HHS Public Access Author manuscript Author Manuscript
J Am Coll Cardiol. Author manuscript; available in PMC 2017 August 03. Published in final edited form as: J Am Coll Cardiol. 2016 May 31; 67(21): 2464–2466. doi:10.1016/j.jacc.2016.03.482.
Interventions for increasing physical activity: From “ingenious toys” to mHealth Evan D. Muse, MD, PhD and Steven R. Steinhubl, MD Scripps Translational Science Institute, La Jolla, California
Author Manuscript Author Manuscript
The ABC’s of primary and secondary cardiovascular disease prevention are not complete without D (diet and weight management) and certainly not E – Exercise (1). While coming in last in the helpful mnemonic it certainly isn’t the least important. The benefits of increased exercise and physical activity are profound and range well beyond cardiovascular disease and weight management to include the prevention of diabetes, cancer, hypertension, depression and osteoporosis (2). However, the time allowed for such discussions during regular outpatient visits are vastly insufficient and horrifyingly disproportionate to the magnitude of the problem that inactivity has bestowed on disease risk (3). While many physicians lost count long ago of the number of times they have explained to patients that they can’t call them daily to deliver personal motivation or be at their side to remind them to take the stairs in lieu of the elevator, today we have multiple options to help us do just that. Telephone calls are heading the way of the telegraph, in that text messages, email, Instagram and Twitter have become preferred modes of communications. And with most patients now having supercomputers literally in their pockets we have, for the first time, the ability to deliver personalized, situationally-appropriate motivational reminders that can be both dynamic and automated. As such, the number of wellness-related smartphone apps has exploded and wearable activity monitors are seemingly more popular as holiday gifts than was Tickle Me Elmo (4). For many consumers it is their interest in wellness and disease prevention that provides their first foray into mobile health (mHealth) via dietary apps and especially activity trackers. But just as some individuals, over 100 years ago, considered early pedometers as “…little better than an ingenious toy” there remains appropriate skepticism to fully embracing mHealth technologies as the panacea for driving behavior changes such as meaningfully increasing daily activity in a sustainable manner (5).
Author Manuscript
Address for Correspondence: Evan D. Muse, MD, PhD, Scripps Translational Science Institute, 3344 North Torrey Pines Court, Suite 300, La Jolla, CA 92037, Telephone: 858-554-5708, Fax: 858-546-9284, [email protected]. Disclosures: SRS – Supported by the National Institutes of Health (NIH)/National Center for Advancing Translational Sciences grant UL1TR001114 and a grant from the Qualcomm Foundation. Medical Advisor for Agile Edge Technologies, Airstrip Technologies, BridgeCrest Medical, DynoSense, FocusMotion and PhysIQ. Serves on the board of directors of Nano Mobile Healthcare, Inc. EDM - Supported by the National Institutes of Health (NIH)/National Center for Advancing Translational Sciences grant UL1TR001114 Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Muse and Steinhubl
Page 2
Author Manuscript
In this issue of JACC, Ganesan and colleagues report promising results from the Stepathlon Cardiovascular Health Study (6). By providing nearly 70,000 participants with an objective means of activity tracking, in their case a traditional, low-cost pedometer, in addition to access to an interactive smartphone or web-based app, they showed consistent and reproducible improvements in step count, exercise days, sitting duration and weight during the course of their 14 week program. While this methodology has been appreciated and reported by others, we congratulate this group for ambitiously yet successfully translating this approach to a large, multi-national population for three successive years. Though encouraged by these results there are several questions that remain. Primarily, can this approach achieve sustained, long-term changes in physical activity that would subsequently lead to improved health and quality of life for all participants?
Author Manuscript Author Manuscript
The immediate successes and positive short-term outcomes (on average ~3 months) for participants using activity monitors and wellness apps are well appreciated (7). But we are still lacking data to support sustained improvements that would carry beyond several months. Maybe it is telling that in the present study, on a year over year basis, the preprogram step count didn’t appear to change perceptibly. For the investigators it might be especially interesting to explore in greater detail workplaces and especially individuals engaged in consecutive years. Perhaps the field’s overall lack of long-term data is secondary to inadequate research funding for such studies or possibly pressure from commercial entities to generate only data supportive of the use of their technologies. With every incentive to remain in the wellness space rather than traverse a potential FDA maze for approved disease management there is little motivation for technology developers to sponsor meaningful, long-term outcome trials. On the other hand, as anyone who has attempted a sustained physical activity or weight loss goal can appreciate first hand, these efforts are incredibly difficult and not traditionally successful, and there are endless volumes of data supporting this. What remains elusive, however, are the key factors that are ultimately responsible for the individual successes or failures in respect to these efforts, and areas that will require a uniquely personalized incentivization targeted to a specific individual. In this study alone, the rate of attrition was significant, a little
J Am Coll Cardiol. Author manuscript; available in PMC 2017 August 03. Published in final edited form as: J Am Coll Cardiol. 2016 May 31; 67(21): 2464–2466. doi:10.1016/j.jacc.2016.03.482.
Interventions for increasing physical activity: From “ingenious toys” to mHealth Evan D. Muse, MD, PhD and Steven R. Steinhubl, MD Scripps Translational Science Institute, La Jolla, California
Author Manuscript Author Manuscript
The ABC’s of primary and secondary cardiovascular disease prevention are not complete without D (diet and weight management) and certainly not E – Exercise (1). While coming in last in the helpful mnemonic it certainly isn’t the least important. The benefits of increased exercise and physical activity are profound and range well beyond cardiovascular disease and weight management to include the prevention of diabetes, cancer, hypertension, depression and osteoporosis (2). However, the time allowed for such discussions during regular outpatient visits are vastly insufficient and horrifyingly disproportionate to the magnitude of the problem that inactivity has bestowed on disease risk (3). While many physicians lost count long ago of the number of times they have explained to patients that they can’t call them daily to deliver personal motivation or be at their side to remind them to take the stairs in lieu of the elevator, today we have multiple options to help us do just that. Telephone calls are heading the way of the telegraph, in that text messages, email, Instagram and Twitter have become preferred modes of communications. And with most patients now having supercomputers literally in their pockets we have, for the first time, the ability to deliver personalized, situationally-appropriate motivational reminders that can be both dynamic and automated. As such, the number of wellness-related smartphone apps has exploded and wearable activity monitors are seemingly more popular as holiday gifts than was Tickle Me Elmo (4). For many consumers it is their interest in wellness and disease prevention that provides their first foray into mobile health (mHealth) via dietary apps and especially activity trackers. But just as some individuals, over 100 years ago, considered early pedometers as “…little better than an ingenious toy” there remains appropriate skepticism to fully embracing mHealth technologies as the panacea for driving behavior changes such as meaningfully increasing daily activity in a sustainable manner (5).
Author Manuscript
Address for Correspondence: Evan D. Muse, MD, PhD, Scripps Translational Science Institute, 3344 North Torrey Pines Court, Suite 300, La Jolla, CA 92037, Telephone: 858-554-5708, Fax: 858-546-9284, [email protected]. Disclosures: SRS – Supported by the National Institutes of Health (NIH)/National Center for Advancing Translational Sciences grant UL1TR001114 and a grant from the Qualcomm Foundation. Medical Advisor for Agile Edge Technologies, Airstrip Technologies, BridgeCrest Medical, DynoSense, FocusMotion and PhysIQ. Serves on the board of directors of Nano Mobile Healthcare, Inc. EDM - Supported by the National Institutes of Health (NIH)/National Center for Advancing Translational Sciences grant UL1TR001114 Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Muse and Steinhubl
Page 2
Author Manuscript
In this issue of JACC, Ganesan and colleagues report promising results from the Stepathlon Cardiovascular Health Study (6). By providing nearly 70,000 participants with an objective means of activity tracking, in their case a traditional, low-cost pedometer, in addition to access to an interactive smartphone or web-based app, they showed consistent and reproducible improvements in step count, exercise days, sitting duration and weight during the course of their 14 week program. While this methodology has been appreciated and reported by others, we congratulate this group for ambitiously yet successfully translating this approach to a large, multi-national population for three successive years. Though encouraged by these results there are several questions that remain. Primarily, can this approach achieve sustained, long-term changes in physical activity that would subsequently lead to improved health and quality of life for all participants?
Author Manuscript Author Manuscript
The immediate successes and positive short-term outcomes (on average ~3 months) for participants using activity monitors and wellness apps are well appreciated (7). But we are still lacking data to support sustained improvements that would carry beyond several months. Maybe it is telling that in the present study, on a year over year basis, the preprogram step count didn’t appear to change perceptibly. For the investigators it might be especially interesting to explore in greater detail workplaces and especially individuals engaged in consecutive years. Perhaps the field’s overall lack of long-term data is secondary to inadequate research funding for such studies or possibly pressure from commercial entities to generate only data supportive of the use of their technologies. With every incentive to remain in the wellness space rather than traverse a potential FDA maze for approved disease management there is little motivation for technology developers to sponsor meaningful, long-term outcome trials. On the other hand, as anyone who has attempted a sustained physical activity or weight loss goal can appreciate first hand, these efforts are incredibly difficult and not traditionally successful, and there are endless volumes of data supporting this. What remains elusive, however, are the key factors that are ultimately responsible for the individual successes or failures in respect to these efforts, and areas that will require a uniquely personalized incentivization targeted to a specific individual. In this study alone, the rate of attrition was significant, a little
