these changes would also be associated with improvement in total wellness . Methods Twenty-two men and 11 women ( 27 years ± 4.0 ) were r and omly assigned to either an intervention ( n = 18 ) or control group ( n = 15 ) . The intervention group interacted with an online personal activity monitor ( Gruve Solution ™ ) design ed to reduce sedentary time  and increase physical activity during activities of daily living . The control group did not interact with the monitor , as they were asked to follow their normal daily physical activities and sedentary behavior routines . The Wellness Evaluation of Lifestyle ( WEL ) inventory was used to assess total wellness . Sedentary time , light , walking , moderate and vigorous intensity physical activities were assessed for both intervention and control groups at baseline and at week-4 by the 7-day Sedentary and Light Intensity Physical Activity Log ( 7-day SLIPA Log ) and the International Physical Activity Question naire ( IPAQ ) . Results Significant increases in pre-post total wellness scores ( from 64 % ± 5.7 to 75 % ± 8.5 ) ( t ( 17 ) = -6.5 , p < 0.001 ) were observed in the intervention group by the end of week four . Intervention participants decreased their sedentary time ( 21 % , 2.3 hours/day ) and increased their light ( 36.7 % , 2.5 hours/day ) , walking ( 65 % , 1057 MET-min/week ) , moderate ( 67 % , 455 MET-min/week ) and vigorous intensity ( 60 % , 442 MET-min/week ) physical activity ( all p < 0.001 ) . No significant differences for total wellness were observed between the groups at baseline and no pre-post significant differences were observed for any outcome variable in the control group . Conclusion Total wellness is improved when sedentary , but sufficiently physically active adults , reduce sedentary time and increase physical activity levels ( i.e. light , waking , moderate and vigorous ) Background Despite the significant health benefits of regular physical activity , approximately half of American adults , particularly women and minorities , do not meet the current physical activity recommendations . Mobile phone technologies are readily available , easily accessible and may provide a potentially powerful tool for delivering physical activity interventions . However , we need to underst and how to effectively apply these mobile technologies to increase and maintain physical activity in physically inactive women . The purpose of this paper is to describe the study design and protocol of the mPED ( mobile phone based physical activity education ) r and omized controlled clinical trial that examines the efficacy of a 3-month mobile phone and pedometer based physical activity intervention and compares two different 6-month maintenance interventions . Methods A r and omized controlled trial ( RCT ) with three arms ; 1 ) PLUS ( 3-month mobile phone and pedometer based physical activity intervention and 6-month mobile phone diary maintenance intervention ) , 2 ) REGULAR ( 3-month mobile phone and pedometer based physical activity intervention and 6-month pedometer maintenance intervention ) , and 3 ) CONTROL ( pedometer only , but no intervention will be conducted ) . A total of 192 physically inactive women who meet all inclusion criteria and successfully complete a 3-week run-in will be r and omized into one of the three groups . The mobile phone serves as a means of delivering the physical activity intervention , setting individualized weekly physical activity goals , and providing self-monitoring ( activity diary ) , immediate feedback and social support . The mobile phone also functions as a tool for communication and real-time data capture . The primary outcome is objective ly measured physical activity . Discussion If efficacy of the intervention with a mobile phone is demonstrated , the results of this RCT will be able to provide new insights for current behavioral sciences and mHealth . Trial Registration Clinical 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 The aim of the project was to reach inactive people through primary care offices and motivate them to become more active for health purpose s. Physical activity question naires based on the transtheoretical model ( TM ) of behaviour change were h and ed out to every person entering one of five primary care offices . All inactive people were entered into a r and omised controlled trial ( RCT ) . Individuals assigned to the feedback group were given feedback from their physician concerning their physical activity level . In addition , the advice plus group received further advice and stage matched leaflets and was offered a 45-min counselling session .  Changes in physical activity behaviour were measured 7 weeks as well as 14 months after the intervention . Physicians and patients alike reacted positively to the project . Ninety percent of patients entering the primary care offices were willing to participate . Ninety percent of inactive people agreed to be entered into the RCT . The follow-up rate in this trial was 82 % at 14 months . At 7 weeks , 35 % of patients in the feedback group were now classified as active and 38 % of patients in the advice plus group . At 14 months , 47 % of the subjects in both groups were active . Inactive people can be reached effectively through primary care offices . Patients receiving feedback from their physician concerning their physical activity level improved their behaviour to the same extent as patients who were given further advice and written material s , and were offered a counselling session Physical inactivity among children is a serious public health problem . It has been suggested that high levels of screen time are contributory factors that encourage sedentary lifestyles in young people . As physical inactivity and obesity levels continue to rise in young people , it has been proposed that new-generation active computer- and video-console games ( otherwise known as “ exergaming ” ) may offer the opportunity to contribute to young people 's energy expenditure during their free time . Although studies have produced some encouraging results regarding the energy costs involved in playing active video-console games , the energy costs of playing the authentic versions of activity-based video games are substantially larger , highlighting that active gaming is no substitute for real sports and activities . A small number of exergaming activities engage children in moderate-intensity activity , but most do not . Only 3 very small trials have considered the effects of exergaming on physical activity levels and /or other health outcomes in children . Evidence from these trials has been mixed ; positive trends for improvements in some health outcomes in the intervention groups were noted in 2 trials . No adequately powered r and omized , controlled trial has been published to date , and no trial has assessed the long-term impact of exergaming on children 's health . We now need high- quality r and omized , controlled trials to evaluate the effectiveness and sustainability of exergaming  , as well as its clinical relevance ; until such studies take place , we should remain cautious about its ability to positively affect children 's health Background Many people in Western countries do not follow public health physical activity ( PA ) recommendations . Web-based interventions provide cost- and time-efficient means of delivering individually targeted lifestyle modification at a population level . Objective To examine whether access to a website with individually tailored feedback and suggestions on how to increase PA led to improved PA , anthropometrics , and health measurements . Methods Physically inactive adults ( n = 12,287 ) participating in a nationwide eHealth survey and health examination in Denmark were r and omly assigned to either an intervention ( website ) ( n = 6055 ) or a no-intervention control group ( n = 6232 ) in 2008 . The intervention website was founded on the theories of stages of change and of planned behavior and , apart from a forum page where a physiotherapist answered questions about PA and training , was fully automated . After 3 and again after 6 months we emailed participants invitations to answer a Web-based follow-up question naire , which included the long version of the International Physical Activity Question naire . A subgroup of participants ( n = 1190 ) were invited to a follow-up health examination at 3 months . Results Less than 22.0 % ( 694/3156 ) of the participants logged on to the website once and only 7.0 % ( 222/3159 ) logged on frequently . We found no difference in PA level between the website and control groups at 3- and 6-month follow-ups . By dividing participants into three groups according to use of the intervention website , we found a significant difference in total and leisure-time PA in the website group . The follow-up health examination showed no significant reductions in body mass index , waist circumference , body fat percentage , and blood pressure , or improvements in arm strength and aerobic fitness in the website group . Conclusions Based on our findings , we suggest that active users of a Web-based PA intervention can improve their level of PA . However , for unmotivated users , single-tailored feedback may be too brief . Future research should focus on developing more sophisticated interventions with the potential to reach both motivated and unmotivated sedentary individuals . Trial Registration Clinical trials.gov NCT01295203 ; http:// clinical trials.gov/ct2/show/NCT01295203 ( Archived by WebCite at http://www.webcitation.org/6B7HDMqiQ Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) BACKGROUND Physical activity and diet are important influences on health , but few data are available about the relationship between these two factors . The purpose of this study was to examine relationships between physical activity and  dietary quality  and to identify determinants of the combination of sedentary behavior and suboptimal diet . METHODS The design of this study was cross-sectional . The setting was a large managed-care organization and the participants were 1,322 racially diverse men and women ages 25 - 91 years . We categorized subjects ' physical activity into vigorous , moderate , and sedentary based on answers to two vali date d interviewer-administered questions about intensity and duration of specified activities . Dietary assessment was by means of a vali date d short food frequency question naire . We defined suboptimal diet as consuming unhealthful quantities of at least two of the following five food groups : fruits , vegetables , whole grain foods , whole-fat dairy foods , and red and processed meats . RESULTS Seven hundred fifty-four ( 57 % ) subjects were sedentary and 617 ( 47 % ) consumed a suboptimal diet . Using multiple linear regression , we found that sedentary individuals consumed smaller amounts of foods and nutrients considered to be healthful , such as fruits and vegetables , fiber , calcium , folate , and vitamins A , C , and E , than more active participants . For nutrients considered to be harmful , such as saturated fat , trans fat , and dietary cholesterol , the association with physical activity was inverse . In multiple logistic regression analyses , the strongest sociodemographic correlates of the joint presence of inactivity and poor diet were less education [ odds ratio for 1-year decrease 1.14 ( 95 % confidence interval 1.06 , 1.22 ) ] , nonwhite race [ 1.48 ( 1.05 , 2.07 ) ] , and nonmarried status [ 1.49 ( 1.06 , 2.10 ) ] . CONCLUSIONS  Physical activity and diet quality  are correlated behaviors . Suboptimal diet and sedentary behavior tend to cluster in individuals who are less educated , not married , and of nonwhite race . Programs that target diet and activity together , informed by their joint determinants , may attain enhanced outcomes BACKGROUND Treatment of COPD requires multiple pharmacological and non-pharmacological intervention strategies . One target is physical inactivity because it leads to disability and contributes to poor physical and mental health . Unfortunately , less than 1 % of eligible patients have access to gold-st and ard pulmonary rehabilitation . METHODS A single-site parallel group r and omized trial was design ed to determine if a self-management lifestyle physical activity intervention would improve physical functioning and dyspnea . During the first six weeks after enrollment patients receive COPD self-management education delivered by a health coach using a workbook and weekly telephone calls . Patients are then r and omized to usual care or the physical activity intervention . The 20 week physical activity intervention is delivered by the health coach using a workbook supported by alternating one-on-one telephone counseling and computer assisted telephone calls . Theoretical foundations include social cognitive theory and the transtheoretical model . RESULTS Primary outcomes include change in Chronic Respiratory Question naire ( CRQ ) dyspnea domain and 6-minute walk distance measured at 6- , 12- , and 18-months after r and omization . Secondary outcomes include other CRQ domains ( fatigue , emotion , and mastery ) , SF-12 , and health care utilization . Other measures include process outcomes and clinical characteristics . CONCLUSIONS This theory driven self-management lifestyle physical activity intervention is design ed to reach patients unable to complete center-based pulmonary rehabilitation . Results will advance knowledge and methods for dissemination of a potentially cost-effective program for patients with COPD OBJECTIVE To evaluate the cost-effectiveness of non-face-to-face interventions for increasing physical activity in sedentary adults . The study took place in Providence , Rhode Isl and between the years 2000 and 2004 . METHODS Two hundred and thirty-nine participants were r and omized to Phone , Print or a contact control . Phone and Print groups were mailed regular surveys regarding their level of physical activity , motivational readiness and self-efficacy . Surveys were scanned by a computer expert system to generate feedback reports . Phone group participants received feedback by telephone . Print group participants received feedback by mail . The contact control group received mailings unrelated to physical activity . Intervention costs were assessed prospect ively , from a payer perspective . Physical activity was measured using the 7-day Physical Activity Recall . Ambulatory health service use was assessed via monthly surveys . RESULTS The Print intervention was more economically efficient than the Phone intervention in engaging participants in a more active lifestyle . CONCLUSION The Print intervention provides an efficient approach to increasing physical activity . Research is needed to determine the cost-effectiveness of the intervention in a more diverse population , within the context of the health service delivery system and over a longer period of time R egular physical activity has been shown to have beneficial effects on both physical and mental health.i4 The Centers for Disease Control and the American College of Sports Medicine have suggested that adults should accumulate at least 30 minutes of moderate physical activity during the course of most days . * In the elderly population , moderate physical activity , such as walking , is associated with improved health outcomes .*5 Nevertheless , the majority of older people are sedentary . Results from the 1985 National Health Interview Survey show that two-thirds of those ages 65 and over do not exercise regularly.‘j The benefits of physical activity for elderly women include decreased risk of osteoporosis , decreased incidence of depression , and increased functional status.‘~7W’0 Despite these findings , the Behavioral Risk Factor Surveillance System reported that in 1990 , 86.7 % of women surveyed ages 65 and over were sedentary.i ’ Yet , little is known about the determinants of exercise behavior in this population . Interventions to increase physical activity in the elderly include public education campaigns , formal education , and training programs.‘2-‘4 These efforts have been unsuccessful at maintaining the adoption of this behavior.‘2-‘4 Dishman et all3 report that 50 % of those who participate in organized exercise programs such as aerobics classes will drop out during the first 3 - 6 months . An individual ’s knowledge , attitude , and demographics are some factors that research ers have found to influence exercise habits.13 Among elderly women , physical and health problems , time constraints , personal issues such as inclement weather , lack of companionship , safety concerns , and lack of motivation interfere with regular exercise.15 Our objective was to use telecommunications technology to underpin an intervention that would be effective , easy to use , convenient , and inexpensive BACKGROUND Underserved children , particularly girls and those in urban communities , do not meet the recommended physical activity guidelines ( > 60min of daily physical activity ) , and this behavior can lead to obesity . The school years are known to be a critical period in the life course for shaping attitudes and behaviors . Children look to schools for much of their access to physical activity . Thus , through the provision of appropriate physical activity programs , schools have the power to influence apt physical activity choices , especially for underserved children where disparities in obesity-related outcomes exist . OBJECTIVES To evaluate the impact of a nurse directed , coordinated , culturally sensitive , school-based , family-centered lifestyle program on activity behaviors and body mass index . DESIGN , SETTING S AND PARTICIPANTS This was a parallel group , r and omized controlled trial utilizing a community-based participatory research approach , through a partnership with a University and 5 community schools . Participants included 251 children ages 8 - 12 from elementary schools in urban , low-income neighborhoods in Los Angeles , USA . METHODS The intervention included Kids N Fitness ( © ) , a 6-week program which met weekly to provide 45min of structured physical activity and a 45min nutrition education class for parents and children . Intervention sites also participated in school-wide wellness activities , including health and counseling services , staff professional development in health promotion , parental education newsletters , and wellness policies for the provision of healthy foods at the school . The Child and Adolescent Trial for Cardiovascular Health School Physical Activity and Nutrition Student Question naire measured physical activity behavior , including : daily physical activity , participation in team sports , attending physical education class , and TV viewing/computer game playing . Anthropometric measures included height , weight , body mass index , resting blood pressure , and waist circumference . Measures were collected at baseline , completion of the intervention phase ( 4 months ) , and 12 months post-intervention . RESULTS Significant results for students in the intervention , included for boys decreases in TV viewing ; and girls increases in daily physical activity , physical education class attendance , and decreases in body mass index z-scores from baseline to the 12 month follow-up . CONCLUSIONS Our study shows the value of utilizing nurses to implement a culturally sensitive , coordinated , intervention to decrease disparities in activity and TV viewing among underserved girls and boys BACKGROUND Declining physical activity is associated with a rising burden of global disease . Efforts to reverse this trend have not been successful . We aim ed to assess the efficacy of a facilitated behavioural intervention to increase the physical activity of sedentary individuals at familial risk of diabetes . METHODS We enrolled 365 sedentary adults who had a parental history of type 2 diabetes . They were recruited from either diabetes or family history registers at 20 general practice clinics in the UK . Eligible participants were r and omly assigned to one of two intervention groups , or to a comparison group . All participants were posted a brief advice leaflet . One intervention group was offered a 1-year behaviour-change programme , to be delivered by trained facilitators in participants ' homes , and the other the same programme by telephone . The programme was design ed to alter behavioural determinants , as defined by the theory of planned behaviour , and to teach behaviour-change strategies . The principal outcome at 1 year was daytime physical activity , which was objective ly measured as a ratio to resting energy expenditure . Analysis was by intention to treat . This study is registered as IS RCT N61323766 . FINDINGS Of 365 patients , we analysed primary endpoints for 321 ( 88 % ) for whom we had data after 1 year of follow-up . At 1 year , the physical-activity ratio of participants who received the intervention , by either delivery route , did not differ from the ratio in those who were given a brief advice leaflet . The mean difference in daytime physical-activity ratio , adjusted for baseline , was -0.04 ( 95 % CI -0.16 to 0.08 ) . The physical-activity ratio did not differ between participants who were delivered the intervention face-to-face or by telephone ( mean difference -0.05 ; 95 % CI -0.19 to 0.10 ) . INTERPRETATION A facilitated theory-based behavioural intervention was no more effective than an advice leaflet for promotion of physical activity in an at-risk group ; therefore health-care providers should remain cautious about commissioning behavioural programmes into individual preventive health-care services BACKGROUND Despite the increasing popularity of activity trackers , little evidence exists that they can improve health outcomes . We aim ed to investigate whether use of activity trackers , alone or in combination with cash incentives or charitable donations , lead to increases in physical activity and improvements in health outcomes . METHODS In this r and omised controlled trial , employees from 13 organisations in Singapore were r and omly assigned ( 1:1:1:1 ) with a computer generated assignment schedule to control ( no tracker or incentives ) , Fitbit Zip activity tracker , tracker plus charity incentives , or tracker plus cash incentives .  Participants had to be English speaking , full-time employees , aged 21 - 65 years , able to walk at least ten steps continuously , and non-pregnant . Incentives were tied to weekly steps , and the primary outcome , moderate-to-vigorous physical activity ( MVPA ) bout min per week , was measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months ( end of intervention ) and 12 months ( after a 6 month post-intervention follow-up period ) . Other outcome measures included steps , participants meeting 70 000 steps per week target , and health-related outcomes including weight , blood pressure , and quality -of-life measures . This trial is registered at Clinical Trials.gov , number NCT01855776 . FINDINGS Between June 13 , 2013 , and Aug 15 , 2014 , 800 participants were recruited and r and omly assigned to the control ( n=201 ) , Fitbit ( n=203 ) , charity ( n=199 ) , and cash ( n=197 ) groups . At 6 months , compared with control , the cash group logged an additional 29 MVPA bout min per week ( 95 % CI 10 - 47 ; p=0·0024 ) and the charity group an additional 21 MVPA bout min per week ( 2 - 39 ; p=0·0310 ) ; the difference between Fitbit only and control was not significant ( 16 MVPA bout min per week [ -2 to 35 ; p=0·0854 ] ) . Increases in MVPA bout min per week in the cash and charity groups were not significantly greater than that of the Fitbit group . At 12 months , the Fitbit group logged an additional 37 MVPA bout min per week ( 19 - 56 ; p=0·0001 ) and the charity group an additional 32 MVPA bout min per week ( 12 - 51 ; p=0·0013 ) compared with control ; the difference between cash and control was not significant ( 15 MVPA bout min per week [ -5 to 34 ; p=0·1363 ] ) . A decrease in physical activity of -23 MVPA bout min per week ( 95 % CI -42 to -4 ; p=0·0184 ) was seen when comparing the cash group with the Fitbit group . There were no improvements in any health outcomes ( weight , blood pressure , etc ) at either assessment . INTERPRETATION The cash incentive was most effective at increasing MVPA bout min per week at 6 months , but this effect was not sustained 6 months after the incentives were discontinued . At 12 months , the activity tracker with or without charity incentives were effective at stemming the reduction in MVPA bout min per week seen in the control group , but we identified no evidence of improvements in health outcomes , either with or without incentives , calling into question the value of these devices for health promotion . Although other incentive strategies might generate greater increases in step activity and improvements in health outcomes , incentives would probably need to be in place long term to avoid any potential decrease in physical activity result ing from discontinuation . FUNDING Ministry of Health , Singapore OBJECTIVE To determine the effectiveness of a pedometer-based telephone intervention on the physical activity levels of cardiac patients who did not attend a CRP . METHODS A r and omised controlled trial was conducted with 215 patients referred to a CRP but who could not or chose not to attend . The 6-week intervention included self-monitoring of physical activity using a pedometer and step calendar ; and behavioural counselling and goal setting sessions . Data were collected at baseline , 6 weeks and 6 months . RESULTS Study groups did not differ significantly at baseline . After 6 weeks , improvements in total physical activity time ( p=0.027 ) , total physical activity sessions ( p=0.003 ) , walking time ( p=0.013 ) and walking sessions ( p=0.002 ) in the intervention group were significantly greater than the control group after adjusting for baseline differences , and remained significant at 6 months . CONCLUSION The findings that the pedometer-based telephone intervention was successful in increasing physical activity levels in cardiac patients who did not attend a CRP could result in major health benefits for this group of people . PRACTICAL IMPLICATION S The pedometer-based telephone intervention could be offered as an effective and accessible option for patients not attending a CRP to increase and maintain their physical activity levels after hospitalisation Background Grade d health benefits of physical activity have been demonstrated for the reduction of coronary heart disease , some cancers , and type-2 diabetes , and for injury reduction and improvements in mental health .  Older adults are particularly at risk of physical inactivity , and would greatly benefit from successful targeted physical activity interventions . Methods / Design The Healthy Steps study is a 12-month r and omized controlled trial comparing the efficacy of a pedometer-based Green Prescription with the conventional time-based Green Prescription in increasing and maintaining physical activity levels in low-active adults over 65 years of age . The Green Prescription interventions involve a primary care physical activity prescription with 3 follow-up telephone counselling sessions delivered by trained physical activity counsellors over 3 months . Those in the pedometer group received a pedometer and counselling based around increasing steps that can be monitored on the pedometer , while those in the st and ard Green Prescription group received counselling using time-based goals . Baseline , 3 month ( end of intervention ) , and 12 month measures were assessed in face-to-face home visits with outcomes measures being physical activity ( Auckl and Heart Study Physical Activity Question naire ) , quality of life ( SF-36 and EQ-5D ) , depressive symptoms ( Geriatric Depression Scale ) , blood pressure , weight status , functional status ( gait speed , chair st and s , and t and em balance test ) and falls and adverse events ( self-report ) . Utilisation of health services was assessed for the economic evaluation carried out alongside this trial . As well , a process evaluation of the interventions and an examination of barriers and motives for physical activity in the sample were conducted . The perceptions of primary care physicians in relation to delivering physical activity counselling were also assessed . Discussion The findings from the Healthy Steps trial are due in late 2009 . If successful in improving physical activity in older adults , the pedometer-based Green Prescription could assist in reducing utilisation of health services and improve cardiovascular health and reduction of risk for a range of non-communicable lifestyles diseases . Trial registration Australian and New Zeal and Clinical Trials Registry Introduction The health benefits of regular cardiovascular exercise are well-known . Such exercise , however , has traditionally been defined as vigorous physical activity , such as jogging , swimming , or aerobic dance . Exercise of moderate intensity also promotes health , and many U.S. adults may be experiencing the health benefits of exercise through lifestyle activities of moderate intensity , such as yard work , housework , or walking for transportation . Until recently , public health surveillance systems have not included assessment s of this type of physical activity , focusing on exercise of vigorous intensity . We used an enhanced surveillance tool to describe the prevalence and amount of both moderate-intensity and vigorous-intensity physical activity among U.S. adults . Methods We analyzed data from the 2001 Behavioral Risk Factor Surveillance System , a state-based , r and om-digit  – dialed telephone survey administered to U.S. adults aged 18 years and older ( n = 82,834 men and 120,286 women ) .  Physical activity behavior was assessed using questions design ed to quantify the frequency of participation in moderate- or vigorous-intensity physical activities performed during leisure time or for household chores and transportation . Results Overall , 45 % of adults ( 48 % of men and 43 % of women ) were active at recommended levels during nonworking hours ( at least 30 minutes five or more days per week in moderate-intensity activities , equivalent to brisk walking , or at least 20 minutes three or more days per week in vigorous activities , equivalent to running , heavy yard work , or aerobic dance ) . Less than 16 % of adults ( 15 % of men and 17 % of women ) reported no moderate or vigorous activity in a usual week . Conclusion Integrating surveillance of lifestyle activities into national systems is possible , and doing so may provide a more accurate representation of the prevalence of recommended levels of physical activity . These results , however , suggest that the majority of U.S. adults are not active at levels associated with the promotion and maintenance of health Background Cardiovascular disease ( CVD ) is the leading cause of death worldwide . With atherosclerosis as the underlying cause for many CVD events , prevention or reduction of sub clinical atherosclerotic plaque burden ( SAPB ) through a healthier lifestyle may have substantial public health benefits . Objective The objective was to describe the protocol of a r and omized controlled trial investigating the effectiveness of a 30‐month worksite‐based lifestyle program aim ed to promote cardiovascular health in participants having a high or a low degree of SAPB compared with st and ard care . Methods We will conduct a r and omized controlled trial including middle‐aged bank employees from the Progression of Early Sub clinical Atherosclerosis cohort , stratified by SAPB ( high SAPB n = 260 , low SAPB n = 590 ) . Within each stratum , participants will be r and omized 1:1 to receive a lifestyle program or st and ard care . The program consists of 3 elements : ( a ) 12 personalized lifestyle counseling sessions using Motivational Interviewing over a 30‐month period , ( b ) a wrist‐worn physical activity tracker , and ( c ) a sit‐st and workstation . Primary outcome measure is a composite score of blood pressure , physical activity , sedentary time , body weight , diet , and smoking ( ie , adapted Fuster‐BEWAT score ) measured at baseline and at 1‐ , 2‐ , and 3‐year follow‐up . Conclusions The study will provide insights into the effectiveness of a 30‐month worksite‐based lifestyle program to promote cardiovascular health compared with st and ard care in participants with a high or low degree of SAPB Background Lifestyle-related health problems are an important health concern in the transport service industry .  Web- and telephone-based interventions could be suitable for this target group requiring tailored approaches . Objective To evaluate the effect of tailored Web-based health feedback and optional telephone coaching to improve lifestyle factors ( body mass index— BMI , dietary intake , physical activity , stress , sleep , tobacco and alcohol consumption , disease history , self-perceived health , and motivation to change health habits ) , in comparison to no health feedback or telephone coaching . Methods Overall , 3,876 employees in the Swedish transport services were emailed a Web-based question naire . They were r and omized into : control group ( group A , 498 of 1238 answered , 40.23 % ) , or intervention Web ( group B , 482 of 1305 answered , 36.93 % ) , or intervention Web + telephone ( group C , 493 of 1333 answered , 36.98 % ) . All groups received an identical question naire , only the interventions differed . Group B received tailored Web-based health feedback , and group C received tailored Web-based health feedback + optional telephone coaching if the participants ’ reported health habits did not meet the national guidelines , or if they expressed motivation to change health habits . The Web-based feedback was fully automated . Telephone coaching was performed by trained health counselors . Nine months later , all participants received a follow-up question naire and intervention Web + telephone . Descriptive statistics , the chi-square test , analysis of variance , and generalized estimating equation ( GEE ) models were used . Results Overall , 981 of 1473 ( 66.60 % ) employees participated at baseline ( men : 66.7 % , mean age : 44 years , mean BMI : 26.4 kg/m2 ) and follow-up . No significant differences were found in reported health habits between the 3 groups over time . However , significant changes were found in motivation to change . The intervention groups reported higher motivation to improve dietary habits ( 144 of 301 participants , 47.8 % , and 165 of 324 participants , 50.9 % , for groups B and C , respectively ) and physical activity habits ( 181 of 301 participants , 60.1 % , and 207 of 324 participants , 63.9 % , for B and C , respectively ) compared with the control group A ( 122 of 356 participants , 34.3 % , for diet and 177 of 356 participants , 49.7 % , for physical activity ) . At follow-up , the intervention groups had significantly decreased motivation ( group B : P<.001 for change in diet ; P<.001 for change in physical activity ; group C : P=.007 for change in diet ; P<.001 for change in physical activity ) , whereas the control group reported significantly increased motivation to change diet and physical activity ( P<.001 for change in diet ; P<.001 for change in physical activity ) . Conclusion Tailored Web-based health feedback and the offering of optional telephone coaching did not have a positive health effect on employees in the transport services . However , our findings suggest an increased short-term motivation to change health behaviors related to diet and physical activity among those receiving tailored Web-based health feedback BACKGROUND Project ACTIVE was a r and omized clinical trial comparing two physical activity interventions , lifestyle and traditional structured exercise . The two interventions were evaluated and compared in terms of cost effectiveness and ability to enhance physical activity among sedentary adults . DESIGN This was a r and omized clinical trial . SETTING / PARTICIPANTS The study included 235 sedentary but healthy community-dwelling adults . INTERVENTION A center-based lifestyle intervention that consisted of behavioral skills training was compared to a structured exercise intervention that included supervised , center-based exercise . MAIN OUTCOME MEASURES The main outcome measures of interest included cost , cardiorespiratory fitness , and physical activity . RESULTS Both interventions were effective in increasing physical activity and fitness . At 6 months , the costs of the lifestyle and structured interventions were , respectively , $ 46.53 and $ 190.24 per participant per month . At 24 months these costs were $ 17.15 and $ 49.31 per participant per month . At both 6 months and 24 months , the lifestyle intervention was more cost-effective than the structured intervention for most outcomes measures . CONCLUSIONS A behaviorally-based lifestyle intervention approach in which participants are taught behavioral skills to increase their physical activity by integrating moderate-intensity physical activity into their daily lives is more cost-effective than a structured exercise program in improving physical activity and cardiorespiratory health . This study represents one of the first attempts to compare the efficiency of intervention alternatives for improving physical activity among healthy , sedentary adults OBJECTIVES : Despite the widely acknowledged benefits of regular physical activity ( PA ) , specific goals for increased population levels of PA , and strongly recommended strategies to promote PA , there is no evidence suggesting that the prevalence of PA is improving . If PA intervention research is to be improved , theory should be used as the basis for intervention development , participant context or environment should be considered in the process , and intervention characteristics that will heighten the likelihood of translation into practice should be implemented ( e.g. , ease of implementation , low human re source costs ) . The purpose of this paper is to describe the implementation of the aforementioned concepts within the intervention development process associated with CardiACTION an ongoing r and omized 2 × 2 factorial trial . METHODS : The Ecological Model of Physical Activity integrated with Protection Motivation Theory was used to inform the design of the interventions . This integrated model was selected to allow for the development of theory-based individual , environmental , and individually + environmentally targeted physical activity interventions . All intervention strategies were matched to proposed mediators of behavior change . Strategies were then matched to the most appropriate interactive technology ( i.e. , interactive computer session , automated telephone counseling , and tailored mailings ) delivery channel . CONCLUSIONS : The potential implication s of this study include determining the independent and combined influence of individual and environment mechanisms of behavior change on intervention effectiveness . In addition , all intervention models are developed to be scalable and disseminable to a broad audience at a low cost Despite the benefits associated with a physically active lifestyle , many older adults are insufficiently active to achieve health gain , and also exhibit decreased activity levels with age . Insufficient physical activity in this population is associated with increased morbidity , mortality and dem and on health care services and expenditure . There is a clear need for effective intervention to encourage physical activity in older adults . The aim of this paper is to describe the development and participant evaluation of a r and omized controlled trial of TeleWalk , a telephone-based motivational counseling intervention to encourage physical activity in adults aged 65 years and older . Participants ( N = 186 , mean age 74 + /- 6 years ) were recruited through their General Practitioner ( primary care physician ) and r and omized to either receive eight telephone counseling sessions and related printed material s over 3 months ( intervention group ) or participate in outcome assessment s only ( control group ) . Intervention group participants were mailed an anonymous evaluation question naire on intervention completion . A high response rate was achieved ( 70 % ) . All respondents ( 100 % ) agreed or strongly agreed that a good overall level of service and support was provided , and that the counselor was underst and ing and supportive . Nearly all respondents agreed or strongly agreed that the service was professional , the counselor advice was helpful and motivating and the information provided was relevant ( 97 , 95 and 89 % , respectively ) . Most ( 87 % ) agreed or strongly agreed that the telephone calls encouraged them to be physically active . Among the participants who received printed material , most agreed or strongly agreed that these encouraged them to become or remain active . Findings from this evaluation can be used to inform such interventions and ensure their relevance to community-dwelling older adults 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 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
CONCLUSIONS Utilizing a consumer-based wearable activity tracker as either the primary component of an intervention or as part of a broader physical activity intervention has the potential to increase physical activity participation .
BACKGROUND The range of benefits associated with regular physical activity participation is irrefutable .
Despite the well-known benefits , physical inactivity remains one of the major contributing factors to ill-health throughout industrialized countries .
Traditional lifestyle interventions such as group education or telephone counseling are effective at increasing physical activity participation ; however , physical activity levels tend to decline over time .
Consumer-based wearable activity trackers that allow users to objective ly monitor activity levels are now widely available and may offer an alternative method for assisting individuals to remain physically active .
OBJECTIVE This review aim ed to determine the effects of interventions utilizing consumer-based wearable activity trackers on physical activity participation and sedentary behavior when compared with interventions that do not utilize activity tracker feedback .