Background Direct-to-consumer mHealth devices are a potential asset to behavioral research but are rarely tested as intervention tools. This trial examined the accelerometer-based Fitbit tracker and website as a basis for a low-touch physical activity intervention. Purpose To evaluate, within a randomized controlled trial, the feasibility and preliminary efficacy of integrating the Fitbit tracker and website into a physical activity intervention for postmenopausal women. Methods Fifty-one inactive, postmenopausal women with BMI≥25.0 kg/m2 were randomized to a 16-week web-based self-monitoring intervention (N=25) or a comparison group (N=26). Those in the Web-Based Tracking Group received a Fitbit, an instructional session, and a follow-up call at 4 weeks. The comparison group received a standard pedometer. All were asked to perform 150 min/week of moderate-to-vigorous physical activity (MVPA). Physical activity outcomes were measured by the ActiGraph GT3X+ accelerometer. Results Data were collected and analyzed in 2013–2014. Participants were 60±7 years old with BMI=29.2±3.5 kg/m2. Relative to baseline, the Web-Based Tracking Group increased MVPA by 62±108 min/week (p<.01), MVPA in 10-min bouts by 38±83 min/week (p=.008), and steps by 789±1,979 (p=.01), compared to non-significant increases in the Pedometer Group (between-group p-values: .11, .28 and .30, respectively). The Web-Based Tracking Group wore the tracker on 95% of intervention days; 96% reported liking the website and 100% liked the tracker. Conclusions The Fitbit was well-accepted in this sample of women and was associated with increased physical activity at 16 weeks. By leveraging direct-to-consumer mHealth technologies that align with behavior change theories, researchers can strengthen physical activity interventions.

BackgroundDirect-to-consumer trackers and devices have potential to enhance theory-based physical activity interventions by offering a simple and pleasant way to help participants self-monitor their behavior. A secondary benefit of these devices is the opportunity for investigators to objectively track adherence to physical activity goals across weeks or even months, rather than relying on self-report or a small number of accelerometry wear periods. The use of consumer trackers for continuous monitoring of adherence has considerable potential to enhance physical activity research, but few studies have been published in this rapidly developing area.ObjectiveThe objective of the study was to assess the trajectory of physical activity adherence across a 16-week self-monitoring intervention, as measured by the Fitbit tracker.MethodsParticipants were 25 overweight or obese, postmenopausal women enrolled in the intervention arm of a randomized controlled physical activity intervention trial. Each participant received a 16-week technology-based intervention that used the Fitbit physical activity tracker and website. The overall study goal was 150 minutes/week of moderate to vigorous intensity physical activity (MVPA) and 10,000 steps/day; however, goals were set individually for each participant and updated at Week 4 based on progress. Adherence data were collected by the Fitbit and aggregated by Fitabase. Participants also wore an ActiGraph GT3X+ accelerometer for 7 days prior to the intervention and again during Week 16.ResultsThe median participant logged 10 hours or more/day of Fitbit wear on 95% of the 112 intervention days, with no significant decline in wear over the study period. Participants averaged 7540 (SD 2373) steps/day and 82 minutes/week (SD 43) of accumulated “fairly active” and “very active” minutes during the intervention. At Week 4, 80% (20/25) of women chose to maintain/increase their individual MVPA goal and 72% (18/25) of participants chose to maintain/increase their step goal. Physical activity levels were relatively stable after peaking at 3 weeks, with only small declines of 8% for steps (P=.06) and 14% for MVPA (P=.05) by 16 weeks.ConclusionsThese data indicate that a sophisticated, direct-to-consumer activity tracker encouraged high levels of self-monitoring that were sustained over 16 weeks. Further study is needed to determine how to motivate additional gains in physical activity and evaluate the long-term utility of the Fitbit tracker as part of a strategy for chronic disease prevention.Trial RegistrationClinicaltrials.gov NCT01837147; http://clinicaltrials.gov/ct2/show/NCT01837147 (Archived by WebCite at http://www.webcitation.org/6d0VeQpvB)

Sit-to-stand transitions may be an intervention target for reducing insulin resistance in breast cancer survivors, which may have favorable downstream effects on cancer prognosis.

The HELP program produces considerable savings (both tangible and intangible) to the Military Healthcare System for small costs. It does this both by increasing access to care at previously inaccessibly remote medical treatment facilities and by consequently decreasing the forward provider's reliance on medical evacuation in questionable cases. This positive ROI was potentially underestimated as this analysis did not account for recapture of care that would otherwise have been sent to the civilian market. On the basis of this analysis, a low bandwidth, asynchronous, and internet accessible teleconsultation system is both a feasible and effective means of projecting quality care forward into the deployed setting. Future implementation of similar initiatives throughout the MHS can be expected, and will likely draw from the lessons learned during the successful implementation and execution of the HELP system.

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