title: Different Location of Triaxial Accelerometer and Different Energy Expenditures mActive: A Randomized Clinical Trial of an Automated mHealth Intervention for Physical Activity Promotion Using a technology-based intervention to promote weight loss in sedentary overweight or obese adults: a randomized controlled trial study design Promoting physical activity using an activity monitor and a tailored web-based advice: design of a randomized controlled trial [ISRCTN93896459] Feasibility and preliminary efficacy of a physical activity counseling intervention using Fitbit in people with knee osteoarthritis: the TRACK-OA study protocol Feasibility and Acceptability of a Wearable Technology Physical Activity Intervention With Telephone Counseling for Mid-Aged and Older Adults: A Randomized Controlled Pilot Trial Are exergames promoting mobility an attractive alternative to conventional self-regulated exercises for elderly people in a rehabilitation setting? Study protocol of a randomized controlled trial Evaluating the effectiveness of organisational-level strategies with or without an activity tracker to reduce office workers’ sitting time: a cluster-randomised trial “Not just another walking program”: Everyday Activity Supports You (EASY) model—a randomized pilot study for a parallel randomized controlled trial Assessing the Impact of a Novel Smartphone Application Compared With Standard Follow-Up on Mobility of Patients With Knee Osteoarthritis Following Treatment With Hylan G-F 20: A Randomized Controlled Trial A Community-Based Physical Activity Counselling Program for People With Knee Osteoarthritis: Feasibility and Preliminary Efficacy of the Track-OA Study Use of activity tracking in major visceral surgery—the Enhanced Perioperative Mobilization (EPM) trial: study protocol for a randomized controlled trial Physical activity, sedentary behavior and total wellness changes among sedentary adults: a 4-week randomized controlled trial Effectiveness of an Activity Tracker- and Internet-Based Adaptive Walking Program for Adults: A Randomized Controlled Trial Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial. Integrating Mobile health and Physical Activity to reduce the burden of Chronic low back pain Trial (IMPACT): a pilot trial protocol Applying a technology‐based system for weight loss in adults with obesity The Effects of Physical Activity Feedback on Behavior and Awareness in Employees: Study Protocol for a Randomized Controlled Trial Effect of wrist-worn activity monitor feedback on physical activity behavior: A randomized controlled trial in Finnish young men Feasibility and Effectiveness of Online Physical Activity Advice Based on a Personal Activity Monitor: Randomized Controlled Trial Design and baseline characteristics of participants in the Enhancing Physical Activity and Reducing Obesity through Smartcare and Financial Incentives (EPAROSFI): A pilot randomized controlled trial. The Impact of Different Degrees of Feedback on Physical Activity Levels: A 4-Week Intervention Study Promoting weight loss through diet and exercise in overweight or obese breast cancer survivors (InForma): study protocol for a randomized controlled trial It's LiFe! Mobile and Web-Based Monitoring and Feedback Tool Embedded in Primary Care Increases Physical Activity: A Cluster Randomized Controlled Trial Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines A 30‐month worksite‐based lifestyle program to promote cardiovascular health in middle‐aged bank employees: Design of the TANSNIP‐PESA randomized controlled trial Use of Consumer Wearable Devices to Promote Physical Activity: A Review of Health Intervention Studies Multidimensional individualised Physical ACTivity (Mi-PACT) – a technology-enabled intervention to promote physical activity in primary care: study protocol for a randomised controlled trial Activity Monitor Intervention to Promote Physical Activity of Physicians-In-Training: Randomized Controlled Trial Feasibility and preliminary efficacy of the ‘HEYMAN’ healthy lifestyle program for young men: a pilot randomised controlled trial Balanced: a randomised trial examining the efficacy of two self-monitoring methods for an app-based multi-behaviour intervention to improve physical activity, sitting and sleep in adults Effect of affordable technology on physical activity levels and mobility outcomes in rehabilitation: a protocol for the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial Effectiveness of a Smartphone application and wearable device for weight loss in overweight or obese primary care patients: protocol for a randomised controlled trial A monitoring and feedback tool embedded in a counselling protocol to increase physical activity of patients with COPD or type 2 diabetes in primary care: study protocol of a three-arm cluster randomised controlled trial Physical Activity Enhancement to a Behavioral Weight Loss Program for Severely Obese Individuals: A Preliminary Investigation "Go4Life" exercise counseling, accelerometer feedback, and activity levels in older people. A randomized lifestyle intervention with 5-year follow-up in subjects with impaired glucose tolerance: Pronounced short-term impact but long-term adherence problems Randomized Trial of a Fitbit-Based Physical Activity Intervention for Women. Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial. Incorporating Novel Mobile Health Technologies Into Management of Knee Osteoarthritis in Patients Treated With Intra-Articular Hyaluronic Acid: Rationale and Protocol of a Randomized Controlled Trial The role and interpretation of pilot studies in clinical research. Technology- and Phone-Based Weight Loss Intervention: Pilot RCT in Women at Elevated Breast Cancer Risk. Preventing weight gain in African American breast cancer survivors using smart scales and activity trackers: a randomized controlled pilot study The comparison of a technology-based system and an in-person behavioral weight loss intervention. The effect of ongoing feedback on physical activity levels following an exercise intervention in older adults: a randomised controlled trial protocol The efficacy of a technology-based system in a short-term behavioral weight loss intervention. Wrist-worn accelerometers in assessment of energy expenditure during intensive training. Organizational-Level Strategies With or Without an Activity Tracker to Reduce Office Workers’ Sitting Time: Rationale and Study Design of a Pilot Cluster-Randomized Trial Enhancing physical activity and reducing obesity through smartcare and financial incentives: A pilot randomized trial. Impact of increasing physical activity on cognitive functioning in breast cancer survivors: Rationale and study design of Memory & Motion. The design and progress of a multidomain lifestyle intervention to improve brain health in middle-aged persons to reduce later Alzheimer's disease risk: The Gray Matters randomized trial
abstract: Purpose We performed a study to determine the best appropriate wearing site of a triaxial accelerometer at different exercise speeds . Material s and Methods We conducted an observational study with 66 healthy Korean adults ( 26 men and 40 women ) .  Resting metabolic rate ( RMR ) before exercise , physical activity-related energy expenditure ( PAEE ) by cardiorespiratory gas analyzer and Signal Vector Magnitude ( SVM ) were measured while wearing four triaxial accelerometers on four different sites ( wrist , waist , upper arm , and ankle ) at exercise speeds from 2 - 10 km/h . Results The mean RMR was 4.03 mL/kg/min and Actual METs ( oxygen consumption at different exercise speeds divided by individual RMR ) compared with the calculated METs ( oxygen consumption divided by 3.5 mL/kg/min ) showed relatively low value . The overall correlation between PAEE and SVM was highest when the accelerometer was worn on the wrist at low exercise speed ( r=0.751 , p<0.001 ) , waist at a moderate speed ( r=0.821 , p<0.001 ) , and ankle at a high speed ( r=0.559 , p<0.001 ) . Using regression analysis , it was shown that the ankle at a low speed ( R2=0.564 , p<0.001 ) , high speed ( R2=0.559 , p<0.001 ) , and the waist at a moderate speed ( R2=0.821 , p<0.001 ) were the best appropriate sites . Conclusion When measuring the PAEE and SVM at different exercise speeds , the ankle in low and high exercise speed , and waist in moderate speed are the most appropriate sites for an accelerometer Background We hypothesized that a fully automated mobile health ( mHealth ) intervention with tracking and texting components would increase physical activity . Methods and Results mActive enrolled smartphone users aged 18 to 69 years at an ambulatory cardiology center in Baltimore , Maryl and . We used sequential r and omization to evaluate the intervention 's 2 core components . After establishing baseline activity during a blinded run‐in ( week 1 ) , in phase I ( weeks 2 to 3 ) , we r and omized 2:1 to unblinded versus blinded tracking . Unblinding allowed continuous access to activity data through a smartphone interface . In phase II ( weeks 4 to 5 ) , we r and omized unblinded participants 1:1 to smart texts versus no texts . Smart texts provided smartphone‐delivered coaching 3 times/day aim ed at individual encouragement and fostering feedback loops by a fully automated , physician‐written , theory‐based algorithm using real‐time activity data and 16 personal factors with a 10 000 steps/day goal . Forty‐eight out patients ( 46 % women , 21 % nonwhite ) enrolled with a mean±SD age of 58±8 years , body mass index of 31±6 kg/m2 , and baseline activity of 9670±4350 steps/day .  Daily activity data capture was 97.4 % . The phase I change in activity was nonsignificantly higher in unblinded participants versus blinded controls by 1024 daily steps ( 95 % confidence interval [ CI ] , −580 to 2628 ; P=0.21 ) . In phase II , participants receiving texts increased their daily steps over those not receiving texts by 2534 ( 95 % CI , 1318 to 3750 ; P<0.001 ) and over blinded controls by 3376 ( 95 % CI , 1951 to 4801 ; P<0.001 ) . Conclusions An automated tracking‐texting intervention increased physical activity with , but not without , the texting component . These results support new mHealth tracking technologies as facilitators in need of behavior change drivers . Clinical Trial Registration URL : http:// Clinical Trials.gov/. Unique identifier : NCT01917812 Purpose : The SenseWear ™ Armb and is an activity monitor developed to improve lifestyle self-monitoring . Currently , few studies assess electronic self-monitoring and weight loss with a lifestyle intervention program . To our knowledge , only one study has used the SenseWear Armb and in combination with a lifestyle intervention to improve weight loss , and no studies have evaluated whether a self-monitoring intervention based solely on the armb and can promote weight loss . Consequently , the aims of the study were to assess weight loss from electronic self-monitoring , to compare these values to the lifestyle intervention and st and ard care groups , and to compare weight loss with lifestyle intervention with and without the armb and . Patients and methods : We recruited 197 sedentary overweight or obese adults ( age , 46.8 ± 10.8 years ; BMI , 33.3 ± 5.2 kg/m2 ) to participate in the 9-month study . Participants were r and omized into one of four weight loss groups : 1 ) the st and ard care group received a self-directed weight loss program , complete with an evidence -based weight loss manual ( st and ard care , n = 50 ) ; 2 ) a 14-week group-based behavioral weight loss program followed by weekly , biweekly , and monthly telephone counseling calls ( GWL , n = 49 ) ; 3 ) the use of the armb and to help improve lifestyle self-monitoring ( SWA alone , n = 49 ) ; or ( 4 ) the group-based behavioral weight loss program and follow-up telephone counseling calls plus the armb and ( GWL + SWA , n = 49 ) . All participants received the evidence -based weight loss manual at baseline . All measures were performed at baseline and months 4 and 9 . The primary outcomes were weight loss and waist circumference reduction . Results : This study is a well- design ed r and omized controlled study powered to detect a 0.5-kg weight loss and 0.6-cm waist circumference reduction in overweight and obese sedentary adults . Conclusion : Innovative technologies are providing lifestyle self-monitoring and weight loss tools . Utilizing these technologies may be an important step in improving the current obesity epidemic Background Ageing is associated with a decrease in physical activity . This decrease particularly occurs during specific transitional life stages . Especially during adolescence and young adulthood a steep decrease in physical activity is observed . Inactive people are often not aware of their inactivity . Providing feedback on the actual physical activity level by an activity monitor can increase awareness and may in combination with an individually tailored physical activity advice stimulate a physically active lifestyle . Methods In a r and omized controlled trial the effectiveness of providing an activity monitor in combination with a personal physical activity advice through the Internet will be examined . Outcome measures are level of physical activity , determinants of physical activity , quality of life , empowerment , aerobic fitness and body composition .  Participants are relatively inactive adolescents and young adults who are measured at baseline , after 3 months intervention and 5 months after the end of the intervention . In addition , facilitating and hindering factors for implementation of the intervention will be investigated . Discussion The use of a personal activity monitor in combination with web-based assisted individually tailored health promotion offers a good opportunity to work interactively with large groups of adolescents and young adults and provide them with advice based on their actual activity level . It has great potential to motivate people to change their behaviour and to our knowledge has not been evaluated before Background Physical activity ( PA ) reduces pain and improves functioning in people with knee osteoarthritis ( OA ) , but few people with the condition meet recommended PA guidelines . Successful intervention strategies to increase PA include goal setting , action planning , self-monitoring , and follow-up feedback from a healthcare professional . Recently developed consumer wearable activity trackers allow users to set activity goals , self-monitor daily goal -progress , and provide feedback on goal attainment . It is hypothesized that a multi-component physiotherapist-led intervention that includes a short ( 40-min ) education module , guided goal - setting and action planning , the use of a wristb and activity tracker , and weekly follow-up phone calls will lead to increased PA outcomes . Methods / design Thirty-six participants will be recruited from the community for a two-group pilot r and omized controlled trial with a stepped-wedge design using an intention-to-treat analysis . Computer-generated block r and omization will be performed using varying block sizes and a 1:1 allocation ratio . The 4-week intervention will be delivered immediately ( immediate-intervention group ) or after a 5-week delay ( delayed-intervention group ) . Outcome measures of pain and disability ( Knee Injury and OA Outcome Score ) , disease self-management ability ( Partners in Health Scale ) , and objective bouted moderate-to-vigorous PA and sedentary time ( BodyMedia SenseWear Mini Armb and ) will be collected at baseline ( week 0 ) and two follow-ups ( weeks 5 and 10 ) , for a total study duration of 11 weeks . Feasibility data relating to process , re source , management , and scientific elements of the trial will be collected . Outcome measure and feasibility data will be summarized , and an estimate of intervention efficacy will be obtained by regression model with planned comparisons . The trial began recruiting in February 2015 . To date , 34 subjects have been recruited . Discussion This study will evaluate the feasibility and preliminary efficacy of a novel intervention to promote  PA in people living with knee OA . The results will provide valuable information to inform a larger r and omized trial to assess intervention effectiveness . Trial registration Clinical Trials.gov Identifier : NCT02313506 ( registration date 8 December 2014 ) . First participant r and omized 20 February 2015 Background As adults age , their physical activity decreases and sedentary behavior increases , leading to increased risk of negative health outcomes .  Wearable electronic activity monitors have shown promise for delivering effective behavior change techniques . However , little is known about the feasibility and acceptability of non-Fitbit wearables ( Fitbit , Inc , San Francisco , California ) combined with telephone counseling among adults aged more than 55 years . Objective The purpose of our study was to determine the feasibility , acceptability , and effect on physical activity of an intervention combining a wearable physical activity monitor , tablet device , and telephone counseling  among adults aged 55 - 79 years . Methods Adults ( N=40 , aged 55 - 79 years , body mass index=25 - 35 , < 60 min of activity per week ) were r and omized to receive a 12-week intervention or to a wait list control . Intervention participants received a Jawbone Up24 monitor , a tablet with the Jawbone Up app installed , and brief weekly telephone counseling . Participants set daily and weekly step goals and used the monitor ’s idle alert to notify them when they were sedentary for more than 1 h. Interventionists provided brief counseling once per week by telephone .  Feasibility was measured using observation and study records , and acceptability was measured by self-report using vali date d items . Physical activity and sedentary time were measured using ActivPAL monitors following st and ard protocol s. Body composition was measured using dual-energy x-ray absorptiometry scans , and fitness was measured using a 6-min walk test . Results Participants were 61.48 years old ( SD 5.60 ) , 85 % ( 34/40 ) female , 65 % ( 26/40 ) white .  Average activity monitor wear time was 81.85 ( SD 3.73 ) of 90 days . Of the 20 Up24 monitors , 5 were reported broken and 1 lost . No related adverse events were reported . Acceptability items were rated at least 4 on a scale of 1 - 5 . Effect sizes for most outcomes were small , including stepping time per day ( d=0.35 ) , steps per day ( d=0.26 ) , sitting time per day ( d=0.21 ) , body fat ( d=0.17 ) , and weight ( d=0.33 ) . Conclusions The intervention was feasible and acceptable in this population . Effect sizes were similar to the sizes found using other wearable electronic activity monitors , indicating that when combined with telephone counseling , wearable activity monitors are a potentially effective tool for increasing physical activity and decreasing sedentary behavior . Trial registration Clinical trials.gov NCT01869348 ; https:// clinical trials.gov/ct2/show/NCT01869348 ( Archived by WebCite at http://www.webcitation.org/6odlIolqy Background Maintaining mobility in elderly persons has become a primary goal within healthcare services . In older adults , exercise programs significantly reduce the risk of falling and death . Long-lasting and high-intensive multi-component exercises are most effective . In a rehabilitation setting , self-regulated exercises are conventionally taught by physiotherapists , using h and outs . However , the adherence of elderly persons to executing these self-administered programs varies considerably . They are often considered tedious and boring , and thus prematurely stopped . The primary aim of this clinical trial is to determine whether elderly persons in a rehabilitation setting show higher adherence to self-regulated training when using exergames than when performing conventional exercises . The second objective is to explore which mode of exercise leads to greater improvement in balance performance . Methods / Design The study consists of a single blind , stratified , r and omized control trial with two parallel groups . Once included , study participants will be stratified according to their balance and computer skills and r and omly allocated to self-regulated training with conventional exercise programs or with exergames played with the Windows Kinect ® sensor and FitBit ® pedometer . In both groups , self-administered exercise programs will be taught by experienced physiotherapists and performed at the patient ’s own discretion during the ten days of intervention . The primary outcome is the performed daily training volume , collected by the participants in a logbook . Secondary outcomes are objective and subjective balance skills measured by an activity tracker and the Fall Efficacy Scale self-administered question naire . Both assessment s will be performed at pre- and post-intervention . Discussion According to the available literature , this study is the first to compare conventional self-regulated exercises with exergames among older patients in a rehabilitation setting . Results of this study will contribute to our underst and ing of its motivational potential on exercise adherence in elderly persons and provide more insight into the potential effectiveness of exergames promoting mobility . Trial registration The present clinical study has been registered on Clinical Trials.gov under the identifier number : NCT02077049 . The detailed trial protocol can be accessed online on : NCT02077049 Background Office workers engage in high levels of sitting time . Effective , context -specific , and scalable strategies are needed to support widespread sitting reduction . This study aim ed to evaluate organisational-support strategies alone or in combination with an activity tracker to reduce sitting in office workers . Methods From one organisation , 153 desk-based office workers were cluster-r and omised ( by team ) to organisational support only ( e.g. , manager support , emails ; ‘ Group ORG ’ , 9 teams , 87 participants ) , or organisational support plus LUMOback activity tracker ( ‘ Group ORG + Tracker ’ , 9 teams , 66 participants ) . The waist-worn tracker provided real-time feedback and prompts on sitting and posture . ActivPAL3 monitors were used to ascertain primary outcomes ( sitting time during work- and overall hours ) and other activity outcomes : prolonged sitting time ( ≥30 min bouts ) , time between sitting bouts , st and ing time , stepping time , and number of steps . Health and work outcomes were assessed by question naire . Changes within each group ( three- and 12 months ) and differences between groups were analysed by linear mixed models . Missing data were multiply imputed . Results At baseline , participants ( 46 % women , 23–58 years ) spent ( mean ± SD ) 74.3 ± 9.7 % of their workday sitting , 17.5 ± 8.3 % st and ing and 8.1 ± 2.7 % stepping . Significant ( p < 0.05 ) reductions in sitting time ( both work and overall ) were observed within both groups , but only at 12 months . For secondary activity outcomes , Group ORG significantly improved in work prolonged sitting , time between sitting bouts and st and ing time , and overall prolonged sitting time ( 12 months ) , and in overall st and ing time ( three- and 12 months ) ; while Group ORG + Tracker , significantly improved in work prolonged sitting , st and ing , stepping and overall st and ing time ( 12 months ) . Adjusted for confounders , the only significant between-group differences were a greater stepping time and step count for Group ORG + Tracker relative to Group ORG ( + 20.6 min/16 h day , 95 % CI : 3.1 , 38.1 , p = 0.021 ; + 846.5steps/16 h day , 95 % CI : 67.8 , 1625.2 , p = 0.033 ) at 12 months . Observed changes in health and work outcomes were small and not statistically significant . Conclusions Organisational-support strategies with or without an activity tracker result ed in improvements in sitting , prolonged sitting and st and ing ; adding a tracker enhanced stepping changes . Improvements were most evident at 12 months , suggesting the organisational-support strategies may have taken time to embed within the organisation . Trial registration Australian New Zeal and Clinical Trial Registry : ACTRN12614000252617 . Registered 10 March 2014 Background Maintaining physical activity is an important goal with positive health benefits , yet many people spend most of their day sitting . Our Everyday Activity Supports You ( EASY ) model aims to encourage movement through daily activities and utilitarian walking . The primary objective of this phase was to test study feasibility ( recruitment and retention rates ) for the EASY model . Methods This 6-month study took place in Vancouver , Canada , from May to December 2013 , with data analyses in February 2014 . Participants were healthy , inactive , community-dwelling women aged 55–70 years . We recruited through advertisements in local community newspapers and r and omized participants using a remote web service . The model included the following : group-based education and social support , individualized physical activity prescription ( called Activity 4 - 1 - 1 ) , and use of a Fitbit activity monitor . The control group received health-related information only . The main outcome measures were descriptions of study feasibility ( recruitment and retention rates ) . We also collected information on activity patterns ( ActiGraph GT3X+ accelerometers ) and health-related outcomes such as body composition ( height and weight using st and ard techniques ) , blood pressure ( automatic blood pressure monitor ) , and psychosocial variables ( question naires ) . Results We advertised in local community newspapers to recruit participants . Over 3 weeks , 82 participants telephoned ; following screening , 68 % ( 56/82 ) met the inclusion criteria and 45 % ( 25/56 ) were r and omized by remote web-based allocation . This included 13 participants in the intervention group and 12 participants in the control group ( education ) . At 6 months , 12/13 ( 92 % ) intervention and 8/12 ( 67 % ) control participants completed the final assessment . Controlling for baseline values , the intervention group had an average of 2,080 [ 95 % confidence intervals ( CIs ) 704 , 4,918 ] more steps/day at 6 months compared with the control group . There was an average between group difference in weight loss of −4.3 [ 95 % CI −6.22 , −2.40 ] kg and reduction in diastolic blood pressure of −8.54 [ 95 % CI −16.89 , −0.198 ] mmHg , in favor of EASY . Conclusions The EASY pilot study was feasible to deliver ; there was an increase in physical activity and reduction in weight and blood pressure for intervention participants at 6 months . Trial registration Clinical Trials.gov identifier : Background Osteoarthritis ( OA ) is a leading cause of disability in the United States . Although no disease-modifying therapies exist , patients with knee OA who increase walking may reduce risk of functional limitations . Objective The objective of the study is to evaluate the impact of a mobile app ( OA GO ) plus wearable activity monitor/pedometer ( Jawbone UP 24 ) used for 90 days on the mobility of patients with knee OA treated with hylan G-F 20 .  Methods Patients with knee OA aged 30 to 80 years who were eligible to receive hylan G-F 20 and were familiar with smartphone technology were enrolled in this r and omized , multicenter , open-label study . Patients who had a body mass index above 35 kg/m2 were excluded . All patients received a single 6-mL injection of hylan G-F 20 and wore the Jawbone monitor . The patients were then r and omized 1:1 to Jawbone and OA GO ( Group A ; n=107 ) with visible feedback ( unblinded ) or Jawbone only ( Group B ; n=104 ) with no visible feedback ( blinded ) . The primary endpoint was mean change from baseline in steps per day at day 90 between Groups A and B. Results Baseline characteristics were similar between groups . There were significant differences between the increases in least squares ( LS ) mean number of steps per day ( 1199 vs 467 , P=.03 ) and the mean percentage change ( 35.8 % vs 11.5 % , P=.02 ) from baseline in favor of Group A over Group B. There was a greater reduction in pain from baseline during the 6-minute walk test in Group A versus Group B. ( LS mean change : −55.3 vs −33.8 , P=.007 ) . Most patients ( 65.4 % ) and surveys of physicians ( 67.3 % ) reported they would be likely or very likely to use/recommend the devices . Patient Activity Measure-13 scores improved from baseline ( LS mean change for Groups A and B : 5.0 vs 6.9 ) , with no significant differences between groups . The occurrence of adverse events was similar in the 2 groups . Conclusions Use of a novel smartphone app in conjunction with a wearable activity monitor provided additional improvement on mobility parameters such as steps per day and pain with walking in the 6-minute walk test in patients with knee OA who were treated with hylan G-F 20 . Results also highlight the amenability of patients and physicians to using mobile health technology in the treatment of OA and suggest further study is warranted Background Physical activity can improve health outcomes in people with knee osteoarthritis ( OA ) ; however , participation in physical activity is very low in this population . Objective The objective of our study was to assess the feasibility and preliminary efficacy of the use of wearables ( Fitbit Flex ) and telephone counselling by a physical therapist ( PT ) for improving physical activity in people with a physician-confirmed diagnosis of knee OA , or who have passed 2 vali date d criteria for early OA . Methods We conducted a community-based feasibility r and omized controlled trial . The immediate group ( n=17 ) received a brief education session by a physical therapist , a Fitbit Flex activity tracker , and a weekly telephone call for activity counselling with the physical therapist . The delayed group ( n=17 ) received the same intervention 1 month later . All participants were assessed at baseline ( T0 ) , and the end of 1 month ( T1 ) and 2 months ( T2 ) . Outcomes were ( 1 ) mean moderate to vigorous physical activity time , ( 2 ) mean time spent on sedentary behavior , ( 3 ) Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , and ( 4 ) Partners in Health Scale . Feasibility data were summarized with descriptive statistics . We used analysis of covariance to evaluate the effect of the group type on the outcome measures at T1 and T2 , after adjusting for blocking and T0 . We assessed planned contrasts of changes in outcome measures over measurement periods . Results We identified 46 eligible individuals ; of those , 34 ( 74 % ) enrolled and no one dropped out . All but 1 participant adhered to the intervention protocol . We found a significant effect , with the immediate intervention group having improved in the moderate to vigorous physical activity time and in the Partners in Health Scale at T0 to T1 compared with the delayed intervention group . The planned contrast of the immediate intervention group at T0 to T1 versus the delayed group at T1 to T2 showed a significant effect in the sedentary time and the KOOS symptoms subscale , favoring the delayed group . Conclusions This study demonstrated the feasibility of a behavioral intervention , supported by the use of a wearable device , to promote physical activity among people with knee OA . Trial Registration Clinical Trials.gov NCT02313506 ; https:// clinical trials.gov/ct2/show/NCT02313506 ( Archived by WebCite at http://www.webcitation.org/6r4P3Bub0 Background Enhanced recovery after surgery ( ERAS ) programs are aim ed at minimizing postoperative stress and accelerating postoperative recovery by implementing multiple perioperative principles . “ Early mobilization ” is one such principle , but the quality of assessment and monitoring is poor , and evidence of improved outcome is lacking . Activity trackers allow precise monitoring and automatic feedback to the patients to enhance their motivation for early mobilization . The aim of the study is to monitor and increase the postoperative mobilization of patients by giving them continuous automatic feedback in the form of a step count using activity-tracking wristb and s. Methods / design Patients undergoing elective open and laparoscopic surgery of the colon , rectum , stomach , pancreas , and liver for any indication will be included . Further inclusion criteria are age between 18 and 75 years , American Society of Anesthesiologists Physical Status class less than IV , and a signed informed consent form . Patients will be stratified into two subgroups , laparoscopic and open surgery , and will be r and omized 1:1 for automatic feedback of their step count using an activity tracker wristb and . The control group will have no automatic feedback . The sample size ( n = 30 patients in each of the four groups , overall n = 120 ) is calculated on the basis of an assumed difference in step count of 250 steps daily ( intervention group versus control group ) . The primary study endpoint is the average step count during the first 5 postoperative days ; secondary endpoints are the percentage of patients in the two groups who master the predefined mobilization ( step count ) targets , assessment of additional activity data obtained from the devices , assessment of preoperative mobility , length of hospital and intensive care unit stays , number of patients who receive physiotherapy , 30-day mortality , and overall 30-day morbidity . Discussion Early mobilization is a key element of ERAS . However , enhanced early mobilization is difficult to define , to assess objective ly , and to implement in clinical practice . Consequently , there is a discrepancy between ERAS targets and actual practice , especially in patients undergoing major visceral surgery . This study is the first r and omized controlled trial investigating the use and feasibility of activity tracking to monitor and enhance postoperative early mobilization . Trial registration Clinical Trials.gov identifier : NCT02834338 . Registered on 15 June 2016 Background The construct of total wellness includes a holistic approach to the body , mind and spirit components of life . While the health benefits of reducing sedentary behavior and increasing physical activity are well documented , little is known about the influence on total wellness of an internet-based physical activity monitor design ed to help people to achieve higher physical activity levels . Purpose The purpose of this four-week , personal activity monitor-based intervention program was to reduce sedentary behavior and increase physical activity levels in daily living for sedentary adults and to determine if these changes would also be associated with improvement in total wellness . Methods Twenty-two men and 11 women ( 27 years ± 4.0 ) were r and omly assigned to either an intervention ( n = 18 ) or control group ( n = 15 ) . The intervention group interacted with an online personal activity monitor ( Gruve Solution ™ ) design ed to reduce sedentary time  and increase physical activity during activities of daily living . The control group did not interact with the monitor , as they were asked to follow their normal daily physical activities and sedentary behavior routines . The Wellness Evaluation of Lifestyle ( WEL ) inventory was used to assess total wellness . Sedentary time , light , walking , moderate and vigorous intensity physical activities were assessed for both intervention and control groups at baseline and at week-4 by the 7-day Sedentary and Light Intensity Physical Activity Log ( 7-day SLIPA Log ) and the International Physical Activity Question naire ( IPAQ ) . Results Significant increases in pre-post total wellness scores ( from 64 % ± 5.7 to 75 % ± 8.5 ) ( t ( 17 ) = -6.5 , p < 0.001 ) were observed in the intervention group by the end of week four . Intervention participants decreased their sedentary time ( 21 % , 2.3 hours/day ) and increased their light ( 36.7 % , 2.5 hours/day ) , walking ( 65 % , 1057 MET-min/week ) , moderate ( 67 % , 455 MET-min/week ) and vigorous intensity ( 60 % , 442 MET-min/week ) physical activity ( all p < 0.001 ) . No significant differences for total wellness were observed between the groups at baseline and no pre-post significant differences were observed for any outcome variable in the control group . Conclusion Total wellness is improved when sedentary , but sufficiently physically active adults , reduce sedentary time and increase physical activity levels ( i.e. light , waking , moderate and vigorous ) Background The benefits of physical activity are well documented , but scalable programs to promote activity are needed . Interventions that assign tailored and dynamically adjusting goals could effect significant increases in physical activity but have not yet been implemented at scale . Objective Our aim was to examine the effectiveness of an open access , Internet-based walking program that assigns daily step goals tailored to each participant . Methods A two-arm , pragmatic r and omized controlled trial compared the intervention to no treatment .  Participants were recruited from a workplace setting and r and omized to a no-treatment control ( n=133 ) or to treatment ( n=132 ) . Treatment participants received a free wireless activity tracker and enrolled in the walking program , Walkadoo .  Assessment s were fully automated : activity tracker recorded primary outcomes ( steps ) without intervention by the participant or investigators . The two arms were compared on change in steps per day from baseline to follow-up ( after 6 weeks of treatment ) using a two-tailed independent sample s t test . Results Participants ( N=265 ) were 66.0 % ( 175/265 ) female with an average age of 39.9 years . Over half of the participants ( 142/265 , 53.6 % ) were sedentary ( < 5000 steps/day ) and 44.9 % ( 119/265 ) were low to somewhat active ( 5000 - 9999 steps/day ) . The intervention group significantly increased their steps by 970 steps/day over control ( P<.001 ) , with treatment effects observed in sedentary ( P=.04 ) and low-to-somewhat active ( P=.004 ) participants alike . Conclusions The program is effective in increasing daily steps .  Participants benefited from the program regardless of their initial activity level . A tailored , adaptive approach using wireless activity trackers is realistically implementable and scalable . Trial Registration Clinical trials.gov NCT02229409 , https:// clinical trials.gov/ct2/show/NCT02229409 ( Archived by WebCite at http://www.webcitation.org/6eiWCvBYe BACKGROUND Despite the increasing popularity of activity trackers , little evidence exists that they can improve health outcomes . We aim ed to investigate whether use of activity trackers , alone or in combination with cash incentives or charitable donations , lead to increases in physical activity and improvements in health outcomes . METHODS In this r and omised controlled trial , employees from 13 organisations in Singapore were r and omly assigned ( 1:1:1:1 ) with a computer generated assignment schedule to control ( no tracker or incentives ) , Fitbit Zip activity tracker , tracker plus charity incentives , or tracker plus cash incentives .  Participants had to be English speaking , full-time employees , aged 21 - 65 years , able to walk at least ten steps continuously , and non-pregnant . Incentives were tied to weekly steps , and the primary outcome , moderate-to-vigorous physical activity ( MVPA ) bout min per week , was measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months ( end of intervention ) and 12 months ( after a 6 month post-intervention follow-up period ) . Other outcome measures included steps , participants meeting 70 000 steps per week target , and health-related outcomes including weight , blood pressure , and quality -of-life measures . This trial is registered at Clinical Trials.gov , number NCT01855776 . FINDINGS Between June 13 , 2013 , and Aug 15 , 2014 , 800 participants were recruited and r and omly assigned to the control ( n=201 ) , Fitbit ( n=203 ) , charity ( n=199 ) , and cash ( n=197 ) groups . At 6 months , compared with control , the cash group logged an additional 29 MVPA bout min per week ( 95 % CI 10 - 47 ; p=0·0024 ) and the charity group an additional 21 MVPA bout min per week ( 2 - 39 ; p=0·0310 ) ; the difference between Fitbit only and control was not significant ( 16 MVPA bout min per week [ -2 to 35 ; p=0·0854 ] ) . Increases in MVPA bout min per week in the cash and charity groups were not significantly greater than that of the Fitbit group . At 12 months , the Fitbit group logged an additional 37 MVPA bout min per week ( 19 - 56 ; p=0·0001 ) and the charity group an additional 32 MVPA bout min per week ( 12 - 51 ; p=0·0013 ) compared with control ; the difference between cash and control was not significant ( 15 MVPA bout min per week [ -5 to 34 ; p=0·1363 ] ) . A decrease in physical activity of -23 MVPA bout min per week ( 95 % CI -42 to -4 ; p=0·0184 ) was seen when comparing the cash group with the Fitbit group . There were no improvements in any health outcomes ( weight , blood pressure , etc ) at either assessment . INTERPRETATION The cash incentive was most effective at increasing MVPA bout min per week at 6 months , but this effect was not sustained 6 months after the incentives were discontinued . At 12 months , the activity tracker with or without charity incentives were effective at stemming the reduction in MVPA bout min per week seen in the control group , but we identified no evidence of improvements in health outcomes , either with or without incentives , calling into question the value of these devices for health promotion . Although other incentive strategies might generate greater increases in step activity and improvements in health outcomes , incentives would probably need to be in place long term to avoid any potential decrease in physical activity result ing from discontinuation . FUNDING Ministry of Health , Singapore Background It is well recognised that low back pain is a significant public health problem and engagement in moderate levels of physical activity is associated with positive outcomes .Conservative active care , such as exercise , is effective in reducing pain and disability associated with chronic low back pain . However , a rapid decline in clinical outcomes is commonly seen after discharge from treatment . Methods / Design We will conduct a r and omised controlled trial to investigate the effectiveness of a mobile health supported physical activity intervention ( compared to st and ard care ) in care-seeking , pain and disability in people with chronic low back pain after discharge from treatment . We will recruit 68 patients with chronic low back pain following discharge from an outpatient hospital program , who will be r and omly allocated to the physical activity intervention ( n = 34 ) or the st and ard care group ( n = 34 ) and monitored for 6 months . The physical activity intervention will involve a physical activity advice booklet , a face-to-face health coaching session and 12 fortnightly follow-up telephone-based health coaching sessions . This intervention will be supported by provision of a specifically design ed web app and a physical activity monitoring device ( FitBit ) . The st and ard care group will receive the physical activity advice booklet only . Discussion This pilot trial will investigate a new model to prevent clinical decline in people following conservative treatment for chronic low back pain . If proven to be effective , this approach will constitute a major advance in the management of low back pain . Chronic patients who experience recurrent pain and disability after treatment are prone to seek additional care in the form of physiotherapy , medication , emergency department attendance , specialist consultation or spinal surgery . This model aims to maintain functional levels and reduce care-seeking empowering patients to self-manage their low back pain by offering them a contemporary patient-centred physical activity program with the support of mobile health technology . The outcomes of this trial will have immediate implication s for clinical practice .Trial registration ACTRN12615000189527 ( 26 - 02 - 2015 ) Summary Objective The aim of this study was to compare an in‐person , group‐based behavioral weight loss intervention to technology‐based interventions in adults with obesity . Methods Adults ( N = 39 ; body mass index : 39.5 ± 2.8 kg m−2 ; age : 39.9 ± 11.5 years ) participated in a 6‐month program with r and omization to one of three intervention groups : st and ard behavioral weight loss , a technology‐based system combined with a monthly intervention telephone call ( TECH ) or an enhanced technology‐based system combined with a monthly intervention telephone call ( EN‐TECH ) . All groups were prescribed an energy‐restricted diet and physical activity . Assessment s occurred at 0 , 3 and 6 months . Separate mixed‐effects models using unstructured dependence structure were fit to the outcomes . Results Weight loss ( least square means ± st and ard error ) at 6 months was −6.57 ± 1.65 kg in st and ard behavioral weight loss , −5.18 ± 1.72 kg in TECH and −6.25 ± 1.95 kg in EN‐TECH ( p‐value for time effect ≤ 0.0001 ) . A similar pattern was observed for change in body mass index , waist circumference and percent body fat . There was a decrease in total energy intake ( p = 0.0005 ) and percent dietary fat intake ( p = 0.0172 ) , and physical activity increased ( p = 0.0003 ) . Conclusions Findings provide initial information on the use of technology‐based interventions that include wearable devices combined with brief monthly telephone calls for weight loss in adults with obesity Purpose . The SenseWear Armb and ( SWA ) is a multisensor activity monitor that can be used in daily life to assess an individual 's physical activity level ( PAL ) . The primary goal of this study was to analyze the impact of different types of feedback on the PAL of Flemish employees . Methods / Design . We recruited 320 sedentary employees ( age , 41.0 ± 10.7 years ; BMI , 26.2 ± 4.2 kg/m2 ) to participate in the 12-month study . Participants were r and omized into one of four intervention groups after being measured for 7 days and nights by means of the SWA : ( 1 ) a minimal intervention group received no feedback ( MIG , n = 56 ) ; ( 2 ) a pedometer group was provided only information on their daily step count ( PG , n = 57 ) ; ( 3 ) a display group received feedback on calories burned , steps taken , and minutes of physical activity by means of the SWA display ( DG , n = 57 ) ; ( 4 ) a coaching group also received the display and had weekly meetings with a Personal Coach ( CoachG , n = 57 ) . We hypothesize that participants receiving feedback ( SG , DG , and CoachG ) will have a greater increase in physical activity outcome variables compared to participants of the minimal intervention group The purpose of this study is to evaluate whether the use of an activity monitor providing feedback has an effect on physical activity ( PA ) in young men . A population -based sample of 276 conscription-aged ( mean = 17.9 , SD = 0.7 years ) men participated in a 3-month r and omized controlled trial in Oulu in 2012 . Participants were r and omized to an intervention group ( INT , N = 137 ) and a control group ( CON , N = 139 ) . INT received a wrist-worn monitor ( Polar Active ) showing daily activity , and CON received identical monitors without feedback . Main outcome was the change from baseline in objective ly measured weekly time spent in moderate-to-vigorous PA ( MVPA ) and sedentary activity ( SED ) , as assessed by generalized estimation equations ( GEE ) . Other lifestyle factors were assessed by a question naire at baseline and at 3 months . Weekly physical activity data ( ≥ 4 days with ≥ 8 h each ) were obtained from 72 ( 53 % ) and 90 ( 65 % ) men in the INT and CON , respectively . Based on GEE , time spent in MVPA increased ( p = 0.012 ) and SED decreased ( p = 0.032 ) in the INT compared with the CON . During the first 7 weeks , the INT spent on average 1 h less sedentary than the CON ( t-test , p < 0.05 ) . During the first week , the INT showed 12 minutes more MVPA compared to the CON ( t-test , p = 0.034 ) . Based on question naire data , the proportion of the most sedentary men decreased in the INT ( Wilcoxon test , 28 % vs. 10 % , p = 0.029 ) , with no change in the CON ( 20 % vs. 19 % , p = 0.546 ) . To conclude , a wrist-worn activity monitor providing feedback had a short-term positive effect on PA and SED in young men . Trial registration This is a pilot study for a larger r and omized controlled trial registered to the clinical trials register NCT01376986 Background Inactive people are often not aware of the fact that they are insufficiently active . Providing insight into their actual physical activity ( PA ) levels may raise awareness and could , in combination with tailored PA advice , stimulate a physically active lifestyle . Objective This study evaluated the feasibility and effectiveness of a 3-month intervention in which Dutch office workers were provided with a personal activity monitor ( PAM ) coupled to simple and concise Web-based tailored PA advice ( PAM COACH ) . Method Participants were r and omly assigned to the 3-month PAM intervention ( n = 51 ) or received a single written information brochure with brief general PA recommendations ( n = 51 ) . Study outcome measures were changes in PA ( recall of minutes per week spent on PA , as measured by the Activity Question naire for Adolescents and Adults ) , determinants of PA , aerobic fitness , and body composition . Follow-up measurements were performed immediately after the 3-month intervention and at 8-months , 5 months after the end of the 3-month intervention period . Results A total of 102 workers , 23 to 39 years old , completed the baseline measurement at the worksite . 48 completed the 3-month follow up and 38 the 8-month follow-up in the intervention group , 50 completed the 3-month follow up and 42 the 8-month follow up in the control group . 35 out of 48 ( 73 % ) participants in the PAM intervention group reported wearing the PAM regularly , and the PAM COACH was used almost once a week ; 24 out of 46 ( 52 % ) PAM users set a personal goal , and 33 ( 72 % ) entered their favorite activities on the website . Main reasons for not using these items were lack of interest or not being able to find the item on the website . The majority of PAM users ( 34 out of 46 , 74 % ) read the advice , of whom 14 ( 39 % ) found it unappealing . After the 3-month intervention , no significant intervention effect was observed ( adjusted difference in min/week ) for sedentary behavior ( β = 10 , 95 % CI = −435 to 455 ) , light-intensity PA ( β = −129 , 95 % CI = −337 to 79 ) , moderate-intensity PA ( β = −13 , 95 % CI = −89 to 63 ) , vigorous-intensity PA ( β= −6 , 95 % CI = −75 to 62 ) , and moderate- to vigorous-intensity PA ( β = −23 , 95 % CI = −121 to 76 ) . No significant intervention effect was observed in the PA outcomes at the 8-month follow-up . For the determinants of PA , aerobic fitness , and body composition , no statistically significant intervention effect was observed in the total study population immediately after the 3-month intervention or the 8-month follow-up . Conclusions The intervention appeared to be easily applicable to real-life setting s. The intervention was ineffective in improving PA behavior or its determinants in healthy office workers . More attention should have been given to the quality and appropriateness of the tailored advice . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 93896459 ; http://www.controlled-trials.com/IS RCT N93896459/ ( Archived by WebCite at http://www.webcitation.org/5iR3mf7ex BACKGROUND An activity tracker combined with a smartphone application ( smartcare ) may help people track and receive feedback on their own activities . However , activity trackers themselves generally fail to drive long-term sustained engagement for a majority of users . One potential strategy for increasing the effectiveness of smartcare is through the use of incentives . The purpose of this pilot r and omized trial is to test the feasibility of our intervention and to assess the extent to which smartcare with or without financial incentives can increase physical activity levels and reduce weight over a 12-week period . METHODS / DESIGN This study employs a three-arm , open-label r and omized controlled trial design : control ( st and ard basic education ) , smartcare , and smartcare plus financial incentives .  Male university students with body mass index ≥ 27 are enrolled . Our primary and secondary endpoints are the amount of weight loss and the level of physical activity respectively . The weight loss goal is 3 % of baseline at week 4 , 5 % at week 8 , and 7 % at week 12 . The daily physical activity goal was individualized according to the participants ' weight . Process incentives are accumulated when participants met daily physical activity goals , and outcome incentives are provided when they met weight reduction goals . DISCUSSION Given the global increase in physical inactivity and obesity , there is a growing need for effective , scalable , and affordable health promotion strategies . Our proof-of-concept study will provide the evidence for the combination of rising health promotion technology of activity trackers and smartphone applications with the modern concept of behavioral economics using financial incentives Assessing levels of  physical activity ( PA ) and providing feedback about these levels might have an effect on participant ’s PA behavior . This study discusses the effect of different levels of feedback — from minimal to use of a feedback display and coach — on PA over a 4-week intervention period . PA was measured at baseline , during and immediately after the intervention . Participants ( n = 227 ) were r and omly assigned to a Minimal Intervention Group ( MIG-no feedback ) , Pedometer Group ( PG-feedback on steps taken ) , Display Group ( DG-feedback on steps , minutes of moderate to vigorous physical activity and energy expenditure ) or Coaching Group ( CoachG-same as DG with need-supportive coaching ) . Two-way ANCOVA showed no significant Group × Time interaction effect for the different PA variables between the MIG and PG . Also no differences emerged between PG and DG . As hypothesized , CoachG had higher PA values throughout the intervention compared with DG . Self-monitoring using a pedometer result ed in more steps compared with a no-feedback condition at the start of the intervention . However , adding individualized coaching seems necessary to increase the PA level until the end of the intervention Background Most women with breast cancer experience a progressive weight gain during and after treatment . Obesity is associated with an increased risk of recurrence , contralateral breast cancer , and death . Physical activity after cancer diagnosis has been reported to have positive effects on body composition and quality of life . We present the protocol of the InForma study , a trial testing the efficacy of an intervention on weight loss ( ≥5 % of the baseline body weight ) in a group of overweight or obese breast cancer survivors . Methods / design This is a four-arm r and omized controlled trial . Patients will receive a 6-month intervention and be followed for a further 18 months . Intervention is design ed to improve adherence to a healthy diet and /or to increase physical activity , taking advantage of a wrist-based activity monitor .  Participants will be recruited among overweight or obese breast cancer patients treated at the European Institute of Oncology , after completion of eventual adjuvant chemotherapy and /or radiotherapy . It is envisaged that 260 patients will be r and omized into four arms : Dietary Intervention ; Physical Activity Intervention ; Physical Activity and Dietary Intervention ; and Less Intensive Intervention . Women will be offered individualized counseling consisting of face-to face discussion and phone calls in addition to group meetings . A motivational interviewing approach will be used to encourage health behavior change . All participants will be given a pedometer device to monitor their physical activity . Participants ’ dietary intake will be repeatedly assessed using a vali date d food frequency question naire . Participants ’ quality of life and anxiety will be assessed with the Functional Assessment of Cancer Therapy-Breast and the State-Trait Anxiety Inventory question naires . Blood sample s will be collected at baseline and follow-up visits to assess lipid and hormone profiles . Body composition will be repeatedly assessed using bioelectrical impedance vector analysis for identifying changes of fat and fat-free mass . Women allocated to the less intensive intervention arm will be considered as the control group . Discussion While there is a rising concern about the role of obesity in cancer recurrence and survival , this trial with its multi-arm design , motivational approach and use of a pedometer device will provide important insights regarding the most effective approach in promoting weight control in breast cancer survivors . Trial registration IS RCT N53325751 ( registration date : 16 October 2015 ) ; Clinical Trials.gov NCT02622711 ( registration date : 2 December 2015 ) Background Physical inactivity is a major public health problem . The It ’s LiFe ! monitoring and feedback tool embedded in the Self-Management Support Program ( SSP ) is an attempt to stimulate physical activity in people with chronic obstructive pulmonary disease or type 2 diabetes treated in primary care . Objective Our aim was to evaluate whether the SSP combined with the use of the monitoring and feedback tool leads to more physical activity compared to usual care and to evaluate the additional effect of using this tool on top of the SSP . Methods This was a three-armed cluster r and omised controlled trial . Twenty four family practice s were r and omly assigned to one of three groups in which participants received the tool + SSP ( group 1 ) , the SSP ( group 2 ) , or care as usual ( group 3 ) . The primary outcome measure was minutes of physical activity per day . The secondary outcomes were general and exercise self-efficacy and quality of life . Outcomes were measured at baseline after the intervention ( 4 - 6 months ) , and 3 months thereafter . Results The group that received the entire intervention ( tool + SSP ) showed more physical activity directly after the intervention than Group 3 ( mean difference 11.73 , 95 % CI 6.21 - 17.25 ; P<.001 ) , and Group 2 ( mean difference 7.86 , 95 % CI 2.18 - 13.54 ; P=.003 ) . Three months after the intervention , this effect was still present and significant ( compared to Group 3 : mean difference 10.59 , 95 % CI 4.94 - 16.25 ; P<.001 ; compared to Group 2 : mean difference 9.41 , 95 % CI 3.70 - 15.11 ; P<.001 ) . There was no significant difference in effect between Groups 2 and 3 on both time points . There was no interaction effect for disease type . Conclusions The combination of counseling with the tool proved an effective way to stimulate physical activity . Counseling without the tool was not effective . Future research about the cost-effectiveness and application under more tailored conditions and in other target groups is recommended . Trial Registration Clinical Trials.gov : NCT01867970 , https:// clinical trials.gov/ct2/show/NCT01867970 ( archived by WebCite at http://www.webcitation.org/6a2qR5BSr ) Background The purpose was to conduct systematic review s of the relationship between physical activity of healthy community-dwelling older ( > 65 years ) adults and outcomes of  functional limitations , disability , or loss of independence .  Methods Prospect i ve cohort studies with an outcome related to functional independence or to cognitive function  were search ed , as well as exercise training interventions that reported a functional outcome . Electronic data base search strategies were used to identify citations which were screened ( title and abstract ) for inclusion . Included articles were review ed to complete st and ardized data extraction tables , and assess study quality . An established system of assessing the level and grade of evidence for recommendations was employed . Results Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence , and 34 were included with a cognitive function outcome . Greater physical activity of an aerobic nature ( categorized by a variety of methods ) was associated with higher functional status ( expressed by a host of outcome measures ) in older age . For functional independence , moderate ( and high ) levels of physical activity appeared effective in conferring a reduced risk ( odds ratio ~0.5 ) of functional limitations or disability . Limitation in higher level performance outcomes was reduced ( odds ratio ~0.5 ) with vigorous ( or high ) activity with an apparent dose-response of moderate through to high activity . Exercise training interventions ( including aerobic and resistance ) of older adults showed improvement in physiological and functional measures , and suggestion of longer-term reduction in incidence of mobility disability . A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia ; however , there were mixed results of the effects of exercise interventions on cognitive function indices . Conclusions There is a consistency of findings across studies and a range of outcome measures related to functional independence ; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age . Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult , it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes Background Cardiovascular disease ( CVD ) is the leading cause of death worldwide . With atherosclerosis as the underlying cause for many CVD events , prevention or reduction of sub clinical atherosclerotic plaque burden ( SAPB ) through a healthier lifestyle may have substantial public health benefits . Objective The objective was to describe the protocol of a r and omized controlled trial investigating the effectiveness of a 30‐month worksite‐based lifestyle program aim ed to promote cardiovascular health in participants having a high or a low degree of SAPB compared with st and ard care . Methods We will conduct a r and omized controlled trial including middle‐aged bank employees from the Progression of Early Sub clinical Atherosclerosis cohort , stratified by SAPB ( high SAPB n = 260 , low SAPB n = 590 ) . Within each stratum , participants will be r and omized 1:1 to receive a lifestyle program or st and ard care . The program consists of 3 elements : ( a ) 12 personalized lifestyle counseling sessions using Motivational Interviewing over a 30‐month period , ( b ) a wrist‐worn physical activity tracker , and ( c ) a sit‐st and workstation . Primary outcome measure is a composite score of blood pressure , physical activity , sedentary time , body weight , diet , and smoking ( ie , adapted Fuster‐BEWAT score ) measured at baseline and at 1‐ , 2‐ , and 3‐year follow‐up . Conclusions The study will provide insights into the effectiveness of a 30‐month worksite‐based lifestyle program to promote cardiovascular health compared with st and ard care in participants with a high or low degree of SAPB Background Although many wearable devices for monitoring and tracking physical activity are available to consumers , relatively few research studies have been conducted to determine their efficacy in promoting health . Methods In this article , data on the use of consumer wearable devices in promoting healthy behaviors  are summarized based upon bibliographic search es in PubMed and Psychology and Behavioral Sciences Collection with relevant search terms through September 2016 . Results A total of 274 articles were identified in the bibliographic search es . By screening abstract s or full-text articles , six pre/post test trials and seven r and omized controlled trials were identified . In initial trials , consumer wearable devices have been shown to increase physical activity and help users lose weight . However , the number of studies completed to date is small and limited by small sample sizes , short study duration s , and uncertain generalizability of the findings . Conclusions Future studies should utilize r and omized controlled trial research design s , larger sample sizes , and longer study periods to better establish the efficacy of wearable devices in promoting physical activity . Additional research is needed to determine the feasibility and effectiveness of wearable devices in promoting physical activity and weight loss in community setting s including communities affected by health disparities . Studies focusing on children and adolescents are also needed Background Low physical activity is a major public health problem . New cost-effective approaches that stimulate meaningful long-term changes in physical activity are required , especially within primary care setting s. It is becoming clear that there are various dimensions to physical activity with independent health benefits . Advances in technology mean that it is now possible to generate multidimensional physical activity ‘ profiles ’ that provide a more complete representation of physical activity and offer a variety of options that can be tailored to the individual . Mi-PACT is a r and omised controlled trial design ed to examine whether personalised multidimensional physical activity feedback and self-monitoring alongside trainer-supportive sessions increases physical activity and improves health outcomes in at-risk men and women . Methods / Design We aim to recruit 216 patients from within primary care aged 40 to 70 years and at medium or high risk of cardiovascular disease and /or type II diabetes mellitus . Adopting an unequal allocation ratio ( intervention : control ) of 2:1 , participants will be r and omised to one of two groups , usual care or the intervention . The control group will receive usual care from their general practitioner ( GP ) and st and ardised messages about physical activity for health . The intervention group will receive physical activity monitors and access to a web-based platform for a 3-month period to enable self-monitoring and the provision of personalised feedback regarding the multidimensional nature of physical activity . In addition , this technology-enabled feedback will be discussed with participants on 5 occasions during supportive one-to-one coaching sessions across the 3-month intervention . The primary outcome measure is physical activity , which will be directly assessed using activity monitors for a 7-day period at baseline , post intervention and at 12 months . Secondary measures ( at these time-points ) include weight loss , fat mass , and markers of metabolic control , motivation and well-being . Discussion Results from this study will provide insight into the effects of integrated physical activity profiling and self-monitoring combined with in-person support on physical activity and health outcomes in patients at risk of future chronic disease . Trial registration IS RCT N18008011 Trial registration date : 31 July Background Physicians are expected to serve as role models for healthy lifestyles , but long work hours reduce time for healthy behaviors . A hospital-based physical activity intervention could improve physician health and increase counseling about exercise . Methods We conducted a two-phase intervention among 104 medical residents at a large hospital in Boston , Massachusetts . Phase 1 was a 6-week r and omized controlled trial comparing daily steps of residents assigned to an activity monitor displaying feedback about steps and energy consumed ( intervention ) or to a blinded monitor ( control ) . Phase 2 immediately followed and was a 6-week non-r and omized team steps competition in which all participants wore monitors with feedback . Phase 1 outcomes were : 1 ) median steps/day and 2 ) proportion of days activity monitor worn . The Phase 2 outcome was mean steps/day on days monitor worn ( ≥500 steps/day ) . Physiologic measurements were collected at baseline and study end . Median steps/day were compared using Wilcoxon rank-sum tests . Mean steps were compared using repeated measures regression analyses . Results In Phase 1 , intervention and control groups had similar activity ( 6369 vs. 6063 steps/day , p = 0.16 ) and compliance with wearing the monitor ( 77 % vs. 77 % of days , p = 0.73 ) . In Phase 2 ( team competition ) , residents recorded more steps/day than during Phase 1 ( Control : 7,971 vs. 7,567 , p = 0.002 ; Intervention : 7,832 vs. 7,739 , p = 0.13 ) . Mean compliance with wearing the activity monitor decreased for both groups during Phase 2 compared to Phase 1 ( 60 % vs. 77 % , p<0.001 ) . Mean systolic blood pressure decreased ( p = 0.004 ) and HDL cholesterol increased ( p<0.001 ) among all participants at end of study compared to baseline . Conclusions Although the activity monitor intervention did not have a major impact on activity or health , the high participation rates of busy residents and modest changes in steps , blood pressure , and HDL suggest that more intensive hospital-based wellness programs have potential for promoting healthier lifestyles among physicians . Trial Registration Clinical trials.gov NCT01287208 Background In young men , unhealthy lifestyle behaviours can be detrimental to their physical and /or mental health and set them on a negative health trajectory into adulthood . Despite this , there is a lack of evidence to guide development of effective health behaviour change interventions for young men . This study assessed the feasibility and preliminary efficacy of the ‘ HEYMAN ’ ( Harnessing Ehealth to enhance Young men ’s Mental health , Activity and Nutrition ) healthy lifestyle program for young men . Methods A pilot RCT with 50 young men aged 18–25 years r and omised to the HEYMAN intervention ( n = 26 ) or waitlist control ( n = 24 ) .  HEYMAN was a 3-month intervention , targeted for young men to improve eating habits , activity levels and well-being . Intervention development was informed by a participatory research model ( PRECEDE-PROCEED ) . Intervention components included eHealth support ( website , wearable device , Facebook support group ) , face-to-face sessions ( group and individual ) , a personalised food and nutrient report , home-based resistance training equipment and a portion control tool . Outcomes included : feasibility of research procedures ( recruitment , r and omisation , data collection and retention ) and of intervention components . Generalized linear mixed models estimated the treatment effect at 3-months for the primary outcomes : pedometer steps/day , diet quality , well-being and several secondary outcomes . Results A 7-week recruitment period was required to enrol 50 young men .  A retention rate of 94 % was achieved at 3-months post-intervention . Retained intervention participants ( n = 24 ) demonstrated reasonable usage levels for most program components and also reported reasonable levels of program component acceptability for attractiveness , comprehension , usability , support , satisfaction and ability to persuade , with scores ranging from 3.0 to 4.6 ( maximum 5 ) . No significant intervention effects were observed for the primary outcomes of steps/day ( 1012.7 , 95 % CI = −506.2 , 2531.6 , p = 0.191 , d = 0.36 ) , diet quality score ( 3.6 , 95 % CI = −0.4 , 7.6 , p = 0.081 , d = 0.48 ) or total well-being score ( 0.4 , 95 % CI = −1.6 , 2.5 , p = 0.683 , d = 0.11 ) . Significant intervention effects were found for daily vegetable servings , energy-dense , nutrient-poor foods , MVPA , weight , BMI , fat mass , waist circumference and cholesterol ( all p < 0.05 ) . Conclusions The HEYMAN program demonstrated feasibility in assisting young men to make some positive lifestyle changes . This provides support for the conduct of a larger , fully-powered RCT , but with minor amendments to research procedures and intervention components required . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12616000350426 Background Many adults are insufficiently physically active , have prolonged sedentary behaviour and report poor sleep . These behaviours can be improved by interventions that include education , goal setting , self-monitoring , and feedback strategies . Few interventions have explicitly targeted these behaviours simultaneously or examined the relative efficacy of different self-monitoring methods . Methods / Design This study aims to compare the efficacy of two self-monitoring methods in an app-based multi-behaviour intervention to improve objective ly measured physical activity , sedentary , and sleep behaviours , in a 9 week 2–arm r and omised trial . Participants will be adults ( n = 64 ) who report being physically inactive , sitting > 8 h/day and frequent insufficient sleep ( ≥14 days out of last 30 ) . The “ Balanced ” intervention is delivered via a smartphone ‘ app ’ , and includes education material s ( guidelines , strategies to promote change in behaviour ) , goal setting , self-monitoring and feedback support . Participants will be r and omly allocated to either a device-entered or user-entered self-monitoring method . The device-entered group will be provided with a activity tracker to self-monitor behaviours . The user-entered group will recall and manually record behaviours . Assessment s will be conducted at 0 , 3 , 6 , and 9 weeks . Physical activity , sedentary behaviour and sleep-wake behaviours will be measured using the wrist worn Geneactiv accelerometer . Linear mixed models will be used to examine differences between groups and over time using an alpha of 0.01 . Discussion This study will evaluate an app-based multi-behavioural intervention to improve physical activity , sedentary behaviour and sleep ; and the relative efficacy of two different approaches to self-monitoring these behaviours . Outcomes will provide information to inform future interventions and self-monitoring targeting these behaviours . Trial registration ACTRN12615000182594 ( Australian New Zeal and Clinical Trials Registry . Registry URL : www.anzctr.org.au ; registered prospect ively on 25 February 2015 ) Introduction People with mobility limitations can benefit from rehabilitation programmes that provide a high dose of exercise . However , since providing a high dose of exercise is logistically challenging and re source -intensive , people in rehabilitation spend most of the day inactive . This trial aims to evaluate the effect of the addition of affordable technology to usual care on physical activity and mobility in people with mobility limitations admitted to inpatient aged and neurological rehabilitation units compared to usual care alone . Methods and analysis A pragmatic , assessor blinded , parallel-group r and omised trial recruiting 300 consenting rehabilitation patients with reduced mobility will be conducted . Participants will be individually r and omised to intervention or control groups . The intervention group will receive technology-based exercise to target mobility and physical activity problems for 6 months . The technology will include the use of video and computer games/exercises and tablet applications as well as activity monitors . The control group will not receive any additional intervention and both groups will receive usual inpatient and outpatient rehabilitation care over the 6-month study period . The co primary outcomes will be objective ly assessed physical activity ( proportion of the day spent upright ) and mobility ( Short Physical Performance Battery ) at 6 months after r and omisation . Secondary outcomes will include : self-reported and objective ly assessed physical activity , mobility , cognition , activity performance and participation , utility-based quality of life , balance confidence , technology self-efficacy , falls and service utilisation . Linear models will assess the effect of group allocation for each continuously scored outcome measure with baseline scores entered as a covariate . Fall rates between groups will be compared using negative binomial regression . Primary analyses will be preplanned , conducted while masked to group allocation and use an intention-to-treat approach . Ethics and dissemination The protocol has been approved by the relevant Human Research Ethics Committees and the results will be disseminated widely through peer- review ed publication and conference presentations . Trial registration number ACTRN12614000936628 . Pre- results Background To evaluate the effectiveness of an experimental intervention based on st and ard diet recommendations plus free Smartphone application ( app ) and wearable device for weight loss , compared with the st and ard diet intervention alone , in primary care patients aged 18 years or older who are overweight or obese . Methods / design Multicentre r and omized , controlled clinical trial . Location : Primary health care centres in the city of Tarragona and surrounding areas . Subjects : 70 primary care patients , aged 18 years or older , with body mass index of 25 g/m2 or greater who wish to lose weight . Description of the intervention : 12 months of st and ard diet recommendations without ( n = 35 ) or with ( n = 35 ) assistance of a free Smartphone app that allows the participant to maintain a record of dietary intake and a bracelet monitor that records physical activity . The outcomes will be weight loss at 12 months ( primary outcome ) , changes in physical activity and cardiometabolic risk factors , frequency of app use , and participant satisfaction after 12 months . Discussion The results of our study will offer evidence of the effectiveness of an intervention using one of the most popular free apps and wearable devices in achieving weight loss among patients who are overweight or obese . If these new technologies are proven effective in our population , they could be readily incorporated into primary care interventions promoting healthy weight . The open design and study characteristics make it impossible for the participants and research ers to be blinded to study group assignment . Research ers responsible for data analysis will be blinded to participant allocation . Trial registration Clinical Register : NCT02417623 . Registered 26 March 2015 Background Physical activity is important for a healthy lifestyle . Although physical activity can delay complications and decrease the burden of the disease , the level of activity of patients with chronic obstructive pulmonary disease ( COPD ) or type 2 Diabetes Mellitus ( DM2 ) is often far from optimal . To stimulate physical activity , a monitoring and feedback tool , consisting of an accelerometer linked to a smart phone and webserver ( It ’s LiFe ! tool ) , and a counselling protocol for practice nurses in primary care was developed ( the Self-management Support Program ) . The main objective of this study is to measure the longitudinal effects of this counselling protocol and the added value of using the tool . Methods / Design This three-armed cluster r and omised controlled trial with 120 participants with COPD and 120 participants with DM2 ( aged 40–70 ) , compares the counselling protocol with and without the use of the tool ( group 1 and 2 ) with usual care ( group 3 ) . Recruitment takes place at GP practice s in the southern regions of the Netherl and s. R and omisation takes place at the practice level . The intended sample ( three arms of 8 practice s ) powers the study to detect a 10-minute difference of moderate and intense physical activity per day between groups 1 and 3 . Participants in the intervention groups have to visit the practice nurse 3–4 times for physical activity counselling , in a 4 - 6-month period . Specific activity goals tailored to the individual patient 's preferences and needs will be set . In addition , participants in group 1 will be instructed to use the tool in daily life . The primary outcome , physical activity , will be measured in all groups with a physical activity monitor ( PAM ) . Secondary outcomes are quality of life , general - and exercise - self-efficacy , and health status . Follow-up will take place after 6 and 9 months . Separately , a process evaluation will be conducted to explore reasons for trial non-participation , and the intervention ’s acceptability for participating patients and nurses . Discussion Results of this study will give insight into the effects of the It ’s LiFe ! monitoring and feedback tool combined with care from a practice nurse for people with COPD or DM2 on physical activity . Trial registration Clinical Trials.gov : Severe obesity is characterized by low physical activity ( PA ) and interventions to enhance PA are needed . Participants ( 45.0 ± 3.9 kg/m2 ) were r and omized to a 6-month st and ard behavioral weight loss program ( SBWL ; n = 14 ) or SBWL+technology ( SBWL+TECH ; n = 15 ) . Both groups received identical SBWL treatment and SBWL+TECH also received a wearable PA monitor , providing “ real-time ” feedback , and website access to monitor energy balance . 6-month retention was similar between groups ( SBWL : 12/13 versus SBWL+TECH : 11/14 completers ; P = 0.19 ) and adherence to wearing the armb and was excellent ( 91.3 % of days ) . Although differences in PA between groups did not meet conventional thresholds of significance , SBWL+TECH increased their moderate-to-vigorous intensity PA by 132.9 ± 216.8 min/week , which was 3 times greater than SBWL ( 44.8 ± 124.3 min/week ; P = 0.27 ; Cohen 's d = 0.50 ) . There was a trend for SBWL+TECH to self-monitor for a greater proportion of days compared to SBWL ( 86.2 ± 21.4 % versus 71.5 ± 19.4 % ; P = 0.098 ; Cohen 's d = 0.72 ) . The difference in weight loss between groups was modest ( SBWL+TECH : −10.0 ± 7.1 % versus SBWL : −7.8 ± 6.7 % ; P = 0.46 ) . These preliminary findings suggest that PA monitors may be one strategy for increasing PA among the severely obese . Larger , long-term trials are needed Older people are more sedentary than other age groups . We sought to determine if providing an accelerometer with feedback about activity and counseling older subjects using Go4Life educational material would increase activity levels . Participants were recruited from independent living areas within assisted living facilities and the general public in the Rochester , MN area . 49 persons aged 65 - 95 ( 79.5±7.0 years ) who were ambulatory but sedentary and overweight participated in this r and omized controlled crossover trial for one year . After a baseline period of 2 weeks , group 1 received an accelerometer and counseling using Go4Life educational material ( www.Go4Life.nia.nih.gov ) for 24 weeks and accelerometer alone for the next 24 weeks . Group 2 had no intervention for the first 24 weeks and then received an accelerometer and Go4Life based counseling for 24 weeks . There were no significant baseline differences between the two groups . The intervention was not associated with a significant change in activity , body weight , % body fat , or blood parameters ( p>0.05 ) . Older ( 80 - 93 ) subjects were less active than younger ( 65 - 79 ) subjects ( p=0.003 ) . Over the course of the 48 week study , an increase in activity level was associated with a decline in % body fat ( p=0.008 ) . Increasing activity levels benefits older patients . However , providing an accelerometer and a Go4Life based exercise counseling program did not result in a 15 % improvement in activity levels in this elderly population . Alternate approaches to exercise counseling may be needed in elderly people of this age range Aims : To compare data on cardiovascular risk factor changes in lipids , insulin , proinsulin , fibrinolysis , leptin and C-reactive protein , and on diabetes incidence , in relation to changes in lifestyle . Methods : The study was a r and omized lifestyle intervention trial conducted in northern Sweden between 1995 and 2000 , in 168 individuals with impaired glucose tolerance ( IGT ) and body mass index above 27 at start . The intensive intervention group ( n = 83 ) was subjected to a 1-month residential lifestyle programme . The usual care group ( n = 85 ) participated in a health examination ending with a single counselling session . Follow-up was conducted at 1 , 3 and 5 years . Results : At 1-year follow-up , an extensive cardio-metabolic risk factor reduction was demonstrated in the intensive intervention group , along with a 70 % decrease of progress to type 2 diabetes . At 5-year follow-up , most of these beneficial effects had disappeared . Reported physical activity and fibre intake as well as high-density lipoprotein cholesterol were still increased , and fasting insulin and proinsulin were lower . Conclusions : The intervention affected several important cardio-metabolic risk variables beneficially , and reduced the risk for type 2 diabetes , but the effects persisted only as long as the new lifestyle was maintained . Increased physical activity seemed to be the behaviour that was most easy to preserve INTRODUCTION Direct-to-consumer mHealth devices are a potential asset to behavioral research but rarely tested as intervention tools . This trial examined the accelerometer-based Fitbit tracker and website as a low-touch physical activity intervention . The purpose of this study is to evaluate , within an RCT , 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 were r and omized to a 16-week web-based self-monitoring intervention ( n=25 ) or comparison group ( n=26 ) . The Web-Based Tracking Group received a Fitbit , instructional session , and follow-up call at 4 weeks . The comparison group received a st and ard pedometer . All were asked to perform 150 minutes/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 aged 60 ( SD=7 ) years with BMI of 29.2 ( 3.5 ) kg/m(2 ) . Relative to baseline , the Web-Based Tracking Group increased MVPA by 62 ( 108 ) minutes/week ( p<0.01 ) ; 10-minute MVPA bouts by 38 ( 83 ) minutes/week ( p=0.008 ) ; and steps by 789 ( 1,979 ) ( p=0.01 ) , compared to non-significant increases in the Pedometer Group ( between-group p=0.11 , 0.28 , and 0.30 , 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 associated with increased physical activity at 16 weeks . Leveraging direct-to-consumer mHealth technologies aligned with behavior change theories can strengthen physical activity interventions Importance Effective long-term treatments are needed to address the obesity epidemic . Numerous wearable technologies specific to physical activity and diet are available , but it is unclear if these are effective at improving weight loss . Objective To test the hypothesis that , compared with a st and ard behavioral weight loss intervention ( st and ard intervention ) , a technology-enhanced weight loss intervention ( enhanced intervention ) would result in greater weight loss . Design , Setting , Participants R and omized clinical trial conducted at the University of Pittsburgh and enrolling 471 adult participants between October 2010 and October 2012 , with data collection completed by December 2014 . Interventions Participants were placed on a low-calorie diet , prescribed increases in physical activity , and had group counseling sessions . At 6 months , the interventions added telephone counseling sessions , text message prompts , and access to study material s on a website . At 6 months , participants r and omized to the st and ard intervention group initiated self-monitoring of diet and physical activity using a website , and those r and omized to the enhanced intervention group were provided with a wearable device and accompanying web interface to monitor diet and physical activity . Main Outcomes and Measures The primary outcome of weight was measured over 24 months at 6-month intervals , and the primary hypothesis tested the change in weight between 2 groups at 24 months . Secondary outcomes included body composition , fitness , physical activity , and dietary intake . Results Among the 471 participants r and omized ( body mass index [ BMI ] , 25 to < 40 ; age range , 18 - 35 years ; 28.9 % nonwhite , 77.2 % women ) , 470 ( 233 in the st and ard intervention group , 237 in the enhanced intervention group ) initiated the interventions as r and omized , and 74.5 % completed the study . For the enhanced intervention group , mean base line weight was 96.3 kg ( 95 % CI , 94.2 - 98.5 ) and 24-month weight 92.8 kg ( 95 % CI , 90.6- 95.0 ) [ corrected ] . For the st and ard intervention group , mean baseline weight was 95.2 kg ( 95%CI,93.0 - 97.3 ) and 24-month weight was 89.3 kg ( 95%CI , 87.1 - 91.5 ) [ corrected ] . Weight change at 24 months differed significantly by intervention group ( estimated mean weight loss , 3.5 kg [ 95 % CI , 2.6 - 4.5 } in the enhanced intervention group and 5.9 kg [ 95 % CI , 5.0 - 6.8 ] in the st and ard intervention group ; difference , 2.4 kg [ 95 % CI , 1.0 - 3.7 ] ; P = .002 ) . Both groups had significant improvements in body composition , fitness , physical activity , and diet , with no significant difference between groups . Conclusions and Relevance Among young adults with a BMI between 25 and less than 40 , the addition of a wearable technology device to a st and ard behavioral intervention result ed in less weight loss over 24 months . Devices that monitor and provide feedback on physical activity may not offer an advantage over st and ard behavioral weight loss approaches . Trial Registration clinical trials.gov Identifier : NCT01131871 Background Osteoarthritis ( OA ) of the knee is one of the leading causes of disability in the United States . One relatively new strategy that could be helpful in the management of OA is the use of mHealth technologies , as they can be used to increase physical activity and promote exercise , which are key components of knee OA management . Objective Currently , no published data on the use of a mHealth approach to comprehensively monitor physical activity in patients with OA are available , and similarly , no data on whether mHealth technologies can impact outcomes are available . Our objective is to evaluate the effectiveness of mHealth technology as part of a tailored , comprehensive management strategy for patients with knee OA . Methods The study will assess the impact of a smartphone app that integrates data from a wearable activity monitor ( thereby both encouraging changes in mobility as well as tracking them ) combined with education about the benefits of walking on patient mobility . The results from the intervention group will be compared with data from a control group of individuals who are given the same Arthritis Foundation literature regarding the benefits of walking and wearable activity monitors but who do not have access to the data from those monitors . Activity monitors will capture step count estimates and will compare those with patients ’ step goals , calories burned , and distance walked . Patients using the novel smartphone app will be able to enter information on their daily pain , mood , and sleep quality . The relationships among activity and pain , activity and mood , and sleep will be assessed , as will patient satisfaction with and adherence to the mobile app . Results We present information on an upcoming trial that will prospect ively assess the ability of a mobile app to improve mobility for knee OA patients who are treated with intra-articular hyaluronic acid . Conclusions We anticipate the results of this study will support the concept that mHealth technologies provide continuous , real-time feedback to patients with OA on their overall level of activity for a more proactive , personalized approach to treatment that may help modify behavior and assist with self-management through treatment support in the form of motivational messages and reminders Pilot studies represent a fundamental phase of the research process . The purpose of conducting a pilot study is to examine the feasibility of an approach that is intended to be used in a larger scale study . The roles and limitations of pilot studies are described here using a clinical trial as an example . A pilot study can be used to evaluate the feasibility of recruitment , r and omization , retention , assessment procedures , new methods , and implementation of the novel intervention . A pilot study is not a hypothesis testing study . Safety , efficacy and effectiveness are not evaluated in a pilot . Contrary to tradition , a pilot study does not provide a meaningful effect size estimate for planning subsequent studies due to the imprecision inherent in data from small sample s. Feasibility results do not necessarily generalize beyond the inclusion and exclusion criteria of the pilot design . A pilot study is a requisite initial step in exploring a novel intervention or an innovative application of an intervention . Pilot results can inform feasibility and identify modifications needed in the design of a larger , ensuing hypothesis testing study . Investigators should be forthright in stating these objectives of a pilot study . Grant review ers and other stakeholders should expect no more INTRODUCTION For women with an increased breast cancer risk , reducing excess weight and increasing physical activity are believed to be important approaches for reducing their risk . This study tested a weight loss intervention that combined commercially available technology-based self-monitoring tools with individualized phone calls . DESIGN Women were r and omized to a  weight loss intervention  arm ( n=36 ) or a  usual care arm ( n=18 ) . SETTING / PARTICIPANTS Participants were women with a BMI ≥ 27.5 kg/m2 and elevated breast cancer risk recruited from the mammography clinic at the Moores Cancer Center at the University of California San Diego . INTERVENTION Intervention participants used the MyFitnessPal website and phone app to monitor diet and a Fitbit to monitor physical activity . Participants received 12 st and ardized coaching calls with trained counselors over 6 months . Usual care participants received the U.S. Dietary Guidelines for Americans at baseline and two brief calls over the 6 months . MAIN OUTCOME MEASURES Weight and accelerometer-measured physical activity were assessed at baseline and 6 months . Data were collected in San Diego , CA , from 2012 to 2014 and analyzed in 2015 . RESULTS Participants ( n=54 ) had a mean age of 59.5 ( SD=5.6 ) years , BMI of 31.9 ( SD=3.5 ) , and a mean Gail Model score of 2.5 ( SD=1.4 ) . At 6 months , intervention participants had lost significantly more weight ( 4.4 kg vs 0.8 kg , p=0.004 ) and a greater percentage of starting weight ( 5.3 % vs 1.0 % , p=0.005 ) than usual care participants . Across arms , greater increases in moderate-to-vigorous physical activity result ed in greater weight loss ( p=0.01 ) . CONCLUSIONS Combining technology-based self-monitoring tools with phone counseling supported weight loss over 6 months in women at increased risk for breast cancer Purpose This study evaluated the feasibility and preliminary efficacy of two 6-month , self-regulation interventions that focused on daily self-weighing ( DSW ) and used objective monitoring and tailored feedback about weight ( ±activity ) , to prevent weight gain among African American breast cancer survivors . Methods Participants ( n = 35 ) were r and omized to an intervention + activity monitoring ( INT+ ) , intervention ( INT ) , or control ( CON ) group . Interventions included a wireless scale ( ±activity tracker ) that transmitted objective data to a mobile app/website , emailed lessons , and tailored feedback based on objective weight ( ±activity data ) . Participants completed in-person and online assessment s at baseline , 3 months , and 6 months . Results Ninety-four percent of participants completed assessment s at 3 months , and 97 % at 6 months . Median ( IQR ) weight change after 6 months was −0.9 % ( −4.4–0.1 ) in the INT+ ( p = 0.075 ; p = 0.067 vs. CON ) and −0.2 % ( −4.2–1.3 ) in the INT groups ( p = 0.463 ; p = 0.357 vs. CON ) , versus a 0.2 % ( −0.7–1.7 ) gain in the CON group . The proportion of INT+ , INT , and CON participants that were at or below baseline weight was 72.7 , 53.8 , and 45.5 % , respectively ( effect sizes d = 0.64 , d = 0.18 ) . Most INT+ participants weighed and wore trackers ≥5 days/week ( INT+ , 81.9 % vs. INT , 38.5 % vs. CON , 0 % ; p < 0.0005 ; INT+ , 72.7 % ) . Both intervention groups perceived DSW as positive , and 100 % would recommend the program to other breast cancer survivors . Conclusion An intervention focused on DSW as a self-monitoring strategy shows promise for preventing weight gain in breast cancer survivors . Implication s for cancer survivorsDaily self-monitoring of weight and activity may be a feasible and accessible approach to promote weight gain prevention in breast cancer survivors . Clinical trial registration Clinical Trials.gov , The purpose of this study was to compare a technology-based system , an in-person behavioral weight loss intervention , and a combination of both over a 6-month period in overweight adults . Fifty-one subjects ( age : 44.2 ± 8.7 years , BMI : 33.7 ± 3.6 kg/m(2 ) ) participated in a 6-month behavioral weight loss program and were r and omized to one of three groups : st and ard behavioral weight loss ( SBWL ) , SBWL plus technology-based system ( SBWL+TECH ) , or technology-based system only ( TECH ) . All groups reduced caloric intake and progressively increased moderate intensity physical activity . SBWL and SBWL+TECH attended weekly meetings . SBWL+TECH also received a TECH that included an energy monitoring armb and and website to monitor energy intake and expenditure . TECH used the technology system and received monthly telephone calls . Body weight and physical activity were assessed at 0 and 6 months . Retention at 6 months was significantly different ( P = 0.005 ) between groups ( SBWL : 53 % , SBWL+TECH : 100 % , and TECH : 77 % ) . Intent-to-treat ( ITT ) analysis revealed significant weight losses at 6 months in SBWL+TECH ( -8.8 ± 5.0 kg , -8.7 ± 4.7 % ) , SBWL ( -3.7 ± 5.7 kg , -4.1 ± 6.3 % ) , and TECH ( -5.8 ± 6.6 kg , -6.3 ± 7.1 % ) ( P < 0.001 ) . Self-report physical activity increased significantly in SBWL ( 473.9 ± 800.7 kcal/week ) , SBWL+TECH ( 713.9 ± 1,278.8 kcal/week ) , and TECH ( 1,066.2 ± 1,371 kcal/week ) ( P < 0.001 ) , with no differences between groups ( P = 0.25 ) . The TECH used in conjunction with monthly telephone calls , produced similar , if not greater weight losses and changes in physical activity than the st and ard in-person behavioral program at 6 months . The use of this technology may provide an effective short-term clinical alternative to st and ard in-person behavioral weight loss interventions , with the longer term effects warranting investigation Background Physical inactivity ranks as a major contributing factor in the development and progression of chronic disease . Lifestyle interventions reduce the progression of chronic disease , however , compliance decreases over time and health effects only persist as long as the new lifestyle is maintained . Telephone counselling ( TC ) is an effective way to provide individuals with ongoing support to maintain lifestyle changes . Remote physical activity monitoring and feedback ( RAMF ) via interactive technologies such as activity trackers and smartphones may be a cost-effective alternative to TC , however , this comparison has not been made . This study , therefore , aims to determine the effect of ongoing feedback ( TC vs. RAMF ) on the maintenance of physical activity following a 12-week individualised lifestyle program , and the effect of this on health risk factors and health services usage . Methods and design A r and omised controlled trial with a parallel groups design . A total of 150 adults ( ≥60 years ) who participate in a 12-week face-to-face individualised lifestyle program will be r and omised to twelve months of RAMF ( n = 50 ) , TC ( n = 50 ) , or usual care ( n = 50 ) . Participants r and omised to RAMF will use a smartphone activity tracker app , synced to a wrist worn activity tracker , to provide them with automated feedback regarding compliance to prescribed activity targets . Telephone counselling involves a follow-up phone call every fortnight for the first three months and a monthly call for the remaining nine months of the follow-up period . The primary outcome measures are physical activity compliance ( accelerometry and Active Australia survey ) . Secondary outcome measures include cardiorespiratory fitness , muscle strength , dynamic balance , quality of life , blood pressure , body composition , and health services usage . Measures will be made before and after the individualised lifestyle program , and at three , six and twelve months during the intervention . Discussion The results of this study will help to determine the efficacy of RAMF devices on compliance to prescribed physical activity compared to the current gold st and ard of TC . If the remote monitoring proves effective , it may provide a cost efficient alternative method of assisting maintenance of behaviour change from lifestyle interventions .Trial registration ACTRN12615001104549 . Retrospectively Registered 20/10/2015 OBJECTIVE The objective was to examine the efficacy of adding a technology-based program to an in-person , behavioral weight loss intervention . RESEARCH METHODS AND PROCEDURES Fifty-seven subjects ( BMI = 33.1+/-2.8 kg/m2 ; age=41.3+/-8.7 years ) participated in a 12-week intervention with r and om assignment to St and ard In-Person Behavioral Weight Control Program ( SBWP ) or Intermittent or Continuous Technology-Based Program ( INT-TECH , CON-TECH ) . SBWP subjects received seven individualized weight loss sessions encouraging dietary and exercise modifications . INT-TECH and CON-TECH subjects received all SBWP components ; additionally , these groups used a SenseWear Pro Armb and ( BodyMedia , Inc. ) to monitor energy expenditure and an Internet-based program to monitor eating behaviors . These features were used by INT-TECH subjects during weeks 1 , 5 , and 9 and CON-TECH subjects weekly throughout the intervention . RESULTS Intent-to-treat analysis revealed weight loss of 4.1+/-2.8 kg , 3.4+/-3.4 kg , and 6.2+/-4.0 kg , for SBWP , INT-TECH , and CON-TECH groups , respectively ( CON-TECH > INT-TECH , p < or=0.05 ) . DISCUSSION These results indicate that the technology-based program needs to be used continuously throughout the intervention period to significantly impact weight loss . Future studies should examine the long-term and independent effect of this technology on weight loss , and for whom this intervention format is most effective We assessed the ability of the Polar activity recorder ( AR ) to measure energy expenditure ( EE ) during military training . Twenty-four voluntary male conscripts participated in the study and wore an AR on the non-dominant wrist 24 h a day for 7 d. The AR analyzed and stored the frequency of h and movements ( f_h and ) into memory at 1 min intervals . The relationship between f_h and and EE was studied over a 7 d period of military training using the doubly labeled water ( DLW ) technique . In addition , the relationship between f_h and and EE was analyzed during walking and running on a treadmill with an indirect calorimeter ( IC ) , and f_h and was measured during a supervised 45 min field march test where the conscripts carried combat gear .  EE was expressed as physical activity level ( PAL ) , total energy expenditure ( TEE ) , and activity-induced energy expenditure adjusted for body mass ( AEE/BM ) . Over the 7 d period , f_h and alone explained 46 % of inter-individual variation in PAL(DLW ) . After inclusion of body height and mass in the model used to predict PAL(DLW ) from f_h and , a very high positive correlation and a low st and ard error of estimate ( SEE ) were observed between the AR and DLW techniques : for TEE r = 0.86 ( p < 0.001 ) , the SEE was 6.3 % , and for AEE/BM r = 0.84 ( p < 0.001 ) , the SEE was 12.8 % . In the treadmill exercise , f_h and correlated highly with PAL(IC ) ( r = 0.97 ± 0.02 ) . In the 45 min field march test , the AR measured similar f_h and as on the treadmill at the same speed . In conclusion , the wrist-worn AR can be regarded as a reliable and valid method for assessing EE during intensive training Background The office workplace is a key setting in which to address excessive sitting time and inadequate physical activity . One major influence on workplace sitting is the organizational environment . However , the impact of organizational-level strategies on individual level activity change is unknown . Further , the emergence of sophisticated , consumer-targeted wearable activity trackers that facilitate real-time self-monitoring of activity , may be a useful adjunct to support organizational-level strategies , but to date have received little evaluation in this workplace setting . Objective The aim of this study is to evaluate the feasibility , acceptability , and effectiveness of organizational-level strategies with or without an activity tracker on sitting , st and ing , and stepping in office workers in the short ( 3 months , primary aim ) and long-term ( 12 months , secondary aim ) . Methods This study is a pilot , cluster-r and omized trial ( with work teams as the unit of clustering ) of two interventions in office workers : organizational-level support strategies ( eg , visible management support , emails ) or organizational-level strategies plus the use of a waist-worn activity tracker ( the LUMOback ) that enables self-monitoring of sitting , st and ing , and stepping time and enables users to set sitting and posture alerts . The key intervention message is to ‘ St and Up , Sit Less , and Move More . ’ Intervention elements will be implemented from within the organization by the Head of Workplace Wellbeing . Participants will be recruited via email and enrolled face-to-face . Assessment s will occur at baseline , 3 , and 12 months . Time spent sitting , sitting in prolonged ( ≥30 minute ) bouts , st and ing , and stepping during work hours and across the day will be measured with activPAL3 activity monitors ( 7 days , 24 hours/day protocol ) , with total sitting time and sitting time during work hours the primary outcomes . Web-based question naires , LUMOback recorded data , telephone interviews , and focus groups will measure the feasibility and acceptability of both interventions and potential predictors of behavior change . Results Baseline and follow-up data collection has finished . Results are expected in 2016 . Conclusions This pilot , cluster-r and omized trial will evaluate the feasibility , acceptability , and effectiveness of two interventions targeting reductions in sitting and increases in st and ing and stepping in office workers . Few studies have evaluated these intervention strategies and this study has the potential to contribute both short and long-term findings OBJECTIVE A pilot r and omized trial assessed the feasibility and effectiveness of an intervention combining Smartcare ( activity tracker with a smartphone application ) and financial incentives . METHODS A three-arm , open-label r and omized controlled trial design involving traditional education , Smartcare , and Smartcare with financial incentives was involved in this study . The latter group received financial incentives depending on the achievement of daily physical activity goals ( process incentive ) and weight loss targets ( outcome incentive ) . Male university students ( N = 105 ) with body mass index of ≥27 were enrolled . RESULTS The average weight loss in the traditional education , Smartcare , and Smartcare with financial incentives groups was -0.4 , -1.1 , and -3.1 kg , respectively , with significantly greater weight loss in the third group ( both Ps < 0.01 ) . The final weight loss goal was achieved by 0 , 2 , and 10 participants in the traditional education , Smartcare , and Smartcare with financial incentives groups ( odds ratio for the Smartcare with financial incentive vs. Smartcare = 7.27 , 95 % confidence interval : 1.45 - 36.47 ) . Levels of physical activity were significantly higher in this group . CONCLUSIONS The addition of financial incentives to Smartcare was effective in increasing physical activity and reducing obesity INTRODUCTION Many breast cancer survivors experience problems with  cognitive functioning  that can persist years after treatment . Increasing physical activity has been shown to improve cognitive functioning in healthy and cognitively impaired adults , but has not yet been tested in cancer survivors . The primary aim of this r and omized controlled trial is to examine the effects of a 3-month physical activity intervention compared to a waitlist Control arm on neuropsychological outcomes and subjective cognitive concerns in breast cancer survivors . METHODS Eighty sedentary breast cancer survivors , self-reporting difficulties with cognition , will be r and omized into an Exercise arm or Control arm . The Exercise arm includes an activity tracker ( i.e. , a Fitbit ) , phone calls , plus tailored and non-tailored email content . The Control arm will receive emails on women 's health topics on the same schedule as the Exercise arm . Assessment s conducted at baseline and 3 months include : neuropsychological testing , cognitive concerns and other aspects of quality of life , and 7 days of a hip-worn accelerometer . Participants will also provide fasting blood draws to assess brain-derived neurotropic factor , Insulin-like growth factor 1 , insulin resistance , and C-reactive protein . Primary and secondary outcomes are changes in neuropsychological testing and cognitive concerns . Biomarkers will be examined to further underst and the underlying relationship between physical activity and cognition . CONCLUSION The Memory & Motion study is design ed to test whether increasing physical activity can improve cognitive functioning in breast cancer survivors . Results from this study could be used to guide development of interventions to improve cognitive functioning in breast cancer survivors Introduction Most Alzheimer 's disease ( AD ) prevention studies focus on older adults or persons with existing cognitive impairment . This study describes the design and progress of a novel pilot intervention , the Gray Matters study . Methods This proof-of-concept r and omized controlled trial tests an evidence -based multidomain lifestyle intervention in 146 persons aged 40 to 64 years , in northern Utah . Data collectors were blinded to participants ' r and omization to treatment ( n = 104 ) or control ( n = 42 ) . Intervention targeted physical activity , food choices , social engagement , cognitive simulation , sleep quality , and stress management , and uses a custom smartphone application , activity monitor , and educational material s. Secondary outcomes include biomarkers , body mass index , cognitive testing , and psychological surveys . Results Midway through the study , achievements include a 98.7 % retention rate , a 96 % rate of compliance with app data entry , and positive trends in behavioral change . Discussion Participants were empowered , learning that lifestyle might impact AD risk , exhibiting positive behavioral changes thus far
target: CONCLUSIONS Utilizing a consumer-based wearable activity tracker as either the primary component of an intervention or as part of a broader physical activity intervention has the potential to increase physical activity participation .
background: BACKGROUND The range of benefits associated with regular physical activity participation is irrefutable .
  Despite the well-known benefits , physical inactivity remains one of the major contributing factors to ill-health throughout industrialized countries .
  Traditional lifestyle interventions such as group education or telephone counseling are effective at increasing physical activity participation ; however , physical activity levels tend to decline over time .
  Consumer-based wearable activity trackers that allow users to objective ly monitor activity levels are now widely available and may offer an alternative method for assisting individuals to remain physically active .
  OBJECTIVE This review aim ed to determine the effects of interventions utilizing consumer-based wearable activity trackers on physical activity participation and sedentary behavior when compared with interventions that do not utilize activity tracker feedback .