Running head: USE OF SMARTPHONE APPS FOR INCREASED PHYSICAL 1

Use of Smartphone Apps for Increased Physical Activity/Weight Loss vs. Traditional Self-

Monitoring

Anthony Ortiz

University of South Florida

USE OF SMARTPHONE APPS FOR INCREASED PHYSICAL 2

Abstract

Clinical Problem: Obesity is one of the leading causes of global deaths and can cause or

exacerbate a wide range of comorbidities, such as hypertension, cancer, and type 2 diabetes.

Objective: To determine if the introduction of smartphone health/fitness applications into the

daily lives of obese patients will assist in increasing their overall physical activity and weight

loss. PubMed and ResearchGate were accessed to obtain clinical trials. The key search terms

used were obesity, health/fitness applications, smartphones, weight loss, and physical activity.

Results: The literature demonstrated that the implementation of a smartphone based application

intervention generated an increase in physical activity and weight loss amongst the participants

in the studies.

Conclusion: Participants who partook in the smartphone based application intervention saw an

increase in their daily physical activity and their long-term weight loss.
USE OF SMARTPHONE APPS FOR INCREASED PHYSICAL 3

Use of Smartphone Apps for Increased Physical Activity/Weight Loss vs. Traditional Self-

Monitoring

According to the American Heart Association (2014), almost 70% of adults in America

are overweight or obese, which can lead to hypertension, heart disease, diabetes, stroke, and

more. In addition, medical costs for patients with obesity can range anywhere from $147-$210

billion dollars a year (Aston, 2014). For these reasons, it is crucial that hospitals and medical

care staff make teaching regarding weight maintenance one of their priorities. However, when

providing teaching to overweight and obese patients about the importance of exercise and

maintaining a healthy diet to lose weight, it can often prove to be a difficult undertaking.

Thankfully, though, we live in an age where technology has become integrated into virtually

every aspect of our lives. With these advances, we can utilize technology such as smartphones to

make such undertakings easier to handle. Use of smartphone health/fitness applications may aid

in making physical activity and weight loss achievable in this population. In overweight/obese

patients, does utilizing smartphone applications result in more physical activity/weight loss when

compared to traditional self-monitoring over the course of 6 months?

Literature Search

PubMed and ResearchGate were accessed to obtain clinical trials. The key search terms

used were obesity, health/fitness applications, smartphones, weight loss, and physical activity.

Literature Review

Three randomized controlled trials were used to evaluate the efficacy of a smartphone

based application intervention on physical activity and weight loss. Svetkey et al. (2015)

conducted a study that utilized two smartphone-based health applications and recorded their

effects when used as weight loss interventions when compared to standard measures
USE OF SMARTPHONE APPS FOR INCREASED PHYSICAL 4

implemented in today’s practice. The study analyzed several factors, including expended energy,

weight, frequency of self-monitoring, BMI, and dietary outcomes. Randomized within the study

groups, 365 individuals participated. In the first group (n=122), the intervention was delivered by

a smartphone application on a cell phone (CP). In the second group (n=120), the intervention

was delivered by personal coaching with an added component of smartphone self-monitoring

(PC). The third group (n=123) was the control group. An average baseline BMI of 35 kg/m2 was

required for all those participating. Strengths of the study included the following: those who

enrolled the subjects into the study were unaware of the fact that the assignments would be

random and the tools utilized to analyze the results were reasonable and dependable. Weaknesses

of the study included the following: those who participated in the study chose whether they

would be in the experimental or control groups as opposed to being placed randomly, and the

providers and participants were aware of the study group. The results of the study concluded that

the CP group was not found to yield better results at any point in which progress was measured.

Participants in the CP group lost a notable amount of weight more than the control group at the

6-month measurement checkpoint (p = 0.003). However, weight loss was not significantly

different at the 12 and 24-month measurement checkpoints.

Turner-Mcgrievy et al. (2013) conducted a study in which physical activity and diet

monitoring were assessed to see the relationship they have with changes in expended energy,

weight, frequency of self-monitoring, BMI, and dietary outcomes. The intervention involved the

use of a smartphone-based application (PA) for physical activity and an app/website/paper

journal monitoring method for diet monitoring. Weight change in kilograms was measured at 24

months. 96 overweight participants were distributed into the podcast group (n=49) and the

podcast+mobile group (n=47). In the podcast group, the intervention was implemented by only
USE OF SMARTPHONE APPS FOR INCREASED PHYSICAL 5

an audio podcast. In the podcast+mobile group, the intervention was implemented by an audio

podcast as well as a diet/physical activity-monitoring app via a social networking site. Strengths

of the study included the following: those who enrolled the subjects into the study were unaware

of the fact that the assignments would be random, and the participants were selected at random

when being placed into the experimental and control groups. Weaknesses of the study included

the following: assessments following the study were not performed for an appropriate amount of

time to thoroughly examine the impact of the intervention and the providers and participants

were aware of the study group. The results of the study concluded that participants who utilized

the PA app more frequently self-monitored their exercise and noted higher intentional physical

activity over the course of the study than participants who did not use the app (p<0.01; p=0.02).

Participants who utilized the PA app also had BMI’s that were notably lower than those who did

not use the app (p=0.02) at the 6-month measurement checkpoint. Self-monitoring frequency was

no different among the various methods of self-monitoring (p=0.63); however, those participants

who used the app consumed less energy than those who simply used the paper journals (p=0.01)

at the 6-months measurement checkpoint. BMI’s were no different among the methods of diet

monitoring (p=0.20).

Martin et al. (2015) conducted a study that tested the effectiveness of a smartphone-based

app for weight loss named SmartLoss. Systolic and diastolic blood pressure (mmHg), change in

body weight (kg), and waist circumference (cm) were measured over the course of the study.

Forty over-weight and obese adults with BMI’s between 25-35 kg/m2 and between the ages of

16-85 years were distributed among the experimental group (n=20) and the control group (n=20).

Strengths of the study included the following: those who enrolled the subjects into the study

were unaware of the fact that the assignments would be random, and the participants in the
USE OF SMARTPHONE APPS FOR INCREASED PHYSICAL 6

groups were demographically and clinically similar. Weaknesses of the study included the

following: assessments following the study were not performed for an appropriate amount of

time to thoroughly examine the impact of the intervention and the providers and participants

were aware of the study group. Study results concluded that weight loss was notably higher

(p<.001) in the group that utilized the SmartLoss app versus the group that was presented with

Health Education.

The guidelines for weight loss and increased activity with the help of mobile smartphone

applications by the Advance Health Network (2015) integrates evidence based practice and

individualized care. AHN proposes the importance of recommending a self-monitoring method,

such as smartphones apps, for weight loss treatment plans that are tailored to patients’ specific

needs. Individualized care will yield higher results.

Synthesis

Svetkey et al. (2015) showed in the study that participants who utilized a smartphone-

based health/fitness application lost a significant amount of weight more when compared to

those that did not use the application. Turner-Mcgrievy et al. (2013) showed that app users more

frequently self-monitored their exercise and had higher intentional physical activity than those

that did not use the app. App users also had lower BMI’s. In addition, Martin et al. (2015)

showed that weight loss was higher in the group that utilized the smartphone-based health/fitness

application SmartLoss. Each of these studies focused on similar parameters for analysis, uch as

weight, BMI, and frequency of self-monitoring. Martin’s study, however, also incorporated

assessments of systolic and diastolic blood pressure. The studies differed greatly in their number

of participants, with Svetkey, Turner-Mcgrievy, and Martin’s groups containing 365, 96, and 40

participants respectively. The research indicates that smartphone and technology based
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interventions implemented into a weight loss program have yielded positive weight loss and

increased activity results. However, further research is necessary to validate the intervention’s

success in other age populations.

Clinical Recommendations

The research suggests that the implementation of smartphone-based health/fitness

application can aid in increasing weight loss and physical activity. These interventions may be

implemented in conjunction with today’s traditional measures of weight loss and self-

monitoring, such as standard diet and exercise recommendations.

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References

American Heart Association. (2014). Obesity information. Retrieved March 04, 2017, from

http://www.heart.org/HEARTORG/HealthyLiving/WeightManagement/Obesity/Obesity-

Information_UCM_307908_Article.jsp

Aston G. (2014). Hospital ratchet up their obesity battle. Hospital Health Network, 88(7), 55-6

Martin, C. K., Miller, A. C., Thomas, D. M., Champagne, C. M., Han, H., & Church, T. (2015).

Efficacy of SmartLoss SM , a smartphone-based weight loss intervention: Results from a

randomized controlled trial. Obesity, 23(5), 935-942. doi:10.1002/oby.21063

Morenus, J. (2015). Weight Loss for the New Age. Retrieved April 01, 2017,

from http://nurse-practitioners-and-physician-

assistants.advanceweb.com/Features/Articles/Weight-Loss-for-the-New-Age.aspx

Svetkey, L. P., Batch, B. C., Lin, P., Intille, S. S., Corsino, L., Tyson, C. C., . . . Bennett, G. B.

(2015). Cell phone intervention for you (CITY): A randomized, controlled trial of

behavioral weight loss intervention for young adults using mobile technology. Obesity,

23(11), 2133-2141. doi:10.1002/oby.21226

Turner-Mcgrievy, G. M., Beets, M. W., Moore, J. B., Kaczynski, A. T., Barr-Anderson, D. J., &

Tate, D. F. (2013). Comparison of traditional versus mobile app self-monitoring of

physical activity and dietary intake among overweight adults participating in an mHealth

weight loss program. Journal of the American Medical Informatics Association, 20(3),

513-518. doi:10.1136/amiajnl-2012-001510