Internet and mobile interventions are effective for lifestyle behavior modification, according to a systematic review published in the Journal of the American Heart Association.
Ashkan Afshin, MD, MPH, ScD, of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, and colleagues identified 224 relevant interventional and prospective observational studies published between 1990 and 2013, using American Heart Association criteria to determine the strength of evidence.
Lifestyle targets included diet, physical activity, adiposity, and tobacco or alcohol use. The researchers found that while numerous interventions including Internet applications, mobile phones, pedometers, accelerometers, and standalone computer software were used, Internet and mobile interventions were most commonly employed.
In studies and randomized controlled trials that measured changes in diet and adiposity as a result of Internet intervention, duration of the interventions typically lasted between 6 weeks and 6 months. The researchers found that 24 out of 35 studies reported significant improvement in adiposity; after 6 months of follow-up, weight reductions ranged from 1 kg to 6 kg. Internet interventions were found to be more effective when combined with in-person counseling as opposed to alone (–1.93 kg; 95% confidence interval [CI]: –2.71 to –1.15 kg vs –0.19 kg; 95% CI: –0.87 to 0.49). Similar results were seen in mobile interventions as well as the combined Internet/mobile intervention studies.
Most physical activity interventions also lasted between 6 weeks and 6 months. Of the Internet intervention studies, 29 out of 33 reported significant improvement. However, there was a wide variation in effect sizes. In studies that measured duration of physical activity, the effect size ranged from 1.5 to 153 minutes per week. In studies that measured frequency of physical activity, the effect sizes ranged from 1 to 1.2 days per week.
Dr Afshin and colleagues also evaluated studies and trials that used personal sensor (pedometer) interventions, either alone or with educational materials, classes, or behavior change techniques. Nearly 80% of these studies reported significant positive effects, including a step count increase from baseline between 900 to 4500 steps per day. These improvements included 97 minutes per week increase in “leisure-time physical activity,” 32% reduction in sedentary participants, 95 minutes per day reduction in sitting time, and a 2-day per week increase in walking days.
In studies that measured the effect of Internet interventions on tobacco use, 17 out of 22 reported a significant increase in abstinence. At 6 months, the odds ratio for 7-day abstinence ranged from 1.6 (95% CI: 1.1-2.4) in an Internet worksite program in the United States to 2.7 (95% CI: 1.8-4.0) in an email counseling program in Switzerland. However, in mobile interventions (eg, text-messaging smoking cessation programs), only 2 of 6 studies reported significant changes with a 7-day abstinence odds ratio ranging between 1.3 (95% CI: 1.2-1.5) in a UK-based study to 2.2 (95% CI: 1.8-2.7) in a New Zealand-based study.
Of the 47 studies that assessed the effect of Internet interventions on excessive alcohol use, 39 reported a significant decrease; of the 41 randomized controlled trials included in the study, 34 reported statistically significant benefits. Similar to the studies that assessed improvements in physical activity, alcohol use studies also had a wide range of effect sizes.
In one study, a 63% reduction in weekly alcohol use was seen after a 3-month intervention. Another study found a 50% reduction in days of heavy drinking in veterans who tested positive for “alcohol misuse” at 6-month follow-up. A study evaluating “risky drinkers” identified an average 7 drinks reduction in mean weekly drinking at 3-month follow-up. The odds ratios for drinking within the recommended limit ranged from 1.7 to 3.7 in studies that evaluated benefits and used compliance with said recommendation as an outcome.
Researchers pointed out that the brief durations (≤1 year) of these interventions may be a limitation for their analysis, as well as the fact that most studies were conducted in higher-income areas of the world. Individuals in these studies may have been more motivated and educated compared with the general public, Dr Afshin and colleagues wrote. In fact, even in this patient population, adherence declined during follow-up in many studies.
Also, as one might expect, interventions were more successful when healthcare providers interacted with their patients, with the smoking cessation programs being one of the prime examples.
Afshin A, Babalola D, McLean M, et al. Information technology and lifestyle: a systematic evaluation of internet and mobile interventions for improving diet, physical activity, obesity, tobacco, and alcohol use. J Am Heart Assoc. 2016;5. doi:10.1161/JAHA.115.003058.