Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour : a systematic review

Background: Health and fitness applications (apps) have gained popularity in interventions to improve diet, physical activity and sedentary behaviours but their efficacy is unclear. This systematic review examined the efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour in children and adults. Methods: Systematic literature searches were conducted in five databases to identify papers published between 2006 and 2016. Studies were included if they used a smartphone app in an intervention to improve diet, physical activity and/or sedentary behaviour for prevention. Interventions could be stand-alone interventions using an app only, or multi-component interventions including an app as one of several intervention components. Outcomes measured were changes in the health behaviours and related health outcomes (i.e., fitness, body weight, blood pressure, glucose, cholesterol, quality of life). Study inclusion and methodological quality were independently assessed by two reviewers. Results: Twenty-seven studies were included, most were randomised controlled trials (n = 19; 70%). Twenty-three studies targeted adults (17 showed significant health improvements) and four studies targeted children (two demonstrated significant health improvements). Twenty-one studies targeted physical activity (14 showed significant health improvements), 13 studies targeted diet (seven showed significant health improvements) and five studies targeted sedentary behaviour (two showed significant health improvements). More studies (n = 12; 63%) of those reporting significant effects detected between-group improvements in the health behaviour or related health outcomes, whilst fewer studies (n = 8; 42%) reported significant within-group improvements. A larger proportion of multi-component interventions (8 out of 13; 62%) showed significant between-group improvements compared to stand-alone app interventions (5 out of 14; 36%). Eleven studies reported app usage statistics, and three of them demonstrated that higher app usage was associated with improved health outcomes. Conclusions: This review provided modest evidence that app-based interventions to improve diet, physical activity and sedentary behaviours can be effective. Multi-component interventions appear to be more effective than standalone app interventions, however, this remains to be confirmed in controlled trials. Future research is needed on the optimal number and combination of app features, behaviour change techniques, and level of participant contact needed to maximise user engagement and intervention efficacy

Cancer Survivors\u27 Self-Efficacy and Spirituality Outcomes Following a Holistic Integrative Intervention

Cancer treatments often negatively impact health-related quality of life (HR-QOL) for cancer survivors (CS), ignoring the multi-dimensional nature of the human experience of cancer and its impact on mental and spiritual domains. A holistic integrative approach was implemented on a heterogenous population of cancer survivors during the COVID epidemic with the goal of improving their overall well-being by looking beyond physical functioning. PURPOSE: To examine the relationship between spirituality and self-efficacy of cancer survivors of all types of cancer following a holistic intervention during the COVID-19 pandemic. METHODS: Subjects were recruited via network partners and self-referral. Subjects were eligible to participate if they were cancer survivors of any type at any stage of cancer treatment; subjects were ineligible to participate if they presented with any absolute contraindications to exercise testing as per ACSM guidelines. For 16 weeks, subjects were asked to participate in three 75-minute sessions of therapeutic yoga-based with loving kindness meditation per week. Psychosocial support text messages were sent daily to subjects based on their motivational state to encourage participation in these health enhancing behaviors. Data was collected through numerous channels including BlueJay Mobile Telehealth medicine application. RESULTS: A total of 29 survivors provided informed consent. The average age of the subjects was 58.9 years, 25 female survivors and 4 male survivors; 11 of the 29 self-reported as Latino/ Hispanic. The 29 subjects were survivors of the following primary cancers: breast cancer (n=21), cervical cancer (n=2), ovarian cancer (n=1), prostate cancer (n=1), sarcoma (n=1), lymphoma (n=1), thyroid cancer (n=1), or leukemia (n=1). There is a positive association between how confident a cancer survivor feels towards performing exercise in various situations and the amount of social support they receive from their family (p\u3c.001) and friends (p\u3c.001). The individual’s confidence to overcome the obstacle to exercise and their level of hope are associated with the support they receive from loved ones. CONCLUSION: The present study suggests that to improve exercise behavior in adult cancer survivors, one should incorporate social support to strengthen barriers self-efficacy to improve outcome expectations. To further understand these associations, longitudinal research is needed and should include more survivors

Mobile Phone Apps for Quality of Life and Well-Being Assessment in Breast and Prostate Cancer Patients: Systematic Review

Background: Mobile phone health apps are increasingly gaining attention in oncological care as potential tools for supporting cancer patients. Although the number of publications and health apps focusing on cancer is increasing, there are still few specifically designed for the most prevalent cancers diagnosed: breast and prostate cancers. There is a need to review the effect of these apps on breast and prostate cancer patients’ quality of life (QoL) and well-being. Objective: The purposes of this study were to review the scientific literature on mobile phone apps targeting breast or prostate cancer patients and involving QoL and well-being (anxiety and depression symptoms) and analyze the clinical and technological characteristics, strengths, and weaknesses of these apps, as well as patients’ user experience with them. Methods: We conducted a systematic review of peer-reviewed literature from The Cochrane Library, Excerpta Medica Database, PsycINFO, PubMed, Scopus, and MEDLINE to identify studies involving apps focused on breast and/or prostate cancer patients and QoL and/or well-being published between January 1, 2000, and July 12, 2017. Only trial studies which met the inclusion criteria were selected. The systematic review was completed with a critical analysis of the apps previously identified in the health literature research that were available from the official app stores. Results: The systematic review of the literature yielded 3862 articles. After removal of duplicates, 3229 remained and were evaluated on the basis of title and abstract. Of these, 3211 were discarded as not meeting the inclusion criteria, and 18 records were selected for full text screening. Finally, 5 citations were included in this review, with a total of 644 patients, mean age 52.16 years. Four studies targeted breast cancer patients and 1 focused on prostate cancer patients. Four studies referred to apps that assessed QoL. Only 1 among the 5 analyzed apps was available from the official app store. In 3 studies, an app-related intervention was carried out, and 2 of them reported an improvement on QoL. The lengths of the app-related interventions varied from 4 to 12 weeks. Because 2 of the studies only tracked use of the app, no effect on QoL or well-being was found. Conclusions: Despite the existence of hundreds of studies involving cancer-focused mobile phone apps, there is a lack of rigorous trials regarding the QoL and/or well-being assessment in breast and/or prostate cancer patients. A strong and collective effort should be made by all health care providers to determine those cancer-focused apps that effectively represent useful, accurate, and reliable tools for cancer patients’ disease management.European Union's Horizon 2020 No 72201

A Framework for the Design of a Mobile-Based Alert System for Outpatient Adherence in Nigeria

Nigeria ranks among the countries with the highest child and maternal mortality rate. Chronic diseases are the most common contributors to the diseases burden in Nigeria most especially Malaria, Tuberculosis (TB) and HIV/AIDS. Adherence to long-term therapy in out-patient condition is required to reduce and curb the prevalence of these diseases. Poor adherence to long-term therapies severely compromises the effectiveness of treatment; making this a critical issue in population health both from the perspective of quality of life and of health economics. This work introduces a m-technology based system that will provide an easy way of complying with drug regimen. It will make use of the Short Messaging Service (SMS) of mobile phones to provide reminders at dosing times. It will design architecture for mobile health interventions and develop a prototype SMS-based system to improve out-patient adherence. This system will be deployed over a period of time at selected hospitals and chronic disease management centers in selected states in Nigeria, and the adherence rates measured via health outcomes and evaluated. This would provide a significant positive return on investment through primary prevention (of risk factors) and secondary prevention of adverse health outcomes. It will also inform predictions of future population health outcomes predicted by treatment efficacy data. Keywords: out-patient, m-technology, adherence, chronic diseases, Nigeria, SM

Fall prevention intervention technologies: A conceptual framework and survey of the state of the art

In recent years, an ever increasing range of technology-based applications have been developed with the goal of assisting in the delivery of more effective and efficient fall prevention interventions. Whilst there have been a number of studies that have surveyed technologies for a particular sub-domain of fall prevention, there is no existing research which surveys the full spectrum of falls prevention interventions and characterises the range of technologies that have augmented this landscape. This study presents a conceptual framework and survey of the state of the art of technology-based fall prevention systems which is derived from a systematic template analysis of studies presented in contemporary research literature. The framework proposes four broad categories of fall prevention intervention system: Pre-fall prevention; Post-fall prevention; Fall injury prevention; Cross-fall prevention. Other categories include, Application type, Technology deployment platform, Information sources, Deployment environment, User interface type, and Collaborative function. After presenting the conceptual framework, a detailed survey of the state of the art is presented as a function of the proposed framework. A number of research challenges emerge as a result of surveying the research literature, which include a need for: new systems that focus on overcoming extrinsic falls risk factors; systems that support the environmental risk assessment process; systems that enable patients and practitioners to develop more collaborative relationships and engage in shared decision making during falls risk assessment and prevention activities. In response to these challenges, recommendations and future research directions are proposed to overcome each respective challenge.The Royal Society, grant Ref: RG13082

Role Of Digital Health Wearables In The Wellbeing And Quality Of Life Of Older People And Carers

The number of adults aged 65 and over has increased by 2% across Europe in the past 15 years, and in Northern Ireland by 22% between 2003-2013. The proportion of the population in this age group is projected to increase by 63% to just under 0.5 million by 2033 – which will be a quarter of the population in Northern Ireland. Given Northern Ireland’s Active Ageing Strategy (2015-2021), there is an increasing focus on encouraging physical activity as we get older to preserve mobility and motor skills, and to enjoy the benefits of living longer and to minimise health problems associated with ageing. Over the last two years, we have been investigating the role of wearable activity tracking technologies in self-monitoring of activity by people aged over 55. Example technologies include activity trackers from Fitbit, Garmin and Samsung, and smart watches. Typically, these devices record steps walked, sleep patterns, calories expended and heart rate. Based on empirical investigations, this policy paper describes the benefits of activity monitors for people aged over 55 for self-monitoring of physical activity, for adopting healthy lifestyles, and for increasing or maintaining physical activity as a way to avoid high blood pressure, obesity, diabetes, and other medical conditions associated with weight or lower physical activity. It outlines the role of activity trackers in post-operative monitoring of mobility during rehabilitation, in caring, and for possible use of the data for diagnosis and medical interventions. It then discusses the challenges for adoption of these technologies, given currently, off-the-shelf devices are designed and calibrated for use by physically fit (typically young active people) with unrealistic fitness targets for the older generation

A systematic review of digital interventions for improving the diet and physical activity behaviors of adolescents

Many adolescents have poor diet and physical activity behaviors, which can lead to the development of noncommunicable diseases in later life. Digital platforms offer inexpensive means of delivering health interventions, but little is known about their effectiveness. This systematic review was conducted to synthesize evidence on the effectiveness of digital interventions to improve diet quality and increase physical activity in adolescents, to effective intervention components and to assess the cost-effectiveness of these interventions. Following a systematic search, abstracts were assessed against inclusion criteria, and data extraction and quality assessment were performed for included studies. Data were analyzed to identify key features that are associated with significant improvement in behavior. A total of 27 studies met inclusion criteria. Most (n = 15) were Web site interventions. Other delivery methods were text messages, games, multicomponent interventions, emails, and social media. Significant behavior change was often seen when interventions included education, goal setting, self-monitoring, and parental involvement. None of the publications reported cost-effectiveness. Due to heterogeneity of studies, meta-analysis was not feasible.It is possible to effect significant health behavior change in adolescents through digital interventions that incorporate education, goal setting, self-monitoring, and parental involvement. Most of the evidence relates to Web sites and further research into alternate media is needed, and longer term outcomes should be evaluated. There is a paucity of data on the cost-effectiveness of digital health interventions, and future trials should report these data