Spring Bonnie, Pellegrini Christine, McFadden H G, Pfammatter Angela Fidler, Stump Tammy K, Siddique Juned, King Abby C, Hedeker Donald
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States.
J Med Internet Res. 2018 Jun 19;20(6):e10528. doi: 10.2196/10528.
Prevalent co-occurring poor diet and physical inactivity convey chronic disease risk to the population. Large magnitude behavior change can improve behaviors to recommended levels, but multiple behavior change interventions produce small, poorly maintained effects.
The Make Better Choices 2 trial tested whether a multicomponent intervention integrating mHealth, modest incentives, and remote coaching could sustainably improve diet and activity.
Between 2012 and 2014, the 9-month randomized controlled trial enrolled 212 Chicago area adults with low fruit and vegetable and high saturated fat intakes, low moderate to vigorous physical activity (MVPA) and high sedentary leisure screen time. Participants were recruited by advertisements to an open-access website, screened, and randomly assigned to either of two active interventions targeting MVPA simultaneously with, or sequentially after other diet and activity targets (N=84 per intervention) or a stress and sleep contact control intervention (N=44). They used a smartphone app and accelerometer to track targeted behaviors and received personalized remote coaching from trained paraprofessionals. Perfect behavioral adherence was rewarded with an incentive of US $5 per week for 12 weeks. Diet and activity behaviors were measured at baseline, 3, 6, and 9 months; primary outcome was 9-month diet and activity composite improvement.
Both simultaneous and sequential interventions produced large, sustained improvements exceeding control (P<.001), and brought all diet and activity behaviors to guideline levels. At 9 months, the interventions increased fruits and vegetables by 6.5 servings per day (95% CI 6.1-6.8), increased MVPA by 24.7 minutes per day (95% CI 20.0-29.5), decreased sedentary leisure by 170.5 minutes per day (95% CI -183.5 to -157.5), and decreased saturated fat intake by 3.6% (95% CI -4.1 to -3.1). Retention through 9-month follow-up was 82.1%. Self-monitoring decreased from 96.3% of days at baseline to 72.3% at 3 months, 63.5% at 6 months, and 54.6% at 9 months (P<.001). Neither attrition nor decline in self-monitoring differed across intervention groups.
Multicomponent mHealth diet and activity intervention involving connected coaching and modest initial performance incentives holds potential to reduce chronic disease risk.
ClinicalTrials.gov NCT01249989; https://clinicaltrials.gov/ct2/show/NCT01249989 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT01249989).
普遍存在的不良饮食和缺乏身体活动会给人群带来慢性病风险。大幅度的行为改变可以将行为改善到推荐水平，但多种行为改变干预措施产生的效果较小且难以维持。
“做出更好选择2”试验测试了一种整合移动健康、适度激励和远程指导的多成分干预措施能否可持续地改善饮食和活动。
在2012年至2014年期间，这项为期9个月的随机对照试验招募了212名芝加哥地区的成年人，他们水果和蔬菜摄入量低，饱和脂肪摄入量高，中度至剧烈身体活动（MVPA）水平低，久坐休闲屏幕时间长。通过广告招募参与者到一个开放访问的网站，进行筛选，并随机分配到两种积极干预措施中的一种，一种是同时针对MVPA以及其他饮食和活动目标，另一种是在其他饮食和活动目标之后依次针对MVPA（每种干预措施84人），或者是压力和睡眠接触控制干预措施（44人）。他们使用智能手机应用程序和加速计来跟踪目标行为，并接受来自经过培训的辅助专业人员的个性化远程指导。完美的行为依从性会获得每周5美元的奖励，持续12周。在基线、3个月、6个月和9个月时测量饮食和活动行为；主要结果是9个月时饮食和活动综合改善情况。
同时干预和依次干预都产生了超过对照组的大幅、持续改善（P<0.001），并将所有饮食和活动行为提升到了指南水平。在9个月时，干预措施使每天的水果和蔬菜摄入量增加了6.5份（95%可信区间6.1 - 6.8），每天的MVPA增加了24.7分钟（95%可信区间20.0 - 29.5），久坐休闲时间每天减少了170.5分钟（95%可信区间 - 183.5至 - 157.5），饱和脂肪摄入量减少了3.6%（95%可信区间 - 4.1至 - 3.1）。9个月随访的保留率为82.1%。自我监测从基线时的96.3%下降到3个月时的72.3%，6个月时的63.5%，9个月时的54.6%（P<0.001）。各干预组之间的损耗率和自我监测的下降情况没有差异。
涉及联网指导和适度初始表现激励的多成分移动健康饮食和活动干预措施有潜力降低慢性病风险。
ClinicalTrials.gov NCT01249989；https://clinicaltrials.gov/ct2/show/NCT01249989（由WebCite存档于https://clinicaltrials.gov/ct2/show/NCT01249989）。
