Take home point

A systematic review of the use of apps and text messaging aimed at reducing cardiovascular disease risk found that these technologies have a positive effect on health promoting behaviors.

More than half of the studies reported significant results in at least one outcome of weight loss, physical activity, dietary intake, decreased BMI, decreased waist circumference, sugar-sweetened beverage intake, screen time, and satisfaction/acceptability outcomes.


While there has been past research on the use of tools like website and email to show they can have an impact on health, there has been little evidence demonstrating the impact of apps or text messaging. As a result, researchers conducted a systematic review of studies on mobile phone technology to determine user satisfaction and effectiveness of smartphone applications and text messaging interventions at promoting weight reduction and physical activity.

Approach to Address Problem

The researchers limited their review to seven studies cited in CINAHL, PubMed, EMBASE, MEDLINE, and PsycINFO and only included studies that were conducted between January 2005 and August 2010. The search was limited to quasi-experimental study designs and randomized controlled trials. The researchers did not include studies that dealt with disease management as the focus was on preventive behaviors.


Although the actual study was not that innovative, the review did identify some innovative  interventions. Two of the studies examined participant use of a smartphone application. These smartphones had the capability to record daily calorie intake and consumption, record daily exercise, and show status of daily goals. One particular innovation – The SmartDiet application – provided participants with a diet and exercise game, as well as an avatar that was altered according to their weight change.

Key Results

The app and text messaging interventions resulted in reductions in body weight, waist circumference, body mass index, sugar-sweetened beverage intake, screen time, and resulted in satisfaction or acceptability outcomes.

Implications for clinicians/health care system

Researchers pointed out that the technology has many implications for cardiovascular nurses in particular and that they should be encouraged to ask about a patient’s use or interest in smartphone applications or text messaging. In the future, nurses could help monitor the progress of patients and provide them with feedback as they use these technologies. These technologies could also be useful for not only cardiovascular nurses but also cardiologists and also primary care health professionals. It could be particularly important in primary care settings where patients might be interested in weight reduction, better eating habits, and general behavior which address risk factors for many chronic diseases.

Implications for public health

The researchers posed the question of, “How can successful interventions be translated to populations?” Perhaps public health workers in the field could be trained on the use of these applications for use in community health centers or other community-based settings. Since the studies were not limited to the United States, these technologies have the possibility of being implemented worldwide and in countries facing chronic disease challenges as they move toward more Western lifestyles.

However, there remains an ongoing need for a public health organization and also for professional organizations to develop and implement criteria for determining which apps are best for patients. This type of systematic review can help guide such organizations.

Future research concerns/challenges

The most obvious challenge facing implementation of apps or text messaging to promote healthy behaviors is that patients or people interested in these types of technologies must have smart phones with data plans that allow for text messaging and downloading of applications. This may pose a challenge to low-income populations or other demographics that may not use smartphones. Another concern is that there are few studies that focused on children (under age 18) or the elderly (those above 65). There were limited studies on adolescents but it appears that these two populations merit further study. The researchers also point out that more rigorous trials are needed to determine what parts of the technology or interventions are effective and how to make these interventions cost-effective.

Reference: Stephens J, Allen J. Mobile phone interventions to increase physical activity and reduce weight: a systematic review. J Cardiovasc Nurs. 2013 Jul-Aug;28(4):320-9. doi: 10.1097/JCN.0b013e318250a3e7.