Mobile Health Intervention Yielded Significant Improvements in Diet, Exercise

Smartphone technology may help patients eat more fruits and vegetables as well as increase physical activity.

ORLANDO, Fla. — Simultaneous or sequential treatment of multiple diet and activity risk behaviors using mobile technologies and remote coaching may produce large, sustained improvements in diet and activity, new data presented at the American Heart Association Scientific Sessions suggest.

Bonnie Spring, PhD, who is the director for the Center for Behavior and Health and a professor of preventive medicine, psychology, and psychiatry, and public health at Northwestern University in Chicago, Illinois, and colleagues conducted 2 studies in adults with 4 risk behaviors deemed unhealthy and targetable. These included low intake of fruits and vegetables, a diet high in saturated fat, low moderate-to-vigorous physical activity, and high leisure screen time.

In the first study, conducted several years ago, the researchers paid 204 participants $175.00 to reach a certain level of improvement in these behaviors. Participants were given a palm pilot for self-monitoring and to receive feedback on their progress.

All but 1 participant successfully achieved behavior change. Surprisingly, even after participants stopped receiving payment, they retained about half of these changes, Dr Spring noted.

“Our Make Better Choices 1 intervention had been more successful at improving multiple diet and activity behaviors than I thought possible. I thought that might have been because we paid people $175.00 to make healthy changes. I wanted to see whether we could reproduce the effect without using a large financial incentive, and I also wanted to see if we could increase physical activity at the same time as making other positive changes,” said Dr Spring.

In Make Better Choices 2, the researchers evaluated behavior change in 212 volunteers (mean age, 40 years) with the same 4 risk factors identified in the previous study. They aimed to test the hypothesis that adding physical activity coaching sequentially rather than simultaneously would maximize health change.

All participants were randomly assigned to 1 of 3 interventions that used a smartphone app, a wireless accelerometer, and remote coaching. The first intervention was sequential and targeted improvement of fruit and vegetable intake and sedentary leisure time first, followed by physical activity. The second intervention was simultaneous and aimed to improve both fruit and vegetable intake and sedentary leisure time while also increasing physical activity. The third was a control intervention designed to improve stress and sleep.

Change in behaviors from baseline through 6 and 9 months of follow-up was evaluated in intent-to-treat analyses using linear mixed-effects models.

The study showed that both treatments increased fruit and vegetable intake, decreased sedentary leisure screen time, and decreased saturated fat intake at 6 and 9 months. Both treatments also increased moderate-to-vigorous-physical activity more than the control intervention at 6 months.

The researchers observed a large magnitude of improvement in a composite healthy lifestyle improvement score, which weighted these behaviors equally, in both the sequential and simultaneous intervention groups that was sustained out to 9 months.

Data also revealed improvements in specific behaviors, including a nearly 6-serving per day increase in fruit and vegetable intake, a 3.7% reduction in saturated fat intake, a mean 126.9-minute decrease in leisure screen time; and a 15.8-minute increase in daily moderate-to-physical activity in the intervention groups. However, the difference in physical activity from baseline between the intervention and control groups no longer reached significance at 9 months, Dr Spring noted.

Attrition and adherence were similar across intervention groups.

Dr Spring said these findings may be of particular interest to endocrinologists who are considering prescribing smartphone apps and wearable sensors.

“It appears feasible to help patients make a number of healthy lifestyle changes either simultaneously or sequentially without requiring frequent in-person treatment sessions. Mobile technologies (smartphone apps, wearable sensors) that support self-monitoring by providing feedback can be quite useful for helping patients make behavior change,” she told Endocrinology Advisor.

“Poor quality diet, overeating, and physical inactivity are common in type 2 diabetes. Unhealthy diet and activity behaviors have profound effects on metabolic function. These findings suggest tools and techniques that can help patients achieve large, sustained diet and activity improvements,” said Dr Spring.


  1. Spring B, Pellegrini CA, McFadden HG, Pfammatter A, Siddique J. LBCT.02 – Decreasing the Global Burden of Disease: Breakthroughs in Prevention. Clinical Trial of a Mobile Health Intervention for Simultaneous versus Sequential Diet and Activity Change. Presented at the American Heart Association Scientific Sessions; November 7-11, 2015; Orlando, FL.