Abstract
Keywords
- •Health and fitness applications or “apps” can help monitor and manage exercise, diet, weight, and sleep.
- •Apps, by providing rapid reliable feedback, may encourage people to achieve health and wellness goals, such as 10,000 steps a day, and gently remind them when they do not meet minimum goals.
- •Sharing app information on social media can result in friendly competition and camaraderie among strangers that may facilitate behavior change and improve well-being.
World Health Organization. Physical inactivity: a global public health problem. Available at: http://www.who.int/dietphysicalactivity/factsheet_inactivity/en/. Accessed August 8, 2014.
Oxford University Press. Definition of app in English. Available at: http://www.oxforddictionaries.com/definition/english/app. Accessed August 8, 2014.
Apple. iTunes Preview. App Store “Health & Fitness”. Available at: https://itunes.apple.com/us/genre/ios-health-fitness/id6013?mt=8&ls=1&v0=www-iphone-5s-appstore-health-fitness. Accessed August 8, 2014.
Google. Google Play. Android apps: health and fitness. Available at: https://play.google.com/store/apps/category/HEALTH_AND_FITNESS?hl=en. Accessed August 8, 2014.
Dredge S. Health and fitness apps booming ahead of Apple's iOS 8 launch. Available at: http://www.theguardian.com/technology/2014/jun/19/health-fitness-apps-apple-ios-8. Accessed August 8, 2014.
Pew Research Center. Mobile technology fact sheet. Available at: http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/. Accessed August 8, 2014.
Pew Research Center. Mobile technology fact sheet. Available at: http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/. Accessed August 8, 2014.
Materials and Methods
Background
Identification, Eligibility, and Selection of Apps
Team TG. The 65 best health & fitness apps of 2014. Available at: http://greatist.com/fitness/best-health-fitness-apps. Accessed August 8, 2014.
Duffy J. The 100 best iPhone apps of 2014. Available at: http://www.pcmag.com/article2/0%2c2817%2c2393847%2c00.asp. Accessed August 8, 2014.
Eddy M. The 100 best android apps of 2014. Available at: http://www.pcmag.com/article2/0,2817,2393101,00.asp. Accessed August 8, 2014.
Rosenzweig F. 15 Best iPhone fitness apps for 2014. Available at: http://www.active.com/fitness/articles/15-best-iphone-fitness-apps-for-2014. Accessed August 8, 2014.
Barroso M, Walkiewicz S. The top 10 fitness apps for 2014. Available at: http://www.mensfitness.com/life/gearandtech/the-top-10-fitness-apps-for-2014. Accessed August 8, 2014.
Borison R. RANKED: the 13 best health and fitness apps. Available at: http://www.businessinsider.com/13-best-health-and-fitness-apps-2014-7?op=1. Accessed August 8, 2014.
Smartphone Applications as Behavior Changers
Basics of Health and Fitness Applications
Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity. Overcoming barriers to physical activity. Available at: http://www.cdc.gov/physicalactivity/everyone/getactive/barriers.html. Accessed August 8, 2014.
Things to Look for in Good Health and Fitness Applications
Khan A. What to look for in a fitness app. Available at: http://health.usnews.com/health-news/health-wellness/articles/2014/07/18/what-to-look-for-in-a-fitness-app. Accessed August 8, 2014.
Recommended Health and Fitness Applications
Category | App Name | Use | Cost US$ |
---|---|---|---|
Fantasy | Zombies, Run! (Six to Start, London, UK) | Increase aerobic exercise (running, jogging) by providing an adventure mission to complete. Interval training, walking, jogging, and favorite songs also can be incorporated. | $3.99 |
Intense Cardio | Strava Running and Cycling (Strava, San Francisco, CA) | Tracks running and cycling. Users can compare their performance on social media with friends, professionals, and network locally to find popular places to run or ride. | Free lite, $5.99 Pro |
Nike+ Running (Nike Inc, Beaverton, OR) | Tracks indoor (treadmill) or outdoor running and coaches user to complete races (5 km to marathon). Provides in-run audio feedback of mile split metrics including time, miles, calories, elevation, average pace, and number of runs. | Free | |
RunKeeper | Tracks all aerobic exercises and weight loss. Synchronizes with 70 other apps, including Fitbit (Fitbit Inc, San Francisco, Calif), Fitocracy, and MyFitnessPal (MyFitnessPal Inc, San Francisco, CA), and synchronizes with devices (eg, Fitbit activity monitoring device). | Free lite, $9.99 Pro | |
Runtastic (Runtastic, San Francisco, CA) | Tracks running and other aerobic exercises (biking, walking), including interval training, target pace, and challenge running. It shows the users route on a map, provides 1-mile split times, distance, duration, speed, elevation change, and calories burned. | Free lite, $4.99 Pro | |
Tracking and Analytics | Map My Fitness (MapMyFitness Inc, Austin, TX) | Workout trainer with 600 exercises; tracks running, cycling, and calories (input and output). Synchronizes with heart rate, speed, cadence, and power sensors from CycleOps, Wahoo, Polar, Garmin, Fitbit, Nike+, and others. | Free lite, $2.99 Pro |
Fitbit | Tracks exercises, food intake, net calories, weight, and sleep. Provides weekly summaries to users featuring steps, miles, calories burned, calories consumed, and weight. | Free | |
Map My Run (MapMyFitness Inc, Austin, TX) | Tracks multiple aerobic and resistance exercises, including running, cycling, cardio, jogging, walking, and gym workouts. For outdoor activities, it provides pace, elevation, calories burned, and split-times. | Free lite, $2.99 Pro | |
Fitocracy | Tracks workouts and motivates through extensive social network sharing. Expert guidance with virtual coaches is available, and team fitness routines can be chosen. | Free | |
Net weight loss | Lose It! | Creates customized weight loss plan based on users' goals (weight, body fat, hydration, sleep, exercise, nutrients, hip/waist measurements). It accurately tracks food calories and calories burned with exercise. | Free lite, $39.99 Pro |
MyFitnessPal | Tracks food calorie intake by barcode scanner, and exercises can be entered to monitor net calories. It also tracks major nutrients (fat, protein, carbohydrates), sugar, fiber, and cholesterol. | Free | |
Noom Weight Loss Coach (Noom Inc, New York, NY) | Tracks energy in (food calories) and out (exercise), and provides evidence-based weight-loss strategies. Intelligent coaching keeps the user motivated with instant feedback, wellness articles, and healthy recipes daily appropriate for their goals. | Free lite, $9.99 Pro | |
Eating/diet | Fitocracy Macros (Fitocracy, New York, NY) | Separately tracks macronutrients in the diet (protein, fat, carbohydrates) to help user achieve dieting goals. Counts fiber, water, and alcohol, and can synchronize with Fitocracy, so it is also able to report energy expenditure. | Free |
Fooducate (Fooducate LTD, Hod Hasharon, IL) | Ranks overall nutrition value of food item from grade A (great) to D (avoid) and suggests alternative for unhealthy food choices. Customized to the user's age, gender, weight, height, activity level, desired weigh loss rate, diet goals, health conditions, and special diets (eg, gluten free, vegan, and allergens). | Free lite, $1.99 Pro | |
Sleep | Sleep Cycle alarm clock (Northcube AB, Göteborg, Sweden) | Tracks sleep quality and quantity, including sounds (snoring) and motion (restlessness); also optimizes wake-up interval. Users also can see how different daily activities (exercise, caffeine consumption, alcohol) affect their sleep. | $0.99 |
Specialized | Couch to 5K (Active Network LLC, San Diego, CA) | Takes a nonexerciser and prepares them to run a 5-km (3.1 mile) race in 3 mo. Includes a training plan, 4 different motivating virtual coaches, real human audio cues, together with their favorite playlists. | $1.99 |
Runtastic Six Pack Abs (Runtastic, San Francisco, CA) | Provides 20 core-strengthening exercises with the goal of 6-pack abdominals in 10 wk. Clearly shows the move and its components, explains it verbally, and the muscles being targeted in the workout are highlighted on screen. | Free lite, $4.99 Pro | |
Charity Miles (Charity Miles LLC, New York, NY) | Motivates more miles (walking, running, or cycling) as each mile results in money donation to charity of users' choice. They earn $0.10/mile for cycling and $0.25/mile for walking and running. | Free | |
WebMD (WebMD, New York, NY) | A basic medical encyclopedia of helpful tips for a patient regarding their medical condition and healthy lifestyle. Healthcare providers need to be aware that although the WebMD app self-diagnosis can provide a correct clinical diagnosis, it also provides a large number of differential diagnoses, some of which may be inappropriate. | Free |
App Name | Audio Cues | Barcode Scanning | Virtual Coaching | Diet Monitoring | Exercise Monitoring | Facebook/Twitter | Goal Setting | Music Playlist | Narrative Story | Progression | Sleep Monitoring | Sync with Other Apps | Sync with Other Devices | Tailored Feedback |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Zombies, Run! | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||
Strava Running and Cycling | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||
Nike+ Running | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||
RunKeeper | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
Runtastic | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||
Map My Fitness | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||
Fitbit | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||
Map My Run | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
Fitocracy | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||
Lose It! | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||
MyFitnessPal | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||
Noom Weight Loss Coach | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||
Fitocracy Macros | ✓ | ✓ | ✓ | ✓ | ✓ | |||||||||
Fooducate | ✓ | ✓ | ✓ | ✓ | ||||||||||
Sleep Cycle alarm clock | ✓ | ✓ | ||||||||||||
Couch to 5K | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||||||
Runtastic Six Pack Abs | ✓ | ✓ | ✓ | ✓ | ||||||||||
Charity Miles | ✓ | ✓ | ✓ | |||||||||||
WebMD | ✓ |
Patient Scenarios and Health and Fitness Applications Recommendations
Patient Scenario | Suggested App |
---|---|
Healthy patient wanting to start basic aerobic exercise | Fitbit, Couch to 5K, Zombies, Run!, Map My Fitness, Map My Run |
Healthy patient already exercising regularly looking to improve fitness or to enter a race | Strava Running and Cycling, Nike+ Running, RunKeeper, Runtastic |
Healthy patient wanting to focus on protein in his/her diet and build more lean muscle for resistance exercises | Fitocracy Macros, Fitocracy |
Healthy patient wanting to flatten his/her abdomen and improve back support | Runtastic Six Pack Abs |
Patient with hypertension wanting to start some exercise to reduce his/her cardiovascular risk | Fitbit, Map My Run |
Overweight patient with osteoarthritis wanting to lose weight and start exercising | Lose It!, Noom Weight Loss Coach, MyFitnessPal |
Gluten intolerant or vegan patient, or patient with food allergy wanting to lose weight | Fooducate |
Patient wanting to exercise and at the same time making a difference to the world | Charity Miles |
Overweight patient wanting to lose weight and consume healthier foods | Lose It!, MyFitnessPal, Noom Weight Loss Coach, Fooducate |
Patient wanting to learn more about his/her medical condition(s) and set some basic exercise goals | WebMD |
Patient with suspected sleep disorder | Sleep Cycle alarm clock |
Limitations of Using Health and Fitness Applications
Pew Research Center. Mobile technology fact sheet. Available at: http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/. Accessed August 8, 2014.
App Limitation |
---|
|
How to Best Integrate Applications into Practice
Future Directions in Health and Fitness Applications
- •Most research to date on changing behavior has found that interventions are more likely to be effective if they are based on behavior change theory models and specifically include features such as goal-setting, rapid intention formation, performance, self-monitoring, individually tailored feedback, goal-reviewing, and progression.8,27,28,29Health and fitness apps should contain some or all of these features and need to be tested with rigorous evidence-based research trials whose results are peer reviewed by independent experts to determine whether the app is safe and effective. In addition, apps should carry a standardized grade based on the listed features so potential users can quickly assess the suitability.
- •Long-term and large sample size randomized control trials in the outpatient setting are required to assess the safety and efficacy of health and fitness apps, and should include heterogeneous participants in terms of age, gender, socioeconomic status, personality type, smartphone, and social networking experience.
- •Apps currently lack an emphasis on evidence-based and medical professional involvement.49For them to be effective and more user-friendly, these features should be incorporated.
- •Apps need to keep up with ongoing developments of smartphone and wireless sensor technology to provide more accurate data. Sensors are being developed that can be woven or integrated into clothing, accessories, and the living environment, such that health and fitness information can be acquired seamlessly and pervasively in daily living.35Such sensors may provide more objective and accurate data on health and fitness to the smartphones, and apps may be better able to prescribe activities that will improve the user's health and fitness.
- •The ability of apps to run within apps so that multiple features and data sharing can occur will likely be a feature of newer-generation smartphones that will provide a more complete overall health and fitness summary for the user.
- •The development of health informatics and apps that deal with the acquisition, transmission, processing, storage, retrieval, and use of health information is needed. This may promote better transparency between the health and fitness app users and their medical provider.35
- •New medical mobile device (mHealth) applications are being developed that will revolutionize how the healthcare industry interacts with patients and create virtual health records that can be accessed worldwide.50
- •Development of security and privacy for app users and healthcare providers: Most apps lack privacy policies, and those that do are not transparent.51
- •Development of apps incorporating more game design or fun tricks to engage users more, while getting them to achieve goals, may improve user app compliance.52
Farr C, Nayak M. New health apps, games reward patients who take their meds. Available at: http://in.reuters.com/article/2014/08/15/mobilephone-health-idINKBN0GF02L20140815. Accessed August 8, 2014.
- •Development of a single powerful “super app” that covers all major aspects of health and fitness, thus eliminating the need for sync between various specialized apps.
Conclusions
References
- Self-reported health, self-reported fitness, and all-cause mortality: prospective cohort study.Br J Health Psychol. 2010; 15: 337-346
World Health Organization. Physical inactivity: a global public health problem. Available at: http://www.who.int/dietphysicalactivity/factsheet_inactivity/en/. Accessed August 8, 2014.
- Evaluation of a website-delivered computer-tailored intervention for increasing physical activity in the general population.Prev Med. 2007; 44: 209-217
- Internet-based physical activity interventions.Am J Lifestyle Med. 2014; 8: 42-68
Oxford University Press. Definition of app in English. Available at: http://www.oxforddictionaries.com/definition/english/app. Accessed August 8, 2014.
Apple. iTunes Preview. App Store “Health & Fitness”. Available at: https://itunes.apple.com/us/genre/ios-health-fitness/id6013?mt=8&ls=1&v0=www-iphone-5s-appstore-health-fitness. Accessed August 8, 2014.
Google. Google Play. Android apps: health and fitness. Available at: https://play.google.com/store/apps/category/HEALTH_AND_FITNESS?hl=en. Accessed August 8, 2014.
- Apps to promote physical activity among adults: a review and content analysis.Int J Behav Nutr Phys Act. 2014; 11: 97
Dredge S. Health and fitness apps booming ahead of Apple's iOS 8 launch. Available at: http://www.theguardian.com/technology/2014/jun/19/health-fitness-apps-apple-ios-8. Accessed August 8, 2014.
Pew Research Center. Mobile technology fact sheet. Available at: http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/. Accessed August 8, 2014.
- The implications of megatrends in information and communication technology and transportation for changes in global physical activity.Lancet. 2012; 380: 282-293
- An evaluation of mobile health application tools.JMIR Mhealth Uhealth. 2014; 2: e19
Team TG. The 65 best health & fitness apps of 2014. Available at: http://greatist.com/fitness/best-health-fitness-apps. Accessed August 8, 2014.
Duffy J. The 100 best iPhone apps of 2014. Available at: http://www.pcmag.com/article2/0%2c2817%2c2393847%2c00.asp. Accessed August 8, 2014.
Eddy M. The 100 best android apps of 2014. Available at: http://www.pcmag.com/article2/0,2817,2393101,00.asp. Accessed August 8, 2014.
Rosenzweig F. 15 Best iPhone fitness apps for 2014. Available at: http://www.active.com/fitness/articles/15-best-iphone-fitness-apps-for-2014. Accessed August 8, 2014.
Barroso M, Walkiewicz S. The top 10 fitness apps for 2014. Available at: http://www.mensfitness.com/life/gearandtech/the-top-10-fitness-apps-for-2014. Accessed August 8, 2014.
Borison R. RANKED: the 13 best health and fitness apps. Available at: http://www.businessinsider.com/13-best-health-and-fitness-apps-2014-7?op=1. Accessed August 8, 2014.
- Measuring and influencing physical activity with smartphone technology: a systematic review.Sports Med. 2014; 44: 671-686
- Effectiveness of a smartphone application for improving healthy lifestyles, a randomized clinical trial (EVIDENT II): study protocol.BMC Public Health. 2014; 14: 254
- Increasing physical activity with mobile devices: a meta-analysis.J Med Internet Res. 2012; 14: e161
- Effectiveness of a smartphone application to promote physical activity in primary care: the SMART MOVE randomised controlled trial.Br J Gen Pract. 2014; 64: e384-e391
- Adherence to a smartphone application for weight loss compared to website and paper diary: pilot randomized controlled trial.J Med Internet Res. 2013; 15: e32
- Exergames for health and fitness: the roles of GPS and geosocial apps.Int J Health Geogr. 2013; 12: 18
- Smart phones are useful for food intake and physical activity surveys.Conf Proc IEEE Eng Med Biol Soc. 2009; 2009: 5183-5186
- Social networking strategies that aim to reduce obesity have achieved significant although modest results.Health Aff (Millwood). 2014; 33: 1641-1647
- A taxonomy of behavior change techniques used in interventions.Health Psychol. 2008; 27: 379-387
- Interventions to increase physical activity among healthy adults: meta-analysis of outcomes.Am J Public Health. 2011; 101: 751-758
- Remote and web 2.0 interventions for promoting physical activity.Cochrane Database Syst Rev. 2013; : CD010395
- Do physical activity and dietary smartphone applications incorporate evidence-based behaviour change techniques?.BMC Public Health. 2014; 14: 646
- Behavior change techniques implemented in electronic lifestyle activity monitors: a systematic content analysis.J Med Internet Res. 2014; 16: e192
- Promoting physical activity through hand-held computer technology.Am J Prev Med. 2008; 34: 138-142
- Dietary self-monitoring, but not dietary quality, improves with use of smartphone app technology in an 8-week weight loss trial.J Nutr Educ Behav. 2014; 46: 440-444
- A persuasive and social mHealth application for physical activity: a usability and feasibility study.JMIR Mhealth Uhealth. 2014; 2: e25
- Unobtrusive sensing and wearable devices for health informatics.IEEE Trans Biomed Eng. 2014; 61: 1538-1554
Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity. Overcoming barriers to physical activity. Available at: http://www.cdc.gov/physicalactivity/everyone/getactive/barriers.html. Accessed August 8, 2014.
- Online social networks that connect users to physical activity partners: a review and descriptive analysis.J Med Internet Res. 2014; 16: e153
Khan A. What to look for in a fitness app. Available at: http://health.usnews.com/health-news/health-wellness/articles/2014/07/18/what-to-look-for-in-a-fitness-app. Accessed August 8, 2014.
- Face-to-face versus remote and web 2.0 interventions for promoting physical activity.Cochrane Database Syst Rev. 2013; : CD010393
- Need to peer-review medical applications for smart phones.J Telemed Telecare. 2012; 18: 124
- Development and implementation of a smartphone application to promote physical activity and reduce screen-time in adolescent boys.Front Public Health. 2014; 2: 42
- The relationship between cell phone use, physical and sedentary activity, and cardiorespiratory fitness in a sample of U.S. college students.Int J Behav Nutr Phys Act. 2013; 10: 79
- Where there's an app, there's a way?.Am J Prev Med. 2011; 40: 390-391
- Behavior change techniques in top-ranked mobile apps for physical activity.Am J Prev Med. 2014; 46: 649-652
- Examining the use of evidence-based and social media supported tools in freely accessible physical activity intervention websites.Int J Behav Nutr Phys Act. 2014; 11: 105
- Desired features of smartphone applications promoting physical activity.Telemed J E Health. 2011; 17: 801-803
- Evaluating user perceptions of mobile medication management applications with older adults: a usability study.JMIR Mhealth Uhealth. 2014; 2: e11
- Beyond the IT productivity paradox.European Management Journal. 1996; 14: 279-290
- Smartphone breast applications–what's the evidence?.Breast. 2014; 23: 683-689
- mHealth 2.0: experiences, possibilities, and perspectives.JMIR Mhealth Uhealth. 2014; 2: e24
- Availability and quality of mobile health app privacy policies.J Am Med Inform Assoc. 2015; 22: e28-e33
Farr C, Nayak M. New health apps, games reward patients who take their meds. Available at: http://in.reuters.com/article/2014/08/15/mobilephone-health-idINKBN0GF02L20140815. Accessed August 8, 2014.
Article Info
Publication History
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: The author had access to the data and played a role in writing this manuscript.
Identification
Copyright
ScienceDirect
Access this article on ScienceDirectLinked Article
- Suicide Prevention by SmartphoneThe American Journal of MedicineVol. 129Issue 8
- PreviewBeyond the benefit of apps for promoting health and fitness,1 smartphone-based life-alert technology might be adapted to reduce suicide, which is the only cause of death among the top 10 in the US for which age-adjusted mortality rates increased between 2005 and 2012.2 The recently identified higher frequency of suicide following discharge from inpatient psychiatric treatment warrants approaches beyond those in usual and customary practice.3-6
- Full-Text
- Preview