Veterans Affairs Center for Clinical Management Research, Ann Arbor Healthcare System, Ann Arbor, MI, United States.
University of Michigan, Department of Family Medicine, Ann Arbor, MI, United States.
J Med Internet Res. 2020 Aug 4;22(8):e19216. doi: 10.2196/19216.
Though maintaining physical conditioning and a healthy weight are requirements of active military duty, many US veterans lose conditioning and rapidly gain weight after discharge from active duty service. Mobile health (mHealth) interventions using wearable devices are appealing to users and can be effective especially with personalized coaching support. We developed Stay Strong, a mobile app tailored to US veterans, to promote physical activity using a wrist-worn physical activity tracker, a Bluetooth-enabled scale, and an app-based dashboard. We tested whether adding personalized coaching components (Stay Strong+Coaching) would improve physical activity compared to Stay Strong alone.
The goal of this study is to compare 12-month outcomes from Stay Strong alone versus Stay Strong+Coaching.
Participants (n=357) were recruited from a national random sample of US veterans of recent wars and randomly assigned to the Stay Strong app alone (n=179) or Stay Strong+Coaching (n=178); both programs lasted 12 months. Personalized coaching components for Stay Strong+Coaching comprised of automated in-app motivational messages (3 per week), telephone-based human health coaching (up to 3 calls), and personalized weekly goal setting. All aspects of the enrollment process and program delivery were accomplished virtually for both groups, except for the telephone-based coaching. The primary outcome was change in physical activity at 12 months postbaseline, measured by average weekly Active Minutes, captured by the Fitbit Charge 2 device. Secondary outcomes included changes in step counts, weight, and patient activation.
The average age of participants was 39.8 (SD 8.7) years, and 25.2% (90/357) were female. Active Minutes decreased from baseline to 12 months for both groups (P<.001) with no between-group differences at 6 months (P=.82) or 12 months (P=.98). However, at 12 months, many participants in both groups did not record Active Minutes, leading to missing data in 67.0% (120/179) for Stay Strong and 61.8% (110/178) for Stay Strong+Coaching. Average baseline weight for participants in Stay Strong and Stay Strong+Coaching was 214 lbs and 198 lbs, respectively, with no difference at baseline (P=.54) or at 6 months (P=.28) or 12 months (P=.18) postbaseline based on administrative weights, which had lower rates of missing data. Changes in the number of steps recorded and patient activation also did not differ by arm.
Adding personalized health coaching comprised of in-app automated messages, up to 3 coaching calls, plus automated weekly personalized goals, did not improve levels of physical activity compared to using a smartphone app alone. Physical activity in both groups decreased over time. Sustaining long-term adherence and engagement in this mHealth intervention proved difficult; approximately two-thirds of the trial's 357 participants failed to sync their Fitbit device at 12 months and, thus, were lost to follow-up.
ClinicalTrials.gov NCT02360293; https://clinicaltrials.gov/ct2/show/NCT02360293.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/12526.
尽管保持身体状况和健康体重是现役军人的要求，但许多美国退伍军人在现役服务结束后会失去身体状况并迅速增重。使用可穿戴设备的移动健康 (mHealth) 干预措施对用户很有吸引力，并且特别可以通过个性化辅导支持来实现效果。我们开发了 Stay Strong，这是一款针对美国退伍军人的移动应用程序，通过腕戴式活动追踪器、蓝牙功能秤和基于应用程序的仪表板来促进身体活动。我们测试了添加个性化辅导组件（Stay Strong+Coaching）是否会比仅使用 Stay Strong 更能提高身体活动水平。
本研究的目的是比较 Stay Strong 单独使用与 Stay Strong+Coaching 联合使用 12 个月的结果。
参与者（n=357）是从最近战争的美国退伍军人的全国随机样本中招募的，并被随机分配到 Stay Strong 应用程序（n=179）或 Stay Strong+Coaching（n=178）；两个程序均持续 12 个月。Stay Strong+Coaching 的个性化辅导组件包括每周 3 条应用内自动激励消息、最多 3 次电话式人类健康辅导以及个性化每周目标设定。两组的注册流程和项目交付的所有方面都是通过虚拟方式完成的，除了电话式辅导。主要结果是在基线后 12 个月时的身体活动变化，通过 Fitbit Charge 2 设备记录的平均每周活跃分钟数来衡量。次要结果包括步数变化、体重变化和患者激活变化。
参与者的平均年龄为 39.8（SD 8.7）岁，25.2%（90/357）为女性。两组的活跃分钟数均从基线下降到 12 个月（P<.001），但在 6 个月（P=.82）或 12 个月（P=.98）时两组之间没有差异。然而，在 12 个月时，两组中有许多参与者都没有记录到活跃分钟数，导致 Stay Strong 的 67.0%（120/179）和 Stay Strong+Coaching 的 61.8%（110/178）数据缺失。Stay Strong 和 Stay Strong+Coaching 中参与者的平均基线体重分别为 214 磅和 198 磅，基线时没有差异（P=.54）或在 6 个月（P=.28）或 12 个月（P=.18）时也没有差异，因为行政体重的缺失率较低。记录的步数变化和患者激活变化也没有因手臂而异。
与单独使用智能手机应用程序相比，添加由应用内自动消息、最多 3 次辅导电话以及自动个性化每周目标组成的个性化健康辅导并未提高身体活动水平。两组的身体活动都随着时间的推移而减少。这项 mHealth 干预措施的长期坚持和参与证明是困难的；大约三分之二的 357 名试验参与者在 12 个月时未能同步他们的 Fitbit 设备，因此失去了随访。
ClinicalTrials.gov NCT02360293；https://clinicaltrials.gov/ct2/show/NCT02360293。
国际注册报告标识符（IRRID）：RR2-10.2196/12526。
