FROM CIRCULATION
Mobile health technology such as wearable monitors, applications, and text-messaging programs may encourage behavioral change, according to a scientific statement by the American Heart Association published Aug. 13.
With cardiovascular disease, heart disease, and stroke remaining a major cause of morbidity and mortality, the AHA has identified four behaviors as part of its 2020 Strategic Impact Goals: promoting physical activity and healthful eating, and reducing weight and tobacco abuse. The AHA included blood pressure, cholesterol, and glucose as health indicators. Together these make up the AHA’s Life’s Simple 7. When taking into account these seven factors, 32% of Americans have a normal body mass index, less than 1% eat healthfully, and more than 30% have not achieved blood pressure or lipid goals.
Therefore, Lora Burke, Ph.D., of the School of Nursing at the University of Pittsburgh, and her colleagues sought to review the studies looking at mobile health interventions’ impact on the CV health indicators and targeted behaviors.
The researchers conducted an English language literature search focused on various mobile health terms and clinical diagnoses and limited to the period of 2004-2014.
Mobile health technology is beneficial for short-term weight loss when included with comprehensive lifestyle interventions. For patients who need to lose weight, physicians should consider recommending mobile health programs that are evidence based and take into account behavioral approaches, healthful eating, and physical activity. Likewise, feedback, social support, and self-monitoring capabilities should be available in the mobile health program.
More than 20% of American adults are using a form of health tracking, but there are not enough data to know if wearable tracking devices are effective at increasing physical activity. Likewise, the associated applications lack studies on their efficacy. The authors note that combining group behavioral interventions with activity trackers may result in more weight loss than with either the group intervention or tracking device alone.
Smoking cessation guidelines encourage the five As: ask, advise, assess, assist, and arrange, but clinicians are providing assessment of tobacco abuse, assistance in cessation, and arrangement for follow-up of the cessation program less often.
Several studies have shown nearly twice the abstinence rates with use of text messaging programs, but most were unsuccessful after 6 months, despite the mobile health device. Therefore, text messaging smoking cessation programs should be considered only if combined with another proven cessation intervention, the researchers noted.
In terms of the use of mobile health technology in improving glucose, blood pressure, and lipids, the data are limited.
Addressing cardiovascular disease risk factors before the development of CVD is associated with reduced CVD mortality. Given the limited face-to-face time physicians have with patients, mobile health technologies have the potential to expand the options to encourage behavioral change in patients.
“Using mHealth tools for monitoring provides the clinician data that far exceed what can be measured in the brief clinical encounter and reflect the status of physiological or behavioral measures in the person’s natural setting,” the authors concluded (Circulation. 2015 Aug. 13. doi: 10.1161/CIR.0000000000000232.)
The authors reported multiple disclosures including involvement with Scale Down, Coeus Health, Actigraph, Open mHealth, and WellDoc which are health technology companies.
