A Theory-Informed, Personalized mHealth Intervention for Adolescents (Mobile App for Physical Activity): Development and Pilot Study

Abstract

Background Evidence suggests that physical activity (PA) during childhood and adolescence is crucial as it usually results in adequate PA levels in adulthood. Given the ubiquitous use of smartphones by adolescents, these devices may offer feasible means to reach young populations and deliver interventions aiming to increase PA participation and decrease sedentary time. To date, very few studies have reported smartphone-based interventions promoting PA for adolescents. In addition, most available fitness apps do not include the latest evidence-based content. Objective This paper described the systematic development of a behavior change, theory-informed Mobile App for Physical Activity intervention with personalized prompts for adolescents aged 16 to 18 years. The within-subject trial results provided the first evidence of the general effectiveness of the intervention based on the outcomes step count, sedentary time, and moderate to vigorous PA (MVPA) minutes. The effectiveness of the intervention component personalized PA prompt was also assessed. Methods A 4-week within-subject trial with 18 healthy adolescents aged 16 to 18 years was conducted (mean age 16.33, SD 0.57 years). After the baseline week, the participants used the Mobile App for Physical Activity intervention (Fitbit fitness tracker+app), which included a daily personalized PA prompt delivered via a pop-up notification. A paired 1-tailed t test was performed to assess the effectiveness of the intervention. Change-point analysis was performed to assess the effectiveness of a personalized PA prompt 30 and 60 minutes after prompt delivery. Results The results showed that the intervention significantly reduced sedentary time in adolescents during the first week of the trial (t17=−1.79; P=.04; bootstrapped P=.02). This trend, although remaining positive, diminished over time. Our findings indicate that the intervention had no effect on metabolic equivalent of task–based MVPA minutes, although the descriptive increase may give reason for further investigation. Although the results suggested no overall change in heart rate–based MVPA minutes, the results from the change-point analyses suggest that the personalized PA prompts significantly increased heart rate per minute during the second week of the study (t16=1.84; P=.04; bootstrapped P=.04). There were no significant increases in participants’ overall step count; however, the personalized PA prompts resulted in a marginally significant increase in step counts per minute in the second week of the study (t17=1.35; P=.09; bootstrapped P=.05). Conclusions The results of the trial provide preliminary evidence of the benefit of the Mobile App for Physical Activity intervention for modest yet significant reductions in participants’ sedentary time and the beneficial role of personalized PA prompts. These results also provide further evidence of the benefits and relative efficacy of personalized activity suggestions for inclusion in smartphone-based PA interventions. This study provides an example of how to guide the development of smartphone-based mobile health PA interventions for adolescents.

Digital Behavior Change Intervention Designs for Habit Formation: Systematic Review

“…Descriptive feedback refers to information displayed related to individual behavior data that are commonly presented as numerical or diagrams [39,45]. On the contrary, evaluative feedback provides comments about individuals' behavior and goal performances [46,47]. Gaps between progress and goals provide explicit information to motivate individuals [48][49][50].…”

“…Virtual rewards (eg, points, badges, and trophies) were the most applied external rewards across the selected studies (16/41, 39%), which commonly used gamified elements to enhance engagement and motivation for physical activity in DBCIs [46,61,[68][69][70]. On the contrary, although financial incentives were demonstrated to be more effective as external rewards compared to virtual rewards, their effects were argued to lack long-term sustainability and diminish over time [38,47]. In addition, emotional motivation was commonly applied as internal rewards across the selected studies (12/41, 29%).…”

Impact of the ActTeens Program on physical activity and fitness in adolescents: a cluster randomized controlled trial

“…Digital programs (eHealth and mHealth) have emerged as a potentially efficacious strategy for promoting PA beyond the school setting (e.g., home, park, leisure time, and transportation) [ 21 ]. It is important to emphasize that during COVID-19 pandemic, several mHealth-based interventions were implemented as they offered a potential solution to social distancing and lockdown (home confinement) [ 22 ].…”