Apps Can Help Health Habits, but Proof Is Poor: AHA Statement

Marlene Busko

August 17, 2015

DALLAS, TX — Although numerous mobile health tools—such as smartphone apps and activity sensors—are available to manage cardiovascular risk factors, evidence for their effectiveness is generally lacking. Nevertheless, clinicians should still encourage patients to use these new tools, and researchers should conduct the studies needed to get more evidence, a scientific statement from the American Heart Association that was published August 13, 2015 in Circulation advises[1].

The statement by Dr Lora Burke (University of Pittsburg, PA) and colleagues focuses on tools to manage six behaviors: controlling blood pressure, managing cholesterol, controlling blood sugar, getting active, losing weight, and stopping smoking. They found that while there are thousands of lifestyle apps, only 69 clinical studies have evaluated the effectiveness of using mobile health tools to improve these cardiovascular-health–related behaviors.

However, "our review of the evidence to date, even with its flaws and limitations, clearly demonstrates the great potential that mobile technologies can have to aid in lifestyle modification," the writing team concludes.

Importantly, clinicians shouldn't ignore the emergence of mobile health technologies, despite the lack of data supporting their use. "Instead, we need to embrace the challenge of producing this needed evidence on how effective these new technologies are and how we can best adopt them in our practice to promote better patient health," Burke and colleagues urge.

Healthcare providers should "be up-front with patients that the evidence is currently weak and we cannot make any definitive recommendations about any particular app or program, but patients should be encouraged to use them and just be careful and also be on the lookout for more evidence," writing committee member Dr Jun Ma (University of Illinois at Chicago) told heartwire from Medscape.

One in Five Americans Uses an App to Track Health Data

Use of smartphones is widespread across all socioeconomic groups, according to the authors. Nearly half of Americans with an annual household income below $30,000 own a smartphone, and use is high among Hispanic and African American households. With the smartphones, one in five American adults uses an app to track health data—most often their exercise, steps, or heart rate.

In an April 2015 search for apps for the six behaviors, the writing committee unearthed thousands of apps for Apple tablets or iPhones that specifically deal with exercise (6312), weight loss (3881), type 2 diabetes (1175), blood pressure (588), and cholesterol (265). There were also 120 to 250 apps for each category for Android devices.

The AHA statement aimed to provide clinicians and researchers with a review of the science for mobile health tools. It is divided into six sections that include summaries of randomized controlled trials that evaluated the use of these tools to help patients with six behaviors: achieve a healthy weight (10 trials), be more physically active (14), quit smoking (14), control blood glucose (15), reach blood-pressure targets (13), and attain lipid targets (three).

Some of the key findings are:

  • For managing weight loss, mobile tools helped with short-term weight loss, but data beyond 12 months are lacking. "In the area of weight loss, we did find that when the mobile technology intervention was part of a comprehensive lifestyle intervention that involved counseling for a healthy diet, physical activity, and behavior change, it was indeed effective," Ma said. The characteristics that make mobile health technologies effective are the same ones that make traditional lifestyle interventions effective, such as tools for self-monitoring and for engaging patients in a productive relationship with a trained counselor, she added.

  • For improving physical activity, although there has been "a prolific explosion" of wearable devices that track physical activity, little is known about how effective they are, and therefore, much more research is needed.

  • For quitting smoking, studies have shown that programs that incorporate text messaging can double the abstinence rates, but about 90% of smokers still fail to quit at 6 months.

Text messaging can also help providers stay in contact with patients and can provide reminders or prompts for them to make changes, Ma noted.

"Obesity and physical inactivity are such prevalent public-health problems, any solution—whether it is mobile technology or traditional lifestyle interventions—cannot by itself combat such epidemics," she noted. "But I do think mobile technology is and will be a crucial component of the overall strategy to address [lifestyle issues, since] the evidence so far, while limited, is promising."

Burke reports receiving a grant from the National Institutes of Health. Ma has no relevant financial relationships. Disclosures for the coauthors are listed in the article.


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