In a recent article published in Journal of Medical Internet Research, researchers from Hebrew University and Ben-Gurion University of the Negev in Israel sought to determine if the use of an app (eBalance) would encourage people to live a healthy lifestyle as compared to people receiving lectures on healthy living.
This is a useful and practical research question with the increasing number of consumers/patients using apps to help them live healthy lives. Most of the apps currently on the market, even the most popular ones, lack evidence. So, this study, among others, helps provide some evidence regarding the potential benefits of this ever increasing category of apps.
Researchers recruited 112 individuals via email for this study from between 2012 and 2013. Researchers state that these people were from the “community” and lists possible sources of the participants – high-tech companies, kibbutzim, large organizations. However, the researchers do not clearly explain why this group of individuals was targeted and potential biases are not clear based on their description of the group. They are also not clear about how many emails were sent out in order to recruit this number of individuals.
Individuals were included in the study if they were “healthy people, aged = or >18 years with Web and email experience, interested in a healthy lifestyle, and willing to commit the necessary time and effort to the study.” They were excluded if they “were participating in a program for weight reduction, pregnancy, and/or lactation.”
Of the 112 individuals recruited, 99 participated in the study and were randomized to the intervention or control groups. All participants received an introductory lecture in a face to face meeting that focused on “a healthy lifestyle, recommendations for healthy nutrition, and the clinical benefits of physical activity for the recommended weekly duration.” No incentives were provided to participants. A set of measurements were taken at the beginning of the study and 14 weeks later. The measurements included: weight, waist circumference, nutritional knowledge, diet quality, and physical activity duration were tested using online questionnaires.
The control group (n=30) was told to continue living a healthy lifestyle based on their own perception of what that meant and the information shared with them. What the control group did instead of using the app is not clear from the study. The intervention group (n=69) received the eBalance web based app and a related password. They were told to use the app as much as they wanted. This web based app was developed using the USDA Dietary Guidelines for 2010 as guidance. The app allows users to monitor diet and physical activity, provides educational information, and encourages healthy eating and physical activity.
Most of the participants completed the study (86%) with 13 dropping out of the intervention group and only 1 dropping out of the control group.
Overall, the study supported the hypothesis that a healthy lifestyle app and a presentation on healthy lifestyles was better than a presentation alone. Key findings included:
- App Usage – Intervention group used the app 2.7 (SD 1.9) days/week
- Physical Activity – Mean change of 63 (SD 20.8) minutes in the intervention group and -30 (SD 27.5) minutes in the control group (P=.02).
- Weight Change – Mean weight change was -1.44 (SD 0.4) kg in the intervention group and -0.128 (SD 0.36) kg in the control group (P=.03).”
- Nutritional Knowledge – Knowledge score increased significantly in the intervention group, 76 (SD 7.5) to 79 (SD 8.7) at the end of the study (P=.04) compared with the control group.
- Diet Quality – Diet quality score also increased significantly at the end of the study, from 67 (SD 9.8) to 71 (SD 7.6; P<.001) in contrast to the control group.
The researchers also used a “success score” to examine factors that were associated with greater success at maintaining a healthy lifestyle. They found that these scores were higher among the app group in comparison with the control group (68% vs. 26%, P<.001). They noted a correlation between success and app use frequency as well.
The findings of this study are interesting but it does have important limitations. First, the participants recruited were clearly a highly selective population of self-motivated individuals. That may not be reflective of the majority of the patients clinicians are counselling in clinic. They also used some metrics of unclear clinical significance like the “success” score. Finally, this was a relatively short study – while short-term success is great, any clinician knows that the bigger challenge is helping our patients make those successes and lifestyle changes durable.