Background Patient engagement with diabetes self-care is critical to reducing morbidity and mortality. Social media is one form of digital health that is available for diabetes self-care, although its use for peer-to-peer communication has not been systematically described, and its potential to support patient self-care is unclear. Objective The primary aim of this systematic review was to describe the use of social media among patients (peer-to-peer) to manage diabetes and cardiovascular disease (CVD). The secondary aim was to assess patients’ clinical outcomes, behavioral outcomes, quality of life, and self-efficacy resulting from peer-to-peer social media use. Methods We conducted a literature search in the following databases: PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO (January 2008 through April 2019). The inclusion criteria were quantitative studies that included peer-to-peer use of social media for self-care of diabetes mellitus (with all subtypes) and CVD, including stroke. Results After an initial yield of 3066 citations, we selected 91 articles for a full-text review and identified 7 papers that met our inclusion criteria. Of these, 4 studies focused on type 1 diabetes, 1 study included both type 1 and 2 diabetes, and 2 studies included multiple chronic conditions (eg, CVD, diabetes, depression, etc). Our search did not yield any individual studies on CVD alone. Among the selected papers, 2 studies used commercial platforms (Facebook and I Seek You), 3 studies used discussion forums developed specifically for each study, and 2 surveyed patients through different platforms or blogs. There was significant heterogeneity in the study designs, methodologies, and outcomes applied, but all studies showed favorable results on either primary or secondary outcomes. The quality of studies was highly variable. Conclusions The future landscape of social media use for patient self-care is promising. However, current use is nascent. Our extensive search yielded only 7 studies, all of which included diabetes, indicating the most interest and demand for peer-to-peer interaction on diabetes self-care. Future research is needed to establish efficacy and safety in recommending social media use among peers for diabetes self-care and other conditions.

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This study investigated the eff ects of biomechanical muscle stimulation (BMS) on low-back and hamstring fl exibility and perceived low back stiff ness. Three healthy populations were examined: college-aged nonathletes, college-aged athletes, and physically active older adults. Low-back stiff ness was reported using a stiff ness Likert scale and range of motion was measured using the sit-and-reach test. Each group received BMS treatment and was retested. The college-aged nonathletes completed a control (no BMS treatment) condition on a separate day. Signifi cant improvement (P Ͻ .001) in sit-andreach performance after treatment in all treatment groups was noted (pre-BMS, 27.8 Ϯ 10.6 cm; post-BMS treatment, 30.1 Ϯ 10.4 cm). Average perceived stiff ness decreased (P = .01) in all groups after undergoing treatment (pre-BMS, 5.0 Ϯ 2.4; post-BMS, 3.2 Ϯ 2.1). Perceived stiff ness did not change (P = .7) in the control condition for the nonathlete group (precontrol, 5.3 Ϯ 2.2; postcontrol, 5.2 Ϯ 2.0).

Relative to sedentary video games (e.g., Playstation 2®), playing physically active video games (e.g., Nintendo Wii Sports Boxing®) significantly increases caloric expenditure in children. Studies have demonstrated that the presence of a peer increases physical activity in children. We sought to determine if children would expend more energy and find playing the “exergame” (Wii) more motivating than the sedentary video game (Playstation 2) when with a peer. Seventeen children (age 8.5 ± 0.4 years) rested, played the sedentary video game and “exergame” for 10 min each, in two conditions: one in which the children rested/played the games alone (alone condition) and another in which they played with a peer (peer condition). Oxygen consumption (VO2), and liking (visual analog scale) was assessed for each 10-min condition. After three 10-min resting/gaming conditions, motivation was assessed using a relative reinforcing value task in which children performed computer mouse presses to gain additional access for either the sedentary video game or “exergame.” VO2 was greater (p < 0.001) during “exergame” play (mean = 12.17 ± 4.1 ml·kg−1·min−1) vs. rest (mean = 5.14 ± 1.46 ml·kg−1·min−1) and the sedentary video game (mean = 5.83 ± 2.1 ml·kg−1·min−1). During the peer condition, there were no significant differences (p > 0.05) in VO2 relative to the alone condition. In an exploratory analysis boys exhibited a greater (p = 0.02) increase in VO2 from rest to “exergame” (Δ 9.0 ± 3.7 ml·kg−1·min−1), relative to girls (Δ 4.9 ± 2.9 ml·kg−1·min−1). Boys showed a significantly greater increase (p = 0.05) in VO2 from the resting condition to “exergame” in the presence of a peer (Δ 11.1 ± 5.3 ml·kg−1·min−1) vs. the alone condition (Δ 6.8 ± 3.1 ml·kg−1 ·min−1). Liking was significantly (p < 0.001) greater for “exergame” (7.7 ± 1.9 cm) and the sedentary video game (8.3 ± 1.3 cm) relative to rest (4.0 ± 2.8 cm). Motivation for “exergame” significantly decreased (p = 0.03) from alone (340.8 ± 106.8 presses) to the peer condition (147.8 ± 81.6 presses).Conclusion: VO2 was greater during “exergame” play relative to the sedentary video game. The presence of a peer did not increase VO2 during “exergame” play. Surprisingly, the presence of a peer decreased children's motivation to play “exergame” vs. the sedentary video game.

BackgroundWhile cardiac rehabilitation has been shown to be effective at improving coronary heart disease (CHD), participation is generally poor. Attempts to increase uptake and adherence often fail. Use of a Facebook intervention for this population may be a unique opportunity to support self-determined motivation and affect adherence.ObjectiveTo evaluate the impact of a Facebook intervention on motivation for exercise and adherence to cardiac rehabilitation in patients with CHD during a 12-week, Phase II cardiac rehabilitation program.MethodsA prospective, randomized controlled pilot study, grounded in Self-Determination Theory, will be conducted. Participants will be recruited from inpatient, or the intake visit to outpatient, cardiac rehabilitation, and then randomly assigned to the intervention or comparison group. Participants in the intervention group will take part in a private Facebook group. Weekly posts will be designed to support self-determined motivation, measured at baseline and postcardiac rehabilitation by the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3). The Psychological Need Satisfaction for Exercise (PNSE) scale will measure fulfillment of needs that affect motivation. Participants in the comparison group will be given the same materials, but these will be supplied via handouts and email. The number of sessions attended will be tallied and analyzed using t tests. Overall motivation will be evaluated using analysis of covariance (ANCOVA) models. Multivariate analysis of variance models will be used to evaluate differences in the change across motivation subtypes. If significant, ANCOVA models for each subtype will be fit. ANCOVA models will be used to compare changes in needs satisfaction, overall and separately among the three subscales, between groups. Engagement in the Facebook group will be measured by number of “likes” and self-report of weekly visits to the group.ResultsThis project was funded in July 2017 and recruitment is currently underway. The recruitment goal is 60 cardiac rehabilitation patients. Data collection is anticipated to be complete by July 2018.ConclusionsThis pilot study will be the first to examine the effect of a Facebook intervention on patient adherence and motivation for exercise in a cardiac rehabilitation setting. Engagement in the Facebook group and participation in the study will help to determine the feasibility of using Facebook to affect adherence and motivation in cardiac rehabilitation patients, potentially improving outcomes through the use of a unique intervention.Trial RegistrationClinicalTrials.gov NCT02971813; https://clinicaltrials.gov/ct2/show/NCT02971813 (Archived by WebCite at http://www.webcitation.org/6sRsz8Zpa)