Multiple Behavior Changes in Diet and Activity: a Randomized Controlled Trial Using Mobile Technology

Overview

Journal Arch Intern Med

Specialty General Medicine

Date 2012 May 29

PMID 22636824

Citations 105

Authors

Bonnie Spring

Kristin Schneider

H Gene McFadden

Jocelyn Vaughn

Andrea T Kozak

Malaina Smith

Arlen C Moller

Leonard H Epstein

Andrew DeMott

Donald Hedeker

Juned Siddique

Donald M Lloyd-Jones

Affiliations

Soon will be listed here.

Abstract

Background: Many patients exhibit multiple chronic disease risk behaviors. Research provides little information about advice that can maximize simultaneous health behavior changes.

Methods: To test which combination of diet and activity advice maximizes healthy change, we randomized 204 adults with elevated saturated fat and low fruit and vegetable intake, high sedentary leisure time, and low physical activity to 1 of 4 treatments: 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. Treatments provided 3 weeks of remote coaching supported by mobile decision support technology and financial incentives. During treatment, incentives were contingent on using the mobile device to self-monitor and attain behavioral targets; during follow-up, incentives were contingent only on recording. The outcome was standardized, composite improvement on the 4 diet and activity behaviors at the end of treatment and at 5-month follow-up.

Results: Of the 204 individuals randomized, 200 (98.0%) completed follow-up. The increase fruits/vegetables and decrease sedentary leisure treatments improved more than the other 3 treatments (P < .001). Specifically, daily fruit/vegetable intake increased from 1.2 servings to 5.5 servings, sedentary leisure decreased from 219.2 minutes to 89.3 minutes, and saturated fat decreased from 12.0% to 9.5% of calories consumed. Differences between treatment groups were maintained through follow-up. Traditional dieting (decrease fat and increase physical activity) improved less than the other 3 treatments (P < .001).

Conclusions: Remote coaching supported by mobile technology and financial incentives holds promise to improve diet and activity. Targeting fruits/vegetables and sedentary leisure together maximizes overall adoption and maintenance of multiple healthy behavior changes.

Citing Articles

The moderating effect of access to food facilities and recreational activity space on mHealth multiple health behavior change intervention.

Battalio S, Barrett B, Arnaoudova I, Press D, Hedeker D, Pfammatter A J Behav Med. 2024; 47(6):965-979.

PMID: 39110353 DOI: 10.1007/s10865-024-00505-2.

Study protocol of a clinical randomized controlled trial on the efficacy of an innovative Digital thErapy to proMote wEighT loss in patients with obesity by incReasing their Adherence to treatment: the DEMETRA study.

Castelnuovo G, Capodaglio P, De Amicis R, Gilardini L, Mambrini S, Pietrabissa G Front Digit Health. 2023; 5:1159744.

PMID: 38098734 PMC: 10720313. DOI: 10.3389/fdgth.2023.1159744.

Joint modeling the frequency and duration of accelerometer-measured physical activity from a lifestyle intervention trial.

Siddique J, Daniels M, Inan G, Battalio S, Spring B, Hedeker D Stat Med. 2023; 42(28):5100-5112.

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Study Design, Rationale, and Methodology for Promote Weight Loss in Patients With Peripheral Artery Disease Who Also Have Obesity: The PROVE Trial.

Whipple M, Pfammatter A, Spring B, Rejeski W, Treat-Jacobson D, Domanchuk K J Am Heart Assoc. 2023; 12(17):e031182.

PMID: 37642035 PMC: 10547361. DOI: 10.1161/JAHA.123.031182.

Lifestyle Medicine as a Treatment for Resistant Hypertension.

Ribeiro F, Teixeira M, Alves A, Sherwood A, Blumenthal J Curr Hypertens Rep. 2023; 25(10):313-328.

PMID: 37470944 DOI: 10.1007/s11906-023-01253-5.

References

Beasley J, Riley W, Jean-Mary J . Accuracy of a PDA-based dietary assessment program. Nutrition. 2005; 21(6):672-7. DOI: 10.1016/j.nut.2004.11.006. View

Spring B . Translational Behavioral Medicine: a pathway to better health. Transl Behav Med. 2013; 1(1):1-3. PMC: 3717684. DOI: 10.1007/s13142-011-0029-z. View

Hamer M, Stamatakis E, Mishra G . Television- and screen-based activity and mental well-being in adults. Am J Prev Med. 2010; 38(4):375-80. DOI: 10.1016/j.amepre.2009.12.030. View

Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson J, Hemio K . Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006; 368(9548):1673-9. DOI: 10.1016/S0140-6736(06)69701-8. View

Colditz G, Taylor P . Prevention trials: their place in how we understand the value of prevention strategies. Annu Rev Public Health. 2010; 31:105-20. PMC: 3618690. DOI: 10.1146/annurev.publhealth.121208.131051. View

Luepker R, Rastam L, Hannan P, Murray D, Gray C, Baker W . Community education for cardiovascular disease prevention. Morbidity and mortality results from the Minnesota Heart Health Program. Am J Epidemiol. 1996; 144(4):351-62. DOI: 10.1093/oxfordjournals.aje.a008936. View

Hu F, Manson J, Stampfer M, Colditz G, Liu S, Solomon C . Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001; 345(11):790-7. DOI: 10.1056/NEJMoa010492. View

Gillman M, Pinto B, Tennstedt S, Glanz K, Marcus B, Friedman R . Relationships of physical activity with dietary behaviors among adults. Prev Med. 2001; 32(3):295-301. DOI: 10.1006/pmed.2000.0812. View

Clark B, Sugiyama T, Healy G, Salmon J, Dunstan D, Owen N . Validity and reliability of measures of television viewing time and other non-occupational sedentary behaviour of adults: a review. Obes Rev. 2008; 10(1):7-16. DOI: 10.1111/j.1467-789X.2008.00508.x. View

10.

Stamatakis E, Hamer M, Dunstan D . Screen-based entertainment time, all-cause mortality, and cardiovascular events: population-based study with ongoing mortality and hospital events follow-up. J Am Coll Cardiol. 2011; 57(3):292-9. DOI: 10.1016/j.jacc.2010.05.065. View

11.

Knowler W, Barrett-Connor E, Fowler S, Hamman R, Lachin J, Walker E . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346(6):393-403. PMC: 1370926. DOI: 10.1056/NEJMoa012512. View

12.

Epstein L, Roemmich J, Paluch R, Raynor H . Influence of changes in sedentary behavior on energy and macronutrient intake in youth. Am J Clin Nutr. 2005; 81(2):361-6. DOI: 10.1093/ajcn.81.2.361. View

13.

Sternfeld B, Jiang S, Picchi T, Chasan-Taber L, Ainsworth B, Quesenberry Jr C . Evaluation of a cell phone-based physical activity diary. Med Sci Sports Exerc. 2011; 44(3):487-95. DOI: 10.1249/MSS.0b013e3182325f45. View

14.

Fukuoka Y, Kamitani E, Dracup K, Jong S . New insights into compliance with a mobile phone diary and pedometer use in sedentary women. J Phys Act Health. 2011; 8(3):398-403. PMC: 4036092. DOI: 10.1123/jpah.8.3.398. View

15.

Fine L, Philogene G, Gramling R, Coups E, Sinha S . Prevalence of multiple chronic disease risk factors. 2001 National Health Interview Survey. Am J Prev Med. 2004; 27(2 Suppl):18-24. DOI: 10.1016/j.amepre.2004.04.017. View

16.

Gierach G, Chang S, Brinton L, Lacey Jr J, Hollenbeck A, Schatzkin A . Physical activity, sedentary behavior, and endometrial cancer risk in the NIH-AARP Diet and Health Study. Int J Cancer. 2009; 124(9):2139-47. PMC: 2845165. DOI: 10.1002/ijc.24059. View

17.

Smith T, Orleans C, Jenkins C . Prevention and health promotion: decades of progress, new challenges, and an emerging agenda. Health Psychol. 2004; 23(2):126-31. DOI: 10.1037/0278-6133.23.2.126. View

18.

Healy G, Wijndaele K, Dunstan D, Shaw J, Salmon J, Zimmet P . Objectively measured sedentary time, physical activity, and metabolic risk: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Diabetes Care. 2007; 31(2):369-71. DOI: 10.2337/dc07-1795. View

19.

Patel A, Bernstein L, Deka A, Feigelson H, Campbell P, Gapstur S . Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. Am J Epidemiol. 2010; 172(4):419-29. PMC: 3590043. DOI: 10.1093/aje/kwq155. View

20.

Grontved A, Hu F . Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a meta-analysis. JAMA. 2011; 305(23):2448-55. PMC: 4324728. DOI: 10.1001/jama.2011.812. View