Abstract
Healthcare providers are often looking for ways to objectively monitor and improve their patients' health and fitness, especially in between patient visits. Some insurance companies are using applications data as incentives to improve health and lower premiums. As more and more people start to use smartphones, they may provide a tool to help improve a patient's health and fitness. Specifically, fitness applications or “apps” on smartphones are programs that use data collected from a smartphone's inbuilt tools, such as the Global Positioning System, accelerometer, microphone, speaker, and camera, to measure health and fitness parameters. The apps then analyze these data and summarize them, as well as devise individualized plans based on users' goals, provide frequent feedback, personalized coaching, and additional motivation by allowing milestones to be shared on social media. This article introduces evidence that apps can better help patients reach their health and fitness goals. It then discusses what features to look for in an app, followed by an overview of popular health and fitness apps. Last, patient scenarios with app recommendations, limitations of apps, and future research are discussed.
Keywords
Clinical Significance
- •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.
SEE RELATED COMMENTARY p. 5
1
Physical inactivity is a major cause of lack of fitness; according to the World Health Organization, approximately 31% of adults are insufficiently active, and approximately 3.2 million deaths each year are due to insufficient physical activity.2
World Health Organization. Physical inactivity: a global public health problem. Available at: http://www.who.int/dietphysicalactivity/factsheet_inactivity/en/. Accessed August 8, 2014.
Given that healthcare providers see their patients for only a brief moment of time, it is a challenge to motivate them to pursue health and fitness in between visits. Internet-based systems have been used to motivate patients to pursue fitness and seem to improve compliance.
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A review of internet-based physical activity interventions noted that 61% of studies reported significant increases in physical activity.4
With the rapid increase of smartphone use in recent years, a new way of monitoring and motivating patients to engage in health and fitness is taking shape.Smartphone users are able to download applications or “apps” to their devices. Apps are self-contained programs for smartphones designed to fulfill a particular purpose.
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Of the more than 1 million apps available, there are 23,490 and 17,756 “health and fitness” apps available on Apple iTunes (iOS) (Apple Inc, Cupertino, Calif) and Google Play (Android OS) (Google, Inc, Mountain View, Calif), respectively.Oxford University Press. Definition of app in English. Available at: http://www.oxforddictionaries.com/definition/english/app. Accessed August 8, 2014.
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, 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.
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, 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.
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This number continues to grow, with the use of health and fitness apps on Apple's iPhone and iPad having increased by 62% in 2014 compared with 33% for apps in general.9
Given that 58% of US adults own smartphones and 47% of those with a household income less than $30,000 have a smartphone, health and fitness apps may have great potential to reach those very populations with limited access to healthcare information and interventions.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.
10
, Pew Research Center. Mobile technology fact sheet. Available at: http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/. Accessed August 8, 2014.
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Most of the popular mobile health and fitness apps focus on fitness and self-monitoring.12
Fitness apps may represent another tool to assist healthcare providers in measuring health and fitness parameters, setting goals for patients, and helping patients achieve their goals.10
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
A search of the English-language scientific literature was performed primarily by searching MEDLINE, PubMed, Google Scholar, and Search for the time period 1976 to April 2015. Keywords used in the search included “smartphone,” “goals,” “apps,” “trainer,” “motivation,” “support,” “aerobic training,” “resistance training,” “healthy lifestyle,” “fitness,” “coach,” “obesity,” “weight,” “overweight,” “exercise,” “physical activity,” and “management.” The bibliographies of articles from these searches were also explored for relevant articles, and links on websites containing published articles were searched for pertinent information. A list of applications was collected on August 8, 2014, using the Power Search function of iTunes version 11.1.5.5 and the Google Play Store Version 4.9.13.
Identification, Eligibility, and Selection of Apps
An approach was chosen to identify preferred apps by using information from both the main smartphone app stores (iTunes and Google Play) and the independent reviews. First, the Apple App and Google Play stores under the “Health & Fitness” categories were reviewed on August 8, 2014. From the iTunes store, 30 apps were selected composed of the top 10 from each of the categories “Top Paid Apps, Top Free Apps, and Top Grossing.” From the Google Play store, 30 apps were selected composed of the top 10 from each of the categories “Top Paid, Top Free, and Top All Prices.” Second, for the independent reviews, the following sources were chosen from top ranking results after a Google search on August 8, 2014, using the key words “Best Fitness Apps Review 2014”: (1) “The 65 Best Health & Fitness Apps of 2014: 65 apps
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; (2) PC Magazine's “The 100 Best iPhone Apps of 2014—Health and Fitness”: 7 appsTeam TG. The 65 best health & fitness apps of 2014. Available at: http://greatist.com/fitness/best-health-fitness-apps. Accessed August 8, 2014.
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; and “The 100 Best Android Apps of 2014—Health and Fitness”: 7 appsDuffy J. The 100 best iPhone apps of 2014. Available at: http://www.pcmag.com/article2/0%2c2817%2c2393847%2c00.asp. Accessed August 8, 2014.
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; (3) Active.com “15 Best iPhone Fitness Apps for 2014”: 15 appsEddy M. The 100 best android apps of 2014. Available at: http://www.pcmag.com/article2/0,2817,2393101,00.asp. Accessed August 8, 2014.
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; (4) Men's Fitness “The Top 10 Fitness Apps for 2014”: 10 appsRosenzweig 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.
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; and (5) Business Insider “RANKED: The 13 Best Health And Fitness Apps”: 13 apps.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.
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Key criteria used by the top/best app lists included highly rated by users, unique, user-friendly, reliable, ability to grow and innovate, cost of app, and number of users logging into app via Facebook. Compiling the apps from all of the listed independent sources resulted in a total of 131 apps being identified.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.
Apps were only eligible if they (1) were available for both iOS and Android OS systems; (2) could be used by most adults (children, adolescents, gender, or pregnancy-specific apps were ineligible); and (3) involved a specific measure and intervention designed to improve some aspect of health and fitness (passive information only apps were ineligible). By using Excel PivotTable (Microsoft Corp, Redmond, Wash), apps that appeared in 2 or more independent lists were chosen, resulting in 19 apps. This search strategy is certainly subject to market response and may not reflect or provide evidence of efficacy or quality. However, because this is such a new field, there are few medical journal articles in the app area.
Smartphone Applications as Behavior Changers
Smartphone technology, including the Global Positioning System, accelerometer, microphone, speaker, and camera, has average-to-excellent accuracy to measure a range of physical activities and can generally differentiate static activities, stair use, cycling, walking, and running.
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This technology has made it possible for smartphone apps to monitor biological parameters, diabetes, cardiac rehabilitation, falls in the elderly, and physical activity.20
Smartphone apps have the capacity to facilitate behavior change.
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They have been adopted and used successfully by young adults to improve eating habits and physical activity.25
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Studies are ongoing to look at apps for older adults.20
Apps whose interventions include features such as goal-setting, rapid intention formation, performance measurement, self-monitoring, individually tailored feedback, goal reviewing, and progression have been associated with greater effectiveness.8
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Activity monitoring apps typically include goal-setting, self-monitoring, and feedback content that closely matches recommendations from social cognitive theory.31
One review of 57 popular physical activity apps noted that on average they included 5 behavior change interventions (range, 2-8), and this did not differ between free and paid apps.8
Others have found more behavior change interventions present in paid apps.30
Given that apps are a relatively new tool, there is limited medical research that has been conducted to date. However, several studies on smartphone app use to change health and fitness have been performed, and these are reviewed in the current article.
A meta-analysis involving 1350 subjects using mobile device interventions, including text messaging, smartphone apps, and self-reports, found the technology was an effective means for influencing physical activity behavior.
21
One study that was part of this meta-analysis noted that in initially underactive adults aged 50 years or more, those who received daily feedback, goal setting, and mobile device support significantly increased their moderate-vigorous physical activity by 178 minutes per week, compared with 80 minutes per week for the control group.32
An 8-week, open-label, randomized controlled trial in Ireland recruited 90 patients aged 16 years or more who were smartphone users and evaluated the effectiveness of app use on physical activity.
22
All participants were provided with similar physical activity goals and information on the benefits of exercise. The intervention group was provided with a smartphone app and detailed instructions on how to use it to achieve these goals. The primary outcome was change in physical activity, as measured by daily step count between baseline and follow-up. The difference in mean improvement in daily step count from week 1 to week 8 was 1029 (95% confidence interval, 214-1843) steps per day, favoring the intervention.In a study comparing a self-monitoring weight management intervention delivered by a smartphone app with a website and paper diary in 128 overweight volunteers, the app group adherence was significantly higher (mean, 92 days) compared with the website (mean, 35 days) or diary group (mean, 29 days) (P < .001).
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Mean weight change at 6 months was −4.6 kg, −2.9 kg, and −1.3 kg in the app, website, and diary groups, respectively. Another weight loss trial compared the mobile app for dietary self-monitoring and weight loss, “Lose It!,” (Lose It!, Boston, MA) with traditional diet counseling and entry methods in 47 overweight subjects.33
They noted that both the app group and the traditional group lost the same amount of weight over the 8-week trial.Another study looked at the feasibility of an app called “Persuasive Social Network for Physical Activity,” modeled on evidence-based health behavior change theories and strategies, as well as delivery of effective and innovative interventions.
34
The study enrolled 13 subjects, aged 24 to 45 years, with body mass index from 18.5 to 42.9 kg/m2, with the goal of increasing step count per day. Half of them were experienced with smartphones, and all were familiar with a social network system. After training, the app was able to be used by all. After 1 week, they unlocked the social networking feature allowing the users to share and compare with others in the trial. The addition of positive social support from social networks was shown to significantly increase the step count: Without the social support at baseline after 1 week, mean steps were 4202 per day compared with including the social feature, mean steps were 6352 per day.Basics of Health and Fitness Applications
Health and Fitness apps cover a wide range, including improving fitness activities, weight goals, nutrition and diet, sleep, relaxation, general healthcare information, pregnancy, and alternative medicine. Most fitness apps have a free trial/lite version that allows one to use basic features of the app and test whether it is relevant. The Pro version charges a 1-time fee or alternatively a subscription fee. Once the user has downloaded the app, basic data are required, such as gender, date of birth, weight, and height. The apps use combinations of the device's accelerometer, Global Positioning System, camera, diary, microphone, and speaker to gather data on the user during his/her activity. Some apps also synchronize wirelessly with other wearable devices, such as wristband sensor, heart rate sensor, belt sensor, shoe sensor, or more recently, smart clothing with wearable sensing technologies.
35
Some apps include an adventure storyline that the user gets immersed into, which distracts them while they get a moderate aerobic workout. Many apps have virtual coaches that can talk and inspire the user, and make them feel like someone is training them in a more personal way. Examples include providing the user with real-time data (on-screen/verbal split times), positive feedback (on-screen/verbal “Awesome! Way to go!,” or encouragement (on-screen/verbal “Keep Going! One more set!” “Hi. I'm Shalane Flanagan. I may have the record for the fastest American 5k, but that was an impressive run!”). The more popular apps have excellent illustrations and animations of the correct way to exercise, such as gym workouts on specific resistance weight machines or free weights, as well as running, jogging, bicycling, rowing, step aerobics, and X-training postures. Apps generally tabulate your data, such as energy output totals for your workouts, energy in for diet apps (taking pictures of food, scanning barcodes, estimates by user), total workout data (miles, speed, reps), body weight data, and sleep-quality data.
Lack of encouragement, support, or companionship from family and friends has been identified by the US Centers for Disease Control and Prevention as the major barrier to physical activity.
36
Apps that encourage social networking and sharing workout achievements, such as Fitocracy (1 million users; Fitocracy, New York, NY) and RunKeeper (23 million users; RunKeeper, Boston, MA), may help overcome these barriers.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.
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Currently, most health and fitness apps allow users to share their accomplishments with friends on social media (Facebook, Twitter, Pinterest, Instagram). The addition of positive social support from social networks can promote feedback and friendly competition, and amplify the smartphone applications' persuasive power.34
Most apps send summary statistics for the user to review and incorporate into his/her health and fitness data management program and may include weekly summaries and suggestions on new workouts and goals for the coming weeks.Things to Look for in Good Health and Fitness Applications
Important features of a good health and fitness app are as follows: has a user-friendly interface; offers a free trial version; is easy to initiate and reliable during activity; allows for goal setting; provides real-time personalized feedback; is customized to the user's skill and fitness level; has expert consultation available; incorporates evidence-based behavior change techniques; syncs with other health and fitness apps, devices (eg, Fitbit activity monitoring device; Fitbit Inc, San Francisco, Calif), and computers to allow easy review and sharing of statistics; supports social networking; and provides periodic summaries.
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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
Apps recommended in this article are based on both sales data (top selling) from the main smartphone app stores (iTunes and Google Play) and independent reviews that rank apps on the basis of criteria, including highly rated by users, unique, user-friendly, reliable, ability to grow and innovate, cost of app, and downloads. These recommended apps are summarized in categories represented by each letter in the word F-I-T-N-E-S-S and shown in Table 1 with their uses and prices, and key features are summarized in Table 2.
Table 1Recommended 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 |
∗ Lite version contains basic features of the app.
† Pro version contains complete features of the app.
Table 2Health and Fitness Applications
| 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
Several patient scenarios and recommended apps are shown in Table 3.
Table 3Patient Scenarios and Suggested Applications
| 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
Some of the limitations of using health and fitness apps are shown in Table 4.
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, Pew Research Center. Mobile technology fact sheet. Available at: http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/. Accessed August 8, 2014.
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Table 4Limitations of Smartphone Applications
| App Limitation |
|---|
|
How to Best Integrate Applications into Practice
Peter Drucker once said: “What gets measured gets managed.”
48
In this respect, the health care provider can first use apps to get an idea of various aspects of the patient's health and wellness, such as activity, dietary intake, medication compliance, and sleep patterns. Apps in addition to wearable devices and clothing can be a great way for these data to be gathered so that the patient and provider know what is actually taking place. Then, having these data, the provider can implement behavior changes and track the resulting changes using the apps. Finally, the app may provide an early warning system for when health and wellness are going off course. In the future, as communication and technology improve, there will likely be a more personalized/precision medicine approach whereby the patient can get advice from his/her provider via the app and query the provider on questions regarding specific health and wellness issues that arise.Future Directions in Health and Fitness Applications
The following are recommended:
- •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
Healthcare providers are always seeking ways to monitor and improve their patients' health and fitness, and smartphone applications may fill this niche. Health and fitness apps can help people with exercise, diet, weight management, stress relief, and sleep monitoring. In addition, the healthcare providers can learn about their patients' health and fitness activities via data summaries provided by the apps. Apps that incorporate evidence-based behavior change techniques are more likely to be effective. These apps also may serve as a handy tool to evaluate and motivate smartphone owners who have limited access to healthcare. More research is needed to objectively examine app effectiveness in changing patients' behaviors and improving their well-being. Health and fitness applications contain a wealth of behavior change techniques typically used in clinical behavioral interventions and may represent a medium by which these interventions could be translated for widespread use. This app technology has the potential for a wide range of uses, including clinical, preventive, public health, and rehabilitation settings.
References
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Article Info
Publication History
Published online: June 16, 2015
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: The author had access to the data and played a role in writing this manuscript.
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© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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