Worldwide, Mass-Participation Virtual 'Race' Keeps Adults Moving, Off Chairs

Marlene Busko

April 11, 2016

CHICAGO, IL — Stepathlon, a mass-participation, type of virtual "race" around the globe in which teams of five employees received pedometers and used a mobile phone app or a dedicated website to record their steps (which were then translated into distances covered), was effective in getting people in developing and developed countries to move more and sit less, researchers report[1].

Although half of the more than 69,000 participants did not finish the 100-day annual event, those who did so in 2012, 2013, and 2014 took more steps, exercised more days per week, spent less time sitting, and lost weight by the end of the event. The improvements were similar in men and women, in lower-middle and high-income countries, and each of the three years.

This study demonstrates that it is efficacious and feasible to deliver a mobile-health (mHealth) workplace lifestyle program to a globally distributed population, Dr Anand N Ganesan (Flinders University of South Australia, Adelaide) said, presenting the results at a late-breaking clinical-trial session and a subsequent press conference at the American College of Cardiology (ACC) 2016 Scientific Sessions. The study was simultaneously published in the Journal of the American College of Cardiology.

Employers paid about $50 US per employee in India, a lower-middle-income country where a company developed the program and where 90% of the participants lived, and they paid about $65 US per employee in other countries. The program "was done in a very low-cost way . . . and [led to lifestyle] changes in large numbers of people; that's the exciting aspect," Ganesan told heartwire from Medscape, stressing that people in rich and poor countries benefited equally.

Panelist Dr David Wood (Fort Sanders Regional Medical Center, Knoxville, TN) cautioned that "the data are descriptive; these are not the results of a randomized controlled trial, and there was no comparator group," so these might just be more motivated individuals. Ganesan countered that this was a preprimary prevention (primordial) trial of people with a mean age of 36, and mHealth technology is evolving very quickly—which would make it extremely difficult to do a traditional trial. Finding similar results in the three separate cohorts strengthens the link between intervention and outcome, he added.

A Step Up to Better Heart Health

"In recent years, there has been growing recognition of the importance of physical inactivity, sitting, and excess weight as key drivers of worldwide morbidity and mortality by their association with diabetes and cardiovascular disease," the researchers write.

They investigated data from 69,219 adult employees from around the world who participated in the annual 100-day Stepathlon events in 3 years.

Three-quarters of the participants were male (76%); they had a mean age of 36, and most were in their 20s to 40s. They came from 1481 cities in 64 countries, spanning the globe, and worked for 481 companies. Most participants (90.2%) came from India, with the rest  coming mostly from Australia (5.0%), New Zealand (1.1%), Singapore (0.6%), and the US (0.3%) but also China, the Philippines, the United Arab Emirates, the UK, Taiwan, Hong Kong, Poland, and other countries.

Participants received a pedometer and were encouraged to be more active and record the number of steps they took each day, using the event's app or website. Activities such as swimming or cycling also counted and were converted to steps. Participants also received encouraging emails and could take part in contests and quizzes, track their team's progress, and post and see comments.

Overall, on average, the 36,652 participants (53.0%) who completed the postevent questionnaire improved their step count by 3519 steps per day, exercised 1 more day a week, sat for 45 minutes less each day, and lost 1.45 kg (P<0.0001 for all).

The overall increases in steps per day were similar in men and women (3398 steps per day and 3159 steps per day, respectively), in participants living in different regions of the world, and in those living in countries with low-middle to high incomes, in each of the 3 years (P<0.0001 for all).

At the end of the 100 days, participants who completed the competition were more likely to report that they exercised more than 30 minutes a day.

"We think that the social camaraderie represents a critical driver of participation in the program," said Ganesan. "The current study demonstrates that utilization of mHealth technology on a large scale may be a potential way to inexpensively communicate messages about behavior change, in a way that could be effective in both high-income and low-middle-income country settings," according to the researchers.

They are currently conducting a larger study that will look at other aspects of this mHealth intervention, such as maintenance of new healthy habits.

Ganesan receives financial support from the National Health and Medical Research Council of Australia. Disclosures for coauthors are listed in the article. The researchers conducted the study as part of an academic-private partnership between researchers at Flinders University and University of Adelaide and Stepathlon, a start-up company based in Mumbai, India. The researchers had no financial relationship with the company, which provided data on an unrestricted basis. Wood receives consultation fees/honoraria from Ferrer International and is on speaker bureaus for Amgen and Sanofi.

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