Lifestyle action plan plus mobile monitoring can help patients

Simple guidelines, including eating more fruits and vegetables and sitting less, combined with progress checks, led patients to change behaviors and sustain improvements.

By — Posted June 11, 2012

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Prevention medicine specialist Bonnie Spring, PhD, says physicians can feel overwhelmed by the limited time they have to help patients change unhealthy lifestyle behaviors.

But she said doctors can help with improvements by recommending that patients eat more fruits and vegetables, decrease their sedentary leisure time and then monitor their progress using mobile technology, such as a smartphone.

That approach led patients to improve healthy behaviors and sustain those changes after 20 weeks, said a study in the May 28 issue of Archives of Internal Medicine. Spring was lead author.

The message for physicians “is that this can be done. You don’t have to be hopeless about it,” said Spring, a professor of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.

If further research supports the study’s findings, using mobile technology to help monitor and change patients’ lifestyle behaviors could potentially revolutionize what can be accomplished in medicine and public health, said William T. Riley, PhD, program director in the Division of Cardiovascular Sciences in the National Heart, Lung and Blood Institute.

“We will be able to monitor and intervene with patients in real time and in the context of the behavior as it’s occurring,” said Riley, who wrote a commentary on the study in the same Archives issue.

Riley said advanced technology already is helping doctors manage patients’ diabetes through the use of wireless blood glucose meters, which transmit data to health professionals.

A key finding of the study was that eating fruits and vegetables and decreasing sedentary ways can improve patients’ health.

“Americans have all these unhealthy behaviors that put them at high risk for heart disease and cancer, but it is hard for them and their doctors to know where to begin to change those unhealthy habits,” Spring said. “This approach [in the Archives study] simplifies it.”

Keeping track of healthy behaviors

Fewer than 25% of U.S. adults meet the recommended dietary guidelines for daily intake of fruit, vegetables and saturated fat.

One in four does not engage in physical activity beyond what is required for his or her job or household duties, the study said.

Researchers randomly assigned 204 Chicago-area adults, ages 21 to 60, who had unhealthy behaviors into one of four treatment groups that asked participants to make two behavioral changes involving diet and physical activity. Participants were studied in three-week intervals from September 2005 to August 2010.

They recorded information on their health behaviors on a Palm Pilot.

The data were sent to coaches who were bachelor-level research assistants. At least once a week, they offered tips via telephone or e-mail on how to reach their health goals.

Participants could earn up to $175 for meeting their health goals. Even after they stopped getting this amount, they maintained their healthy lifestyles. During follow-up, they received $30 to $80 a month for recording their health behavior data.

After 20 weeks of follow-up, the group that was assigned to increase fruits and vegetables and decrease sedentary leisure was considered the most successful. Individuals in this group consumed more than twice the previous servings of fruits and vegetables.

Their sedentary leisure time dropped from a mean of 219.2 minutes each day at the start of the study to 125.7 minutes a day. Unexpectedly, the group’s daily calories from saturated fat decreased during the study period, even though it wasn’t targeted during treatment.

This type of approach could be implemented in the primary care setting, Riley said.

A majority of people have cell phones on which they could record diet and physical activity information, and a computer program could be developed to offer the patient automated feedback, he said.

“The most important thing was that people were able to meet these goals, and they did it fast,” Spring added. “The average time it took them was a day or two after we set the ?target.”

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How to help patients live healthier lifestyles

Poor diet and inactivity increase people’s risk of developing cancer, cardiovascular disease and diabetes. Bonnie Spring, PhD, a professor of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago, offers physicians practical tips on how to help patients change their behaviors and improve their health:

  • Encourage patients to increase fruit and vegetable intake and decrease sedentary leisure time.
  • Recommend that people keep track of what they eat each day and how many minutes they spend in sedentary leisure by writing the information on paper or typing it into a smartphone.
  • Urge patients to reward themselves for progress they make toward meeting their goals. Such rewards could include planning a trip or buying something special.
  • Encourage people to develop a support group, such as family or friends, who can encourage them to keep working toward their goals.

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External links

“Multiple Behavior Changes in Diet and Activity: A Randomized Controlled Trial Using Mobile Technology,” Archives of Internal Medicine, May 28 (link)

“Low-risk lifestyle behaviors and all-cause mortality: findings from the National Health and Nutrition Examination Survey III Mortality Study,” American Journal of Public Health, October 2011 (link)

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