Mobile health interventions to promote physical activity and reduce sedentary behaviour in the workplace: A systematic review

Objective This systematic review aimed to assess the effectiveness, feasibility and acceptability of mobile health (mHealth) technology (including wearable activity monitors and smartphone applications) for promoting physical activity (PA) and reducing sedentary behaviour (SB) in workplace settings. Methods Systematic searches were conducted in seven electronic databases (MEDLINE, SPORTDiscus, Scopus, EMBASE, PsycINFO, Web of Science and the Cochrane library). Studies were included if mHealth was a major intervention component, PA/SB was a primary outcome, and participants were recruited and/or the intervention was delivered in the workplace. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. Interventions were coded for behaviour change techniques (BCTs) using the Coventry, Aberdeen and London – Refined (CALO-RE) taxonomy. Results Twenty-five experimental and quasi-experimental studies were included. Studies were highly heterogeneous and only one was rated as ‘strong’ methodological quality. Common BCTs included self-monitoring, feedback, goal-setting and social comparison. A total of 14/25 (56%) studies reported a significant increase in PA, and 4/10 (40%) reported a significant reduction in sedentary time; 11/16 (69%) studies reported a significant impact on secondary outcomes including reductions in weight, systolic blood pressure and total cholesterol. While overall acceptability was high, a large decline in technology use and engagement was observed over time. Conclusions While methodological quality was generally weak, there is reasonable evidence for mHealth in a workplace context as a feasible, acceptable and effective tool to promote PA. The impact in the longer term and on SB is less clear. Higher quality, mixed methods studies are needed to explore the reasons for decline in engagement with time and the longer-term potential of mHealth in workplace interventions. Protocol registration: The review protocol was registered with PROSPERO: CRD42017058856

[1]  Nicholas D. Gilson,et al.  Measuring and Influencing Physical Activity with Smartphone Technology: A Systematic Review , 2014, Sports Medicine.

[2]  P. Côté,et al.  Are workplace health promotion programs effective at improving presenteeism in workers? a systematic review and best evidence synthesis of the literature , 2011, BMC public health.

[3]  A. Thorndike,et al.  Activity Monitor Intervention to Promote Physical Activity of Physicians-In-Training: Randomized Controlled Trial , 2014, PloS one.

[4]  S. Michie,et al.  A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy , 2011, Psychology & health.

[5]  Donna Spruijt-Metz,et al.  Current mHealth technologies for physical activity assessment and promotion. , 2013, American journal of preventive medicine.

[6]  A. Bandura Self-Efficacy: The Exercise of Control , 1997, Journal of Cognitive Psychotherapy.

[7]  Adrià Muntaner,et al.  Increasing physical activity through mobile device interventions: A systematic review , 2016, Health Informatics J..

[8]  C. Gotay,et al.  Feasibility of a telephone and web-based physical activity intervention for women shift workers , 2017, Translational behavioral medicine.

[9]  M. Petticrew,et al.  Developing and evaluating complex interventions: the new Medical Research Council guidance , 2008, BMJ : British Medical Journal.

[10]  T. Dwyer,et al.  Objectively Measured Daily Steps and Subsequent Long Term All-Cause Mortality: The Tasped Prospective Cohort Study , 2015, PloS one.

[11]  Lora Giangregorio,et al.  Behavior Change Techniques Present in Wearable Activity Trackers: A Critical Analysis , 2016, JMIR mHealth and uHealth.

[12]  B. Fjeldsoe,et al.  Organizational-Level Strategies With or Without an Activity Tracker to Reduce Office Workers’ Sitting Time: Rationale and Study Design of a Pilot Cluster-Randomized Trial , 2016, JMIR research protocols.

[13]  S. Pedersen,et al.  An e-health intervention designed to increase workday energy expenditure by reducing prolonged occupational sitting habits. , 2014, Work.

[14]  W. Brown,et al.  A Brief Self-Directed Intervention to Reduce Office Employees’ Sedentary Behavior in a Flexible Workplace , 2018, Journal of occupational and environmental medicine.

[15]  C. A. Jones Examining the efficacy and feasibility of digital activity monitors and shared active desks to reduce employee sedentary behavior , 2016 .

[16]  B. H. Thomas,et al.  A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. , 2004, Worldviews on evidence-based nursing.

[17]  A. Koyle The value of infusing self-efficacy theory with smartphone technology to sustain walking for exercise in a worksite population , 2013 .

[18]  J. Seeley,et al.  Get Moving: A Web Site That Increases Physical Activity of Sedentary Employees , 2011, American journal of health promotion : AJHP.

[19]  Genevieve N Healy,et al.  Prolonged sitting: is it a distinct coronary heart disease risk factor? , 2011, Current opinion in cardiology.

[20]  S. Wannamethee,et al.  Physical Activity in the Prevention of Cardiovascular Disease , 2001, Sports medicine.

[21]  Alberto M. Segre,et al.  Gamifying Accelerometer Use Increases Physical Activity Levels of Sedentary Office Workers , 2018, Journal of the American Heart Association.

[22]  G. Cummings,et al.  Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. , 2012, Journal of evaluation in clinical practice.

[23]  Willem Van Mechelen,et al.  Feasibility and Effectiveness of Online Physical Activity Advice Based on a Personal Activity Monitor: Randomized Controlled Trial , 2009, Journal of medical Internet research.

[24]  Aki Vehtari,et al.  The effectiveness of physical activity monitoring and distance counselling in an occupational health setting - a research protocol for a randomised controlled trial (CoAct) , 2009 .

[25]  Annemarie Sullivan Empowering Students in Transition , 2016, Front. Public Health.

[26]  C. Abraham,et al.  The Behavior Change Technique Taxonomy (v1) of 93 Hierarchically Clustered Techniques: Building an International Consensus for the Reporting of Behavior Change Interventions , 2013, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[27]  W. Rosamond,et al.  Associations between Patterns of Objectively Measured Physical Activity and Risk Factors for the Metabolic Syndrome , 2010, American journal of health promotion : AJHP.

[28]  Dylan S. Small,et al.  Individual Versus Team-Based Financial Incentives to Increase Physical Activity: A Randomized, Controlled Trial , 2016, Journal of General Internal Medicine.

[29]  Tanya Robinson,et al.  Applying the Socio-ecological Model to Improving Fruit and Vegetable Intake Among Low-Income African Americans , 2008, Journal of Community Health.

[30]  Andrew D. McGavigan,et al.  International Mobile-Health Intervention on Physical Activity, Sitting, and Weight: The Stepathlon Cardiovascular Health Study. , 2016, Journal of the American College of Cardiology.

[31]  C. Abraham,et al.  A taxonomy of behavior change techniques used in interventions. , 2008, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[32]  A. Howarth,et al.  The impact of digital health interventions on health-related outcomes in the workplace: A systematic review , 2018, Digital health.

[33]  B. Ainsworth,et al.  International physical activity questionnaire: 12-country reliability and validity. , 2003, Medicine and science in sports and exercise.

[34]  Charlotte L Edwardson,et al.  Office Workers' Objectively Measured Sedentary Behavior and Physical Activity During and Outside Working Hours , 2014, Journal of occupational and environmental medicine.

[35]  E. Deci,et al.  The "What" and "Why" of Goal Pursuits: Human Needs and the Self-Determination of Behavior , 2000 .

[36]  D. Conroy,et al.  Behavior change techniques in top-ranked mobile apps for physical activity. , 2014, American journal of preventive medicine.

[37]  S. Nie,et al.  Leisure time physical activity and cancer risk: evaluation of the WHO's recommendation based on 126 high-quality epidemiological studies , 2015, British Journal of Sports Medicine.

[38]  C. Abraham,et al.  Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions , 2011, BMC public health.

[39]  C. Vandelanotte,et al.  Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review , 2016, International Journal of Behavioral Nutrition and Physical Activity.

[40]  I. Hendriksen,et al.  Longitudinal Relationship Between Sitting Time on a Working Day and Vitality, Work Performance, Presenteeism, and Sickness Absence , 2016, Journal of occupational and environmental medicine.

[41]  Ralf Schwarzer,et al.  Mechanisms of health behavior change in persons with chronic illness or disability: the Health Action Process Approach (HAPA). , 2011, Rehabilitation psychology.

[42]  W. Nilsen,et al.  Health behavior models in the age of mobile interventions: are our theories up to the task? , 2011, Translational behavioral medicine.

[43]  Sharon Fraser,et al.  The Effect of an e-Health Intervention Designed to Reduce Prolonged Occupational Sitting on Mean Arterial Pressure , 2014, Journal of occupational and environmental medicine.

[44]  Aki Vehtari,et al.  The effectiveness of physical activity monitoring and distance counseling in an occupational setting – Results from a randomized controlled trial (CoAct) , 2012, BMC Public Health.

[45]  Maria E Fernandez,et al.  How we design feasibility studies. , 2009, American journal of preventive medicine.

[46]  M. Leary Self-presentational processes in exercise and sport. , 1992 .

[47]  R. Furberg,et al.  Systematic review of the validity and reliability of consumer-wearable activity trackers , 2015, International Journal of Behavioral Nutrition and Physical Activity.

[48]  E. Finkelstein,et al.  Design and baseline characteristics of participants in the TRial of Economic Incentives to Promote Physical Activity (TRIPPA): a randomized controlled trial of a six month pedometer program with financial incentives. , 2015, Contemporary clinical trials.

[49]  H. Sherrard,et al.  The Impact of Web-Based Feedback on Physical Activity and Cardiovascular Health of Nurses Working in a Cardiovascular Setting: A Randomized Trial , 2018, Front. Physiol..

[50]  Impact of Electronic Feedback and Peer Comparisons on Residents' Physical Activity Level. , 2017, Journal of graduate medical education.

[51]  Chris D. Nugent,et al.  Using computer, mobile and wearable technology enhanced interventions to reduce sedentary behaviour: a systematic review and meta-analysis , 2017, International Journal of Behavioral Nutrition and Physical Activity.

[52]  Brianna S Fjeldsoe,et al.  Evaluating the effectiveness of organisational-level strategies with or without an activity tracker to reduce office workers’ sitting time: a cluster-randomised trial , 2016, International Journal of Behavioral Nutrition and Physical Activity.

[53]  S. Blair Physical inactivity: the biggest public health problem of the 21st century. , 2009, British journal of sports medicine.

[54]  Charles D. Barrett Understanding Attitudes and Predicting Social Behavior , 1980 .

[55]  S. Clemes,et al.  A survey of sitting time among UK employees. , 2014, Occupational medicine.

[56]  Willem van Mechelen,et al.  Reliability and validity of the Activity Questionnaire for Adults and Adolescents (AQuAA) , 2009, BMC medical research methodology.

[57]  Physical activity initiated by employer and its health effects; an eight week follow-up study , 2016, BMC Public Health.

[58]  R. Cialdini Influence: Science and Practice , 1984 .

[59]  J. Katz,et al.  Implementation of a workplace intervention using financial rewards to promote adherence to physical activity guidelines: a feasibility study , 2017, BMC Public Health.

[60]  Justin D. Schrager,et al.  Assessing the Influence of a Fitbit Physical Activity Monitor on the Exercise Practices of Emergency Medicine Residents: A Pilot Study , 2017, JMIR mHealth and uHealth.

[61]  Corneel Vandelanotte,et al.  Effect and Process Evaluation of a Smartphone App to Promote an Active Lifestyle in Lower Educated Working Young Adults: Cluster Randomized Controlled Trial , 2018, JMIR mHealth and uHealth.

[62]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2009, Journal of clinical epidemiology.

[63]  Aart van Halteren,et al.  Toward a persuasive mobile application to reduce sedentary behavior , 2013, Personal and Ubiquitous Computing.

[64]  Florian Mueller,et al.  Preliminary results from a study of the impact of digital activity trackers on health risk status , 2014, HIC.

[65]  T. Kolbe-Alexander,et al.  Changing Diet and Physical Activity in Nurses: A Pilot Study and Process Evaluation Highlighting Challenges in Workplace Health Promotion , 2018, Journal of nutrition education and behavior.

[66]  J. Vlaanderen,et al.  Meta‐analysis on shift work and risks of specific obesity types , 2018, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[67]  G. Flores Mateo,et al.  Mobile Phone Apps to Promote Weight Loss and Increase Physical Activity: A Systematic Review and Meta-Analysis , 2015, Journal of medical Internet research.

[68]  Cindy M. Gray,et al.  Evaluating the Impact of Physical Activity Apps and Wearables: Interdisciplinary Review , 2018, JMIR mHealth and uHealth.

[69]  Mikko Härmä,et al.  Shift work and cardiovascular disease - pathways from circadian stress to morbidity. , 2010, Scandinavian journal of work, environment & health.

[70]  C. Vandelanotte,et al.  A Smartphone App to Promote an Active Lifestyle in Lower-Educated Working Young Adults: Development, Usability, Acceptability, and Feasibility Study , 2018, JMIR mHealth and uHealth.

[71]  Nathan K. Cobb,et al.  Effectiveness of an Activity Tracker- and Internet-Based Adaptive Walking Program for Adults: A Randomized Controlled Trial , 2016, Journal of medical Internet research.

[72]  Shiyi Cao,et al.  Shift work and diabetes mellitus: a meta-analysis of observational studies , 2014, Occupational and Environmental Medicine.

[73]  Dylan S. Small,et al.  Framing Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults , 2016, Annals of Internal Medicine.

[74]  Nicholas D. Gilson,et al.  Chronic disease risks and use of a smartphone application during a physical activity and dietary intervention in Australian truck drivers , 2016, Australian and New Zealand journal of public health.

[75]  K. Khunti,et al.  Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis , 2012, Diabetologia.

[76]  M. Lachman,et al.  Behavior Change with Fitness Technology in Sedentary Adults: A Review of the Evidence for Increasing Physical Activity , 2017, Front. Public Health.

[77]  Corneel Vandelanotte,et al.  The impact of an m-Health financial incentives program on the physical activity and diet of Australian truck drivers , 2017, BMC Public Health.

[78]  C. Matthews,et al.  Too much sitting: the population health science of sedentary behavior. , 2010, Exercise and sport sciences reviews.

[79]  Sean P Mullen,et al.  Increasing Physical Activity With Mobile Devices: A Meta-Analysis , 2012, Journal of medical Internet research.

[80]  Dylan S. Small,et al.  A Randomized, Controlled Trial of Lottery-Based Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults , 2018, American journal of health promotion : AJHP.

[81]  I-Min Lee,et al.  Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. , 2015, JAMA internal medicine.

[82]  W. Brown,et al.  Steps and sitting in a working population , 2004, International journal of behavioral medicine.

[83]  Artur Direito,et al.  mHealth Technologies to Influence Physical Activity and Sedentary Behaviors: Behavior Change Techniques, Systematic Review and Meta-Analysis of Randomized Controlled Trials , 2017, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[84]  E. Finkelstein,et al.  Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): a randomised controlled trial. , 2016, The lancet. Diabetes & endocrinology.

[85]  I. Hendriksen,et al.  Effectiveness of a Multilevel Workplace Health Promotion Program on Vitality, Health, and Work-Related Outcomes , 2016, Journal of occupational and environmental medicine.