Internet and mobile interventions may increase healthy behaviors

Most people spend hours each day searching the internet and using mobile phones for work or for pleasure. Those activities may also benefit them in maintaining a healthier lifestyle.

A systematic review of 224 studies found that internet interventions helped improve people’s poor diet, lack of physical activity, adiposity, tobacco use and excess alcohol consumption. Meanwhile, mobile interventions such as receiving text messages and using smartphone applications were effective at improving physical activity and adiposity.

Lead researcher Ashkan Afshin, MD, MPH, MSc, ScD, of the University of Washington in Seattle, and colleagues published their results online in the Journal of the American Heart Association on Aug. 31.

“Programs that have components such as goal-setting and self-monitoring and use multiple modes of communication with tailored messages tended to be more effective,” Afshin said in a news release. “We also found these programs were more effective if they included some interactions with healthcare providers.”

The researchers mentioned that a poor diet, physical inactivity, tobacco use, adiposity and excessive alcohol use were major cause of noncommunicable diseases (NCDs), which accounted for 65 percent of deaths worldwide in 2010. They added that internet and mobile interventions were promising because of their low cost, use in multiple settings and opportunities to easily modify and improve them.

For this analysis, the researchers searched the PubMed database for randomized and quasi-experimental trials and prospective observational cohort studies that evaluated the effect of technologies on diet habits, adiposity, physical inactivity, smoking cessation and excessive alcohol use among adults.

They identified 224 relevant reports among healthy adults that were published between January 1990 and November 2003.

Of the 35 studies that evaluated Internet interventions and adiposity, 69 percent showed significant improvements after the interventions. In addition, 70 percent of studies found significant dietary improvements following an Internet-based diet intervention.

Further, two of the three studies evaluating adiposity and mobile interventions found that adiposity improved, while 81 percent of the studies that combined internet and mobile interventions showed a significant reduction in adiposity.

Meanwhile, 88 percent of Internet interventions reported a significant improvement in physical activity, while 79 percent of studies that evaluated pedometers alone or with educational materials, classes or behavioral change techniques had significant positive effects.

More than 80 percent of the studies also reported a significant increase in tobacco abstinence following internet interventions, although only two of seven mobile interventions significantly improved tobacco abstinence.

Only 34 percent of internet interventions decreased alcohol use, but 83 percent of the randomized trials had significant decreases in alcohol use among patients who had the internet interventions.

The lack of long-term studies lasting more than six months may limit the generalizability of the findings, according to the researchers. They also noted that most studies were in high-income countries and enrolled volunteers who were more motivated and educated than the general public. In addition, they mentioned that most studies with a follow-up period of more than three months had low adherence rates.

As of now, most policies trying to improve population lifestyle behaviors focus on mass media and school-based programs, according to the researchers. However, some initiatives such as the U.S. National Physical Activity Plan have adopted newer technologies.

“Considering the strength of the evidence, our findings suggest that the application and testing of novel information and communication technologies should be greatly expanded,” the researchers wrote. “Our systematic review supports the effectiveness of Internet and mobile interventions to improve lifestyle and reduce NCD risk factors. Our findings also highlight the need for greater evaluation of long-term effectiveness, sustainability, and assessment of utility in more diverse population subgroups.”