TAME Health: Testing Activity Monitors’ Effect on Health
Lewis-Powell, Zakkoyya H
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To promote physical activity in healthcare, the American Heart Association suggests 5 A’s counseling and technology-based resources for individuals at moderate risk for cardiovascular disease. Pedometers are low-tech devices that are often used to supplement counseling. However, the addition of an electronic activity monitor (EAM) to in-clinic counseling may provide more effective behavior change and increase overall motivation for exercise. We conducted a 12-week intervention to compare the effectiveness of 5 A’s counseling and self-control with an EAM or a pedometer. Primary care patients (n=40) were eligible for the study if they were 55-74 years of age, inactive, overweight or obese, in good health, and had access to a smart device. Participants were randomized to receive a pedometer (Digi-Walker CW-700/701, YAMAX, San Antonio, TX) or an EAM (UP24, Jawbone, San Francisco, CA) and the partnering UP application (app). They were also invited to participate in a focus group after completing the intervention. Stakeholders (n=36) were also recruited to provide feedback. Our study had three aims: 1) evaluate the feasibility and acceptability of implementing a technology-enhanced brief intervention, 2a) compare counseling plus Jawbone to counseling plus pedometer intervention on physiological outcomes, 2b) compare group effectiveness on motivational outcomes, 3) conduct focus groups with primary care stakeholders. To assess each aim we examined social support within the UP app, study feasibility based on RE-AIM indicators, change in cardiovascular related outcomes, and change in motivation. We found that older adults frequently provide emotional support comments and used self-talk within a mobile app. RE-AIM indicators coincide with previous interventions and some indicators suggest that the EAM monitor is more feasible and acceptable than a low-tech pedometer. Comparatively, the two tested monitors improved CVD related outcomes. The EAM produced small-to-moderate effect sizes on PA, waist-to-hip ratio, and physical function. In addition, the EAM group had a significantly greater impact on SDT constructs compared to the pedometer. Future research should investigate methods to enhance social support and competence, test other behavior change techniques, incorporate counseling on multiple health behaviors, and evaluate long-term maintenance of behavior change.