A Physical Activity and Diet Program Delivered by Artificially Intelligent Virtual Health Coach: Proof-of-Concept Study

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>Poor diet and physical inactivity are leading modifiable causes of death and disease. Advances in artificial intelligence technology present tantalizing opportunities for creating virtual health coaches capable of providing personalized support at scale.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>This proof of concept study aimed to test the feasibility (recruitment and retention) and preliminary efficacy of physical activity and Mediterranean-style dietary intervention (MedLiPal) delivered via artificially intelligent virtual health coach.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This 12-week single-arm pre-post study took place in Adelaide, Australia, from March to August 2019. Participants were inactive community-dwelling adults aged 45 to 75 years, recruited through news stories, social media posts, and flyers. The program included access to an artificially intelligent chatbot, Paola, who guided participants through a computer-based individualized introductory session, weekly check-ins, and goal setting, and was available 24/7 to answer questions. Participants used a Garmin Vivofit4 tracker to monitor daily steps, a website with educational materials and recipes, and a printed diet and activity log sheet. Primary outcomes included feasibility (based on recruitment and retention) and preliminary efficacy for changing physical activity and diet. Secondary outcomes were body composition (based on height, weight, and waist circumference) and blood pressure.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Over 4 weeks, 99 potential participants registered expressions of interest, with 81 of those screened meeting eligibility criteria. Participants completed a mean of 109.8 (95% CI 1.9-217.7) more minutes of physical activity at week 12 compared with baseline. Mediterranean diet scores increased from a mean of 3.8 out of 14 at baseline, to 9.6 at 12 weeks (mean improvement 5.7 points, 95% CI 4.2-7.3). After 12 weeks, participants lost an average 1.3 kg (95% CI –0.1 to –2.5 kg) and 2.1 cm from their waist circumference (95% CI –3.5 to –0.7 cm). There were no significant changes in blood pressure. Feasibility was excellent in terms of recruitment, retention (90% at 12 weeks), and safety (no adverse events).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>An artificially intelligent virtual assistant-led lifestyle-modification intervention was feasible and achieved measurable improvements in physical activity, diet, and body composition at 12 weeks. Future research examining artificially intelligent interventions at scale, and for other health purposes, is warranted.</jats:p> </jats:sec>

Artificial Intelligence Chatbot Behavior Change Model for Designing Artificial Intelligence Chatbots to Promote Physical Activity and a Healthy Diet: Viewpoint

“…Patients actively engaged with the chatbot, reported experiencing positive progress toward their goals, and deemed the chatbot helpful. One proof-of-concept study [ 45 ] reported on the Paola chatbot, which provided educational messages on physical activity and diet, weekly check-ins, and answers to user questions. The results showed that participants reported relevant weight loss and improved diet.…”

“…The above-reviewed chatbots showed preliminary evidence supporting the efficacy of using chatbots to deliver physical activity and diet interventions. It is worth noting that four out of seven (57.1%) studies reported chatbots as the only intervention used to deliver behavior change strategies [ 26 , 43 , 44 , 46 ], whereas the other three articles reported chatbots as an auxiliary component complementing other intervention approaches such as messages and conversations delivered by human facilitators [ 41 , 42 , 45 ] ( Multimedia Appendix 1 ). The reviewed chatbots were designed with different theoretical components and varied in their abilities to engage in natural language conversations, relationship building, and emotional understanding.…”

A Process Evaluation Examining the Performance, Adherence, and Acceptability of a Physical Activity and Diet Artificial Intelligence Virtual Health Assistant

“…The current study was a secondary analysis process evaluation of a 12-week lifestyle physical activity and healthy eating (based upon the Mediterranean dietary pattern) program delivered via a virtual health assistant in a single-arm repeated measures study. Full details of the virtual health assistant, study methods, and primary outcomes have been published elsewhere [19]. Briefly, over the 12-week study period, participants significantly increased their self-reported weekly moderate-to-vigorous physical activity (MVPA) by 110 min, increased their diet quality scores by 150%, lost 1.3 kg in body weight, and lost 2.1 cm from their waist circumference (all p < 0.05) [19].…”

“…Full details of the virtual health assistant, study methods, and primary outcomes have been published elsewhere [19]. Briefly, over the 12-week study period, participants significantly increased their self-reported weekly moderate-to-vigorous physical activity (MVPA) by 110 min, increased their diet quality scores by 150%, lost 1.3 kg in body weight, and lost 2.1 cm from their waist circumference (all p < 0.05) [19].…”

“…Paola was recently evaluated in a 12-week single-arm, pre-post pilot study [19]. The present study aimed to examine:…”