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Mechanisms of an App-Based Physical Activity Intervention
Quick Takes
- The digital technology-based app-based physical activity program (mPED) significantly increased daily steps and moderate to vigorous physical activity minutes in physically inactive women at 3-month post-intervention and during the 6-month maintenance period.
- Although use of the mPED improved physical activity, the intervention women had reduced self-efficacy at 3 and 9 months, possibly related to their awareness of challenges and emotional states in judging one’s capabilities to reach preprogrammed goals.
- Social support from friends rather than family is important for maintenance of long-term physical activity.
Study Questions:
What is the role of mediating factors (self-efficacy for physical activity, social support, and barriers for physical activity) in physically inactive women using a mobile app program and accelerometer to measure daily steps and moderate to vigorous physical activity over a 9-month period?
Methods:
This study enrolled 210 physically inactive women in a trial consisting of a 3-month intervention period using an app and brief counseling, and a 6-month maintenance period. Both groups received an accelerometer to record total daily steps and moderate to vigorous physical activity. However, only the intervention group received brief in-person counseling at randomization, 6 weeks, and 3 months and had access to the app-based physical activity program (mPED) over the 9-month study. The content covered in the counseling sessions and the mPED preprogrammed daily message/video clips included: goal setting, intensity, identification of barriers (lack of time, motivation, or energy), and health benefits, diet, and weight management. At baseline, 3 months, and 9 months, the Barriers to Being Active Quiz was administered to measure barriers to physical activity engagement, the Social Support and Exercise Survey to assess mediators for family and friend social support related to physical activity, and the Modified Self-efficacy for Physical Activity to measure how confident the participant is to engage in physical activity.
Results:
The intervention group, as compared to the control group, significantly improved total steps/day by an average 2,060 steps/day at 3 months and 1,360 steps/days during maintenance period at 9 months; and a net difference of moderate to vigorous physical activity 18.2 min/day at 3 months (95% confidence interval [CI], 10.9-25.4) and 8.4 min/day at 9 months (95% CI, 2.0-14.9). The intervention group significantly reduced physical activity barriers (p = -0.003 at 3 months, p = 0.33 at 9 months), and gained more social support from family and friends at 3 months (p = 0.002 and p = 0.001, respectively). However, social support from family was significantly reduced at 9 months (p = 0.45). At 3 and 9 months, the intervention group, as compared to the control group, had a significant reduction in self-efficacy scores (p = 0.05 and p = 0.025, respectively).
Conclusions:
This study found that a digital technology-based physical activity program significantly improved total steps/day and moderate to vigorous physical activity during the 3-month intervention period. However, over the 6-month maintenance period, self-efficacy was significantly reduced in the intervention group despite having preprogrammed app-based counseling and goal setting likely due to their awareness of the challenges to reach the incremental goals set by the app. In addition, social support from friends rather than family played a greater role in maintenance. Based on this study, a digital technology-based physical activity program needs to tailor content based on patients' needs, but also to incorporate realistic goals that are adjusted throughout maintenance programs to improve self-confidence strategies and the sustainability of lifelong physical activity.
Perspective:
This digital technology-based physical activity program using brief in-person counseling and an app-based program significantly increased daily steps and moderate to vigorous physical activity minutes in physically inactive women from baseline to the 3-month intervention period and during the 6-month maintenance period. However, a reduction in self-efficacy was observed in the intervention group, as compared with the control group, at 3 and 9 months. Incorporating strategies to improve self-efficacy, overcome physical activity barriers, and promote social support for physical activity is important for the design of physical activity programs for sustained health benefits.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Diet, Exercise
Keywords: Accelerometry, Counseling, Diet, Exercise, Friends, Mobile Applications, Motivation, Patient Care Team, Primary Prevention, Sedentary Behavior, Social Support, Weight Reduction Programs, Women
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