The diet and activity levels of patients may be improved through use of mobile technology, remote coaching and financial incentives, according to a report of a randomized controlled trial published in the May 28 issue of Archives of Internal Medicine, a JAMA Network publication.1
Not following a physician’s lifestyle change advice is a major barrier to patients achieving effective preventive care. Many physicians are skeptical that patients will change their unhealthy behaviors, and physicians also report a lack of time and training to effectively counsel their patients, researchers write in the study background.
“This study’s interventions leveraged handheld technology to create efficient interventions that make self-monitoring more convenient, extend decision support into life contexts where lifestyle choices are made, and convey time-stamped behavioral data to paraprofessionals who provide coaching remotely,” the researchers note.
Bonnie Spring, Ph.D., of Northwestern University Feinberg School of Medicine, Chicago, and colleagues randomly assigned 204 adult patients (48 men) with elevated intake of saturated fat and low intake of fruits and vegetables, and high sedentary leisure time and low physical activity into 1 of 4 treatments. The treatments were: increase fruit/vegetable intake and physical activity, decrease fat and sedentary leisure, decrease fat and increase physical activity, and increase fruit/vegetable intake and decrease sedentary leisure. Patients used personal digital assistant devices to record and self-regulate their behaviors.
During three weeks of treatment, patients uploaded their data daily and communicated as needed with their coaches by telephone or by email. The participants could earn $175 for meeting goals during the treatment phase. In addition, there was a 20-week follow-up during which patients could earn from $30 to $80 for continuing to record and transmit their data.
“The increase fruits/vegetables and decrease sedentary leisure treatment maximized healthy lifestyle change compared with the other interventions,” the authors comment. They note that lifestyle gains diminished once treatment ended, as expected, but improvements persisted throughout the follow-up period.
From baseline to the end of treatment to the end of the follow-up, respectively, mean (average) servings per day of fruits/vegetables changed from 1.2 to 5.5 to 2.9, mean minutes per day of sedentary leisure from 219.2 to 89.3 to 125.7, and daily calories from saturated fat from 12 percent to 9.4 percent to 9.9 percent, according to the study results.
“This study demonstrates the feasibility of changing multiple unhealthy diet and activity behaviors simultaneously, efficiently and with minimal face-to-face contact by using mobile technology, remote coaching, and incentives,” the authors comment.
In an invited commentary2, William T. Riley, Ph.D., of the National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md., writes: “Via technology, we will soon be able to deliver fully automated and configurable multiple risk factor interventions that monitor progress continuously and can be delivered throughout the day every day.”
“It remains an empirical question, however, whether these technological advances improve outcomes, reduce costs or both,” Riley continues.
“Spring et al have contributed to the empirical evidence of the value of these technologies, but many more research contributions such as this are needed to establish that technologically delivered multiple risk factor interventions improve outcomes,” Riley concludes.
1. (Arch Intern Med. 2012;172:789-796.
2. (Arch Intern Med. 2012:172:796-798.