Evaluating the impact of physical activity apps and wearables: interdisciplinary review

Background: Although many smartphone apps and wearables have been designed to improve physical activity, their rapidly evolving nature and complexity present challenges for evaluating their impact. Traditional methodologies, such as randomized controlled trials (RCTs), can be slow. To keep pace with rapid technological development, evaluations of mobile health technologies must be efficient. Rapid alternative research designs have been proposed, and efficient in-app data collection methods, including in-device sensors and device-generated logs, are available. Along with effectiveness, it is important to measure engagement (ie, users’ interaction and usage behavior) and acceptability (ie, users’ subjective perceptions and experiences) to help explain how and why apps and wearables work. Objectives: This study aimed to (1) explore the extent to which evaluations of physical activity apps and wearables: employ rapid research designs; assess engagement, acceptability, as well as effectiveness; use efficient data collection methods; and (2) describe which dimensions of engagement and acceptability are assessed. Method: An interdisciplinary scoping review using 8 databases from health and computing sciences. Included studies measured physical activity, and evaluated physical activity apps or wearables that provided sensor-based feedback. Results were analyzed using descriptive numerical summaries, chi-square testing, and qualitative thematic analysis. Results: A total of 1829 abstracts were screened, and 858 articles read in full. Of 111 included studies, 61 (55.0%) were published between 2015 and 2017. Most (55.0%, 61/111) were RCTs, and only 2 studies (1.8%) used rapid research designs: 1 single-case design and 1 multiphase optimization strategy. Other research designs included 23 (22.5%) repeated measures designs, 11 (9.9%) nonrandomized group designs, 10 (9.0%) case studies, and 4 (3.6%) observational studies. Less than one-third of the studies (32.0%, 35/111) investigated effectiveness, engagement, and acceptability together. To measure physical activity, most studies (90.1%, 101/111) employed sensors (either in-device [67.6%, 75/111] or external [23.4%, 26/111]). RCTs were more likely to employ external sensors (accelerometers: P=.005). Studies that assessed engagement (52.3%, 58/111) mostly used device-generated logs (91%, 53/58) to measure the frequency, depth, and length of engagement. Studies that assessed acceptability (57.7%, 64/111) most often used questionnaires (64%, 42/64) and/or qualitative methods (53%, 34/64) to explore appreciation, perceived effectiveness and usefulness, satisfaction, intention to continue use, and social acceptability. Some studies (14.4%, 16/111) assessed dimensions more closely related to usability (ie, burden of sensor wear and use, interface complexity, and perceived technical performance). Conclusions: The rapid increase of research into the impact of physical activity apps and wearables means that evaluation guidelines are urgently needed to promote efficiency through the use of rapid research designs, in-device sensors and user-logs to assess effectiveness, engagement, and acceptability. Screening articles was time-consuming because reporting across health and computing sciences lacked standardization. Reporting guidelines are therefore needed to facilitate the synthesis of evidence across disciplines

Design Strategies for Playful Technologies to Support Light-intensity Physical Activity in the Workplace

Moderate to vigorous intensity physical activity has an established preventative role in obesity, cardiovascular disease, and diabetes. However recent evidence suggests that sitting time affects health negatively independent of whether adults meet prescribed physical activity guidelines. Since many of us spend long hours daily sitting in front of a host of electronic screens, this is cause for concern. In this paper, we describe a set of three prototype digital games created for encouraging light-intensity physical activity during short breaks at work. The design of these kinds of games is a complex process that must consider motivation strategies, interaction methodology, usability and ludic aspects. We present design guidelines for technologies that encourage physical activity in the workplace that we derived from a user evaluation using the prototypes. Although the design guidelines can be seen as general principles, we conclude that they have to be considered differently for different workplace cultures and workspaces. Our study was conducted with users who have some experience playing casual games on their mobile devices and were able and willing to increase their physical activity.Comment: 11 pages, 5 figures. Video: http://living.media.mit.edu/projects/see-saw

Enhancing physical activity coaching through personalized motivational strategies and self-adaptive goal-setting: development of self-adaptive processes in a monitoring and coaching smartphone application

Dissertação para obtenção do Grau de Mestre em Engenharia BiomédicaThe rising age of the European population brings increased costs in healthcare mainly related to the management of chronic diseases. Regular physical activity has been shown to help in the prevention and control of disease risk. Mobile phones have provided promising and emergent ways of promoting healthy lifestyles, allowing real-time monitoring and coaching to be delivered at any time and any place. The presented work adds new features to the Activity Coach, an ambulatory feedback system that aims to encourage physical activity. The Integral of the Modulus of Body Acceleration (IMA) is the unit used as an estimate for energy expenditure. Although previous research demonstrated the potential of this system, results also showed that adherence drops after a few weeks. The primary goal of this research was to design, implement, and test adaptive goal-setting and personalized feedback strategies in order to encourage physical activity. Regarding the self-adaptive goal-setting feature, the goal for each day is defined automatically based on the physical activity performed at that day of the week since the beginning of the intervention. Hence, the intention is to help the user to increase or maintain his level of physical activity taking his daily routine as a reference. The second element added to the system regards motivational feedback messages, a key factor in interventions aiming at behavior change. Based on the levels of self-efficacy, stage-of-change, and daily activity, the user is assigned to one of the six pre-defined feedback strategies in the system. The content of the motivational cues depends on the selected feedback strategy. The evaluation of the system focused on providing better understandable and more accurate feedback to the user. To do so, we evaluated the challenge and attainability of the goals provided to the user with (1) data acquired during previous studies, and (2) newly gathered data from a single-subject study. As part of the evaluation, we translated IMA counts into ‘steps’, a commonly understandable measure for physical activity, comparing the data acquired from the Activity Coach sensor with a Fitbit, a commercially available pedometer. Although further tests with more subjects and different activities should be performed, we suggest that the default values set to the system are in agreement with the Goal-Setting Theory providing challenging and attainable goals. The results from this research will be used in future experiments using the Activity Coach and can be adapted to other ambulatory feedback systems regarding promotion of physical activity

Wearables at work:preferences from an employee’s perspective

This exploratory study aims to obtain a first impression of the wishes and needs of employees on the use of wearables at work for health promotion. 76 employ-ees with a mean age of 40 years old (SD ±11.7) filled in a survey after trying out a wearable. Most employees see the potential of using wearable devices for workplace health promotion. However, according to employees, some negative aspects should be overcome before wearables can effectively contribute to health promotion. The most mentioned negative aspects were poor visualization and un-pleasantness of wearing. Specifically for the workplace, employees were con-cerned about the privacy of data collection

14 Years of Self-Tracking Technology for mHealth -- Literature Review: Lessons Learnt and the PAST SELF Framework

In today's connected society, many people rely on mHealth and self-tracking (ST) technology to help them adopt healthier habits with a focus on breaking their sedentary lifestyle and staying fit. However, there is scarce evidence of such technological interventions' effectiveness, and there are no standardized methods to evaluate their impact on people's physical activity (PA) and health. This work aims to help ST practitioners and researchers by empowering them with systematic guidelines and a framework for designing and evaluating technological interventions to facilitate health behavior change (HBC) and user engagement (UE), focusing on increasing PA and decreasing sedentariness. To this end, we conduct a literature review of 129 papers between 2008 and 2022, which identifies the core ST HCI design methods and their efficacy, as well as the most comprehensive list to date of UE evaluation metrics for ST. Based on the review's findings, we propose PAST SELF, a framework to guide the design and evaluation of ST technology that has potential applications in industrial and scientific settings. Finally, to facilitate researchers and practitioners, we complement this paper with an open corpus and an online, adaptive exploration tool for the PAST SELF data.Comment: 40 pages, 10 figure