By Harold L. Karpman, MD, FACC, FACP
Clinical Professor of Medicine, UCLA School of Medicine
Dr. Karpman reports no financial relationships relevant to this field of study.
SYNOPSIS: Health and fitness apps currently available on many smartphones contain a wealth of behavior change techniques typically used in clinical behavior interventions and may represent a medium by which these interventions can be adjusted rapidly as needed.
SOURCE: Higgins JP. Smart phone applications for patients’ health and fitness. Am J Med 2016;129:11-19.
Physical inactivity is a major cause of poor fitness, according to the World Health Organization, which has concluded that 31% of adults are insufficiently active, contributing to 3.2 million deaths each year.1 The rapid increase of smartphone use in recent years has provided a new way of monitoring and motivating patients to engage in their health and fitness. Because of a chronic lack of time and inadequate physician/patient interaction, Internet-based systems may motivate patients to pursue fitness activities and improve health. As a result, 61% of recent studies have reported significant increases in physical activities among the general population often motivated by using smartphone applications.2
John Higgins from the Memorial Hermann Sports Medicine Institute of The University of Texas Health Science Center analyzed7 the growing use of health and fitness applications on Apple’s iPhone and iPad, which increased by 62% in 2014, compared with 33% for apps in general.3 Since most of the popular mobile health and fitness applications focus on fitness and self-monitoring,4 they offer an easy-to-use tool to assist healthcare providers in measuring health and fitness parameters, setting goals for patients, and, more importantly, helping patients achieve these goals.5 Higgins identified multiple preferred applications by using information from smartphone application stores (iTunes and Google Play) and from independent reviews. After careful analysis of all these data, he concluded that healthcare providers can learn about their patient’s health and fitness activities via data summaries provided by the applications. Additionally, these applications incorporate evidence-based behavior change techniques, which, if used properly, are more likely to be effective.
COMMENTARY
This extensive analysis of health and fitness applications has demonstrated that patients will benefit by improving exercise activities, diet control, weight management, stress relief, and sleep monitoring. Smartphone applications obviously will benefit patients who have only limited access to healthcare providers, but more research is needed to objectively evaluate if these applications are effective in changing behavior patterns and improving well-being in a significantly increased number of patients. Health and fitness apps contain a wealth of behavior change techniques typically used in clinical behavioral interventions and may represent a medium by which these interventions can be translated into widespread use. However, it is too early to say how effective their use will be in the general population.
Applications have potential value for a wide range of uses, including clinical treatment activities, prevention of disease, public health activities, and in rehabilitation settings. Long-term and large sample size randomized, controlled trials are needed to assess the safety and efficacy of the ever-increasing number of health and fitness applications. In addition, smartphone manufacturers will have to develop new features such as wireless sensor technology that can integrate into clothing, accessories, and/or the living environment to provide health and fitness information that one can acquire seamlessly and pervasively during daily living activities.6
Finally, medical device companies are developing devices such as an Internet-connected inhaler to treat chronic obstructive pulmonary disease. The inhaler will detect and report usage and other information and transmit data to a patient’s smartphone via a dedicated application, which will then transmit the data into the cloud. This data will permit patients to monitor their own health status and/or will allow treating physicians to monitor each patient’s adherence to the medications they take, which obviously is vital to their health outcomes and thereby will improve compliance. Healthcare providers can use cloud data to monitor vital symptoms and encourage patients to take their medications once they leave the hospital or the office. One of the effective ways to appropriately monitor congestive heart failure therapy is by weighing patients daily to check for excessive fluid retention, which, if it occurs, can be treated effectively.
In summary, we are at the dawn of a new technological era that will permit physicians to interact with their patients and with patients who do not have adequate healthcare using remote technology that almost certainly will continue to improve.
REFERENCES
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World Health Organization. Physical inactivity: A global public health problem. Available at: http://bit.ly/24UKgjh. Accessed Aug. 8, 2014.
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Joseph RP, et al. Internet-based physical activity interventions. Am J Lifestyle Med 2014;8:42-68.
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Dredge S. Health and fitness apps booming ahead of Apple’s iOS8 launch. Available at: http://bit.ly/1lGc98B. Accessed Aug. 8, 2014.
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Sama PR, et al. An evaluation of mobile health application tools. JMIR Mhealth Uhealth 2014;2:E19.
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Pew Research Center. Mobile technology fact sheet. Available at: http://pewrsr.ch/OotDJE. Accessed Aug. 8, 2014.
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Zheng YL, et al. Unobtrusive sensing and wearable devices for health informatics. IEEE Trans Biomed Eng 2014;61:1538-1554.
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Higgins JP. Smart phone applications for patients’ health and fitness. Am J Med 2016;129:11-19.
