Future Work

• The EAMS interventions studied in this review demonstrated ability to increase PA and decrease weight. Though comparisons to other interventions produced equivocal results, effect sizes suggest potentially clinically significant outcomes

• The limitations of this study include:

• A chance that not all relevant articles were captured

• This review does not reflect the current state of EAMS due to quickly changing technology

• Could not conduct a meta-analysis due to heterogeneity

• First systematic review on EAMS research and outlines steps for future research.Methods

• Articles were collected from CINAHL, Cochrane CENTRAL, Medline Ovid, and PsychINFO databases, clinical trial registry (clinicaltrials.gov), and reference searching

• Two investigators screening articles for eligibility

Using an electronic activity monitor system as an intervention modality: A systematic reviewZakkoyya H. Lewis1,2, Elizabeth J. Lyons1,3,4, Jessica M. Jarvis1,2, Jacques G. Baillargeon2,5

1Division of Rehabilitation Sciences 2Department of Preventative Medicine & Community Health 3 Department of Nutrition and Metabolism 4 Center for Interdisciplinary Research in Women’s Health 5UTMB, Division of

Epidemiology and Outcomes, Correctional Managed

ResultsBackground• Technology is commonly used to combat obesity,

but an electronic activity monitor system (EAMS) is not yet evaluated.

• EAMSs are defined as a wearable device that objectively measures lifestyle physical activity and can provide feedback, beyond the display of basic activity count information, via the monitor display or through a partnering application to elicit continual self-monitoring of activity behavior.

• Study Aim: synthesize the efficacy results and feasibility of an EAMS within a physical activity intervention.

References1Barwais F, Cuddihy T, Tomson L: Physical activity, sedentary behavior and total wellness changes among sedentary adults: A 4-week randomized controlled trial. In Health and quality of life outcomes, vol. 11; 2013.2Fitzsimons CF, Kirk A, Baker G, Michie F, Kane C, Mutrie N: Using an individualised consultation and activPAL feedback to reduce sedentary time in older Scottish adults: results of a feasibility and pilot study. Preventive Medicine 2013, 57:718-720. 3Hurling R, Catt M, Boni M, Fairley B, Hurst T, Murray P, Richardson A, Sodhi J: Using internet and mobile phone technology to deliver an automated physical activity program: randomized controlled trial. In Journal of medical Internet research, vol. 9. pp. e7; 2007:e7. 4Pellegrini CA, Verba SD, Otto AD, Helsel DL, Davis KK, Jakicic JM: The comparison of a technology-based system and an in-person behavioral weight loss intervention. Obesity (Silver Spring) 2012, 20:356-363.5Polzien KM, Jakicic JM, Tate DF, Otto AD: The efficacy of a technology-based system in a short-term behavioral weight loss intervention. Obesity (Silver Spring) 2007, 15:825-830. 6Reijonsaari K, Vehtari A, Kahilakoski O, Mechelen W, Aro T, Taimela S: The effectiveness of physical activity monitoring and distance counseling in an occupational setting - results from a randomized controlled trial (CoAct). In BMC public health, vol. 12. pp. 344; 2012:344. 7Shuger SL, Barry VW, Sui X, McClain A, Hand GA, Wilcox S, Meriwether RA, Hardin JW, Blair SN: Electronic feedback in a diet- and physical activity-based lifestyle intervention for weight loss: a randomized controlled trial. Int J Behav Nutr Phys Act 2011, 8:41. 8Slootmaker SM, Chinapaw MJ, Schuit AJ, Seidell JC, Van Mechelen W: Feasibility and effectiveness of online physical activity advice based on a personal activity monitor: randomized controlled trial. Journal of Medical Internet Research 2009, 11:e27. 9Tabak M, Op dAH, Hermens H: Motivational cues as real-time feedback for changing daily activity behavior of patients with COPD. In Patient education and counseling, vol. 94. pp. 372-378; 2014:372-378. 10Thompson WG, Kuhle CL, Koepp GA, McCrady-Spitzer SK, Levine JA: "Go4Life" exercise counseling, accelerometer feedback, and activity levels in older people. Arch Gerontol Geriatr 2014, 58:314-319. 11Thorndike AN: Be Fit in Residency: a Randomized Controlled Trial of an Activity Device Among Medicine Residents. clinicaltrials.gov: Massachusetts General Hospital; 2012.

• The 11 studies included 1,272 participants with a mean age ranging from 27 to 79 years.

• Most of the studies were found to be of medium quality1,2,3,4,5,6,9,10, two studies were low quality8,11, and one was of high quality7.

• Gruve (Gruve Solution™ MUVE, Inc., USA)1, activPAL (PAL Technologies Ltd., Glasgow, Scotland)2, Bluetooth Actiwatch3, Sense Wear armband (BodyMedia, Pittsburgh PA)4,5,7, PAM (model AM 200/model AM 101, PAM BV, the Netherlands)6,8, MTx-W sensor (Xsens Technologies, Enschese, The Netherlands)9, and Fitbit (Fitbit, San Francisco, CA)10,11 devices were used in the studies.

• 5 reported significant pre-post intervention differences1,2,3,4,5, and 1 reported a significant increase compared to the control group3.

• 4 reported significant decreases over time4,5,7,10, and 2 reported significant differences between the EAMS group and another intervention or control group5,7.

• EAMS interventions appear to be feasible with most studies reporting continual wear of the device during waking hours and a higher retention rate of participants in the EAMS groups.

EAMS examples

Screening Process

Funding for this project was provided by a beginning grant-in-aid from the American Heart Association (13BGIA17110021). Dr. Lyons was additionally supported by a research career development award (K12HD052023: Building Interdisciplinary Research Careers in Women’s Health Program –BIRCWH) from ORWH, OD, NIAID, and NICHD (National Institutes of Health) and a Mentored Research Scholar Grant in Applied and Clinical Research, MRSG-14-165-01-CPPB, from the American Cancer Society. This study was conducted with the support of the Institute for Translational Sciences, supported in part by a Clinical and Translational Science Award (UL1TR000071) from the National Center for Advancing Translational Sciences. The UTMB Claude D. Pepper Older Americans Independence Center (P30AG024832) also provided support.Conclusion

• There are several gaps within the literature. We suggest several strategies to produce more rigorous research in order to evaluate an EAMS’ effectiveness.

• Behavioral Change Techniques: EAMSs provide proven behavioral change techniques and have the potential to change behavior. The rationale for using these devices follow different behavior change theories and different versions of devices offer different techniques. Authors should explicitly discuss EAMS version, theoretical rationale, and the implemented behavioral change techniques.

• Theoretical Framework: There are several different components within an EAMS that can make them effective. In order to evaluate which components result in physical activity change authors should maximize the potential of EAMSs by using all their components and provide more in-depth process evaluations

• Study Design: In order to aggregate data quantitatively and move research forward, studies should:

• Be sufficiently powered

• Conduct follow-up assessments

• Objectively measure physical activity

• Include diverse populations

• Complete analyses of cost-effectiveness and public health impact