Effect of Smartphone-Based Lifestyle Coaching App on Community-Dwelling Population With Moderate Metabolic Abnormalities: Randomized Controlled Trial

Abstract

Background Metabolic disorders are established precursors to cardiovascular diseases, yet they can be readily prevented with sustained lifestyle modifications. Objective We assessed the effectiveness of a smartphone-based weight management app on metabolic parameters in adults at high-risk, yet without physician diagnosis nor pharmacological treatment for metabolic syndrome, in a community setting. Methods In this 3-arm parallel-group, single-blind, randomized controlled trial, we recruited participants aged 30 to 59 years with at least 2 conditions defined by the Third Report of the National Cholesterol Education Program expert panel (abdominal obesity, high blood pressure, high triglycerides, low high-density lipoprotein cholesterol, and high fasting glucose level). Participants were randomly assigned (1:1:1) by block randomization to either the nonuser group (control), the app-based diet and exercise self-logging group (app only), or the app-based self-logging and personalized coaching from professional dieticians and exercise coordinators group (app with personalized coaching). Assessments were performed at baseline, week 6, week 12, and week 24. The primary outcome was change in systolic blood pressure (between baseline and follow-up assessments). Secondary outcomes were changes in diastolic blood pressure, body weight, body fat mass, waist circumference, homeostatic model of assessment of insulin resistance, triglyceride level, and high-density lipoprotein cholesterol level between baseline and follow-up assessments. Analysis was performed using intention-to-treat. Results Between October 28, 2017 and May 28, 2018, 160 participants participated in the baseline screening examination. Participants (129/160, 80.6%) who satisfied the eligibility criteria were assigned to control (n=41), app only (n=45), or app with personalized coaching (n=43) group. In each group, systolic blood pressure showed decreasing trends from baseline (control: mean –10.95, SD 2.09 mmHg; app only: mean –7.29, SD 1.83 mmHg; app with personalized coaching: mean –7.19, SD 1.66 mmHg), yet without significant difference among the groups (app only: P=.19; app with personalized coaching: P=.16). Instead, those in the app with personalized coaching group had greater body weight reductions (control: mean –0.12, SD 0.30 kg; app only: mean –0.35, SD 0.36 kg, P=.67; app with personalized coaching: mean –0.96, SD 0.37 kg; P=.08), specifically by body fat mass reduction (control: mean –0.13, SD 0.34 kg; app only: mean –0.64, SD 0.38 kg, P=.22; app with personalized coaching: mean –0.79, SD 0.38 kg; P=.08). Conclusions Simultaneous diet and exercise self-logging and persistent lifestyle modification coaching were ineffective in lowering systolic blood pressure but effective in losing weight and reducing body fat mass. These results warrant future implementation studies of similar models of care on a broader scale in the context of primary prevention. Trial Registration ClinicalTrials.gov NCT03300271; http://clinicaltrials.gov/ct2/show/NCT03300271

The Effect of a Lifestyle Intervention Program Using a Mobile Application for Adults with Metabolic Syndrome, versus the Effect of a Program Using a Booklet: A Pilot Randomized Controlled Trial

“…Two systematic reviews have highlighted that a successful structured e-health program should be specifically tailored to the target group and have features that support self-monitoring, feedback, the use of theory, interactivity, and goal setting to change behavior. 16 , 38 , 39 Given that the same information on MetS was provided to the booklet group and to the app group, the members’ area and interactive platform and other features of the MetS app may have further facilitated the self-monitoring of individual health and the recording of exercise, body weight, and waist circumference, thereby enhancing the participants’ self-efficacy for adequate dietary control, exercise initiation, self-monitoring, and maintenance, leading to a greater amount of exercise and body weight reduction. 29–31 In addition, the alert and reminder functions of the app encouraged the participants to maintain their exercise habits.…”

“…Previous studies have consistently shown a positive effect of increased physical activity on body weight control and lipid profile over a period of 3 or more months. 13 , 22 , 23 , 39 , 40 The success of other programs 13 , 16 , 22 , 23 , 40 may be due to their labor-intensive components, such as individual counselling for dietary and exercise advice or a supervised exercise program. However, our study relied solely on the app support, leading to an increase in the amount of physical exercise and weight reduction over the 3-month study period.…”

Cross-National Outcomes of a Digital Weight Loss Intervention in the United States, Canada, United Kingdom and Ireland, and Australia and New Zealand: A Retrospective Analysis

“…In addition, the study retrospectively explores outcomes for better external validity, so that aspects of a formal clinical setting such as specific study timepoints or requirements do not inflate outcomes that individuals ordinarily manage on their own (18,19). The study used a global, highly assessed mHealth intervention called Noom that has been found to result in clinically significant weight loss in healthy and at-risk populations in observational studies and randomized controlled trials (RCTs) (20)(21)(22)(23)(24). RCTs have found that Noom reduced weight and body fat in individuals at risk for metabolic disorders, individuals with pre-diabetes, and individuals with colorectal polyps compared to control conditions (22)(23)(24).…”

A Technology-Mediated Interventional Approach to the Prevention of Metabolic Syndrome: A Systematic Review and Meta-Analysis

“…Technology-mediated interventions can address these limitations and inconveniences while delivering reliable educational materials to many people at a convenient time and place [ 67 ]. People can receive consistently and the same intervention regardless of healthcare providers’ level of expertise.…”