Interactive, mobile-based health approaches may enable global implementation of workplace physical activity programs, and show an increase in physical activity, reduction in sitting duration and contribute to modest weight loss, according to research presented April 3 at ACC.16 in Chicago and simultaneously published in the Journal of the American College of Cardiology.

The Stepathlon Cardiovascular Health Study, led by Anand N. Ganesan, MBBS, PhD, et al, analyzed data from participants in Stepathlon, an international, low-cost mobile health intervention designed as a workplace exercise and wellness program, and differed from most physical intervention trials in that it was conducted mainly in lower-middle income countries. Only 8 percent of countries in the study were high-income. In 1,481 cities across 64 countries including China, India and United Arab Emirates, 69,219 individuals participated (76.2 percent male, 23.9 percent female), representing 481 employers. Improvements in number of steps, amount of physical activity and weight occurred in both men and women across all geographic regions and income levels. The results were reproduced in 2012, 2013, and 2014 cohorts.

Participants in each workplace were separated into teams and given non-interactive pedometers. Individuals were encouraged to increase daily steps and physical activity, avoid sitting, and to self-report via the Stepathlon mobile app or website. Web-based questionnaires were administered before and after the 100-day event. Baseline data was required for event entry. Of the 69,219 participants, 53 percent completed the post-event questionnaire.

The Stepathlon website was designed to be interactive and encouraging, with fitness and health tips, a leaderboard tracking the performance of each team and personalized tools for self-monitoring. Quizzes and other activities were used to encourage interaction with the interface, which was offered via web or mobile app. Emails were sent daily to participants offering encouragement, recognizing individual milestones and providing content on physical activity and nutrition.

At the conclusion of each 100-day Stepathlon event, overall step count was found to increase by 3,519 steps per day for both women and men in all three-year cohorts. Exercise days per week increased by .89 overall. Sitting hours decreased overall by .74 hours. Overall participant weight decreased by 1.45 kg. The improvements were seen in both women and men, and in all year cohorts. The results were similar in every country and income level. Step count increase, sitting time decrease and increased exercise days were all associated with decreases in weight.

The authors posit that the Stepathlon study "demonstrates the feasibility of implementation and delivery of a low-cost, global, mass-participation workplace-based pedometer and wellness program, delivered electronically to an internationally distributed 'real world' participant base." The program's efficacy is shown by its statistically significant and reproducible year-by-year results–improvements in short-term measures of physical activity, sitting and weight in both men and women across countries and income levels.

"The enormous global scale of the crisis of physical inactivity, sedentary behavior and excess weight suggests a need for mass-participation lifestyle interventions implementable in both high-income and lower-middle income countries," said the authors. The results of the Stepathlon study suggest that using low-cost mobile health technology on a large scale may be a way to effectively communicate messages about lifestyle change in a way that could benefit patients from a variety of economic backgrounds and global regions.

Keywords: ACC Annual Scientific Session, Actigraphy, Body Weight, Exercise, Obesity

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