BHAN 435 Exam 3

Fitness Apps

*Integrate with smartphone features: Use internal accelerometer in smartphone to track movement and activity levels *Enables users to: - Set activity goals - Receive feedback in real-time - Monitor activity progress and trends over time - Link to social media and other health apps

Overview of Basic Wearable Software

*Wireless connection to a mobile app and/or website *Device-User Interface Features: - Goal setting - Link to social media sites - Visual display (self-monitoring) - Data trends available on app/website (self-monitoring - Behavioral feedback - Reminders - Rewards

Built Environment Influences on PA and Active Living

- Access/Availability - Walkable & Bikeable Destinations - Street connectivity - Residential density - Land-use mix - Presence of sidewalks and bike lanes - Adequate street lighting

Wearable PA Trackers

- And their apps are a promising medium for delivering a more personalized PA intervention. - 1 in 10 U.S. adults now own a fitness tracker.

Environmental Audits

- Assessments performed "in the field" by trained observers - Can be very detailed - Ex: Number of people using a park or playground; Condition and quality of environmental structures

Built Environment

- Constructed places, features, and elements that together make our cities, villages, and towns where we live, work, and play. - Varies from large-scale urban areas to rural development and personal space - Includes indoor and outdoor places: Parks, Trails, Streets and Sidewalks, Fitness Centers, Community Centers

Limitations of Environmental Audits

- Difficult to measure since the broad environment includes many possible factors that could influence PA behavior (confounding factors) - Cannot perform randomized controlled trials which Limits ability to determine causality between physical structures or features and PA outcomes

Short term effects of SMS PA prompts

- During the first week, there was a significant increase in PA, which suggests these messages were able to serve as cues (or reminders) - However, this effect was not maintained by the second week and into the remainder of the study

Street-scale urban design

- Focuses on smaller changes within neighborhoods - Includes: Pedestrian walkways Marked street crossings Speed bumps Aesthetic landscaping Street and walkway lighting

Qualities of a bad app

- Glitchy - Focus too much on making money, not enough on the customer. Note: Star Wars: Battlefront 2 - Poorly researched market/audience - Bad first impressions - Annoying to use

BCTs and Wearable Activity Trackers

- Have shown success in increasing activity levels, but are costly to implement face-to-face. - To date, research is limited as to the effectiveness of wearable PA tracking devices for increasing PA.

Considerations when designing apps?

- Is there a need? - What would make someone want to use it? - What would make someone want to continue using it?

Designing and building healthy places

- Make active living easier and more convenient - Create open and aesthetically pleasing spaces and pedestrian/bike friendly paths and routes

App Design Rules

- Make first experience positive - Make subsequent experiences helpful and compelling - Consistency between screens - Similar metaphors to other apps, as appropriate - Well-written text - Judicious use of imagery - Name and branding - Creative use of mobile capabilities!

Chronology of Fitbit Trackers

- One, Zip, Flex, Charge, Charge HR, Surge, Blaze, Atla - To date, 20 Fitbit measurement papers have been published since 2012 - Since 2014, only 2 of 13 studies included the Fitbit Flex

Built Environment Correlates of PA

- Personal Safety and Crime - Green Space - Access to places to be active - Availability of structures, places, and resources to be active - Aesthetics

Natural Environment Correlates of PA

- Pollution / Air quality - Temperature & Humidity - Inclement Weather - Geography: Beach, Mountains

Qualities of a good app

- Simple and Clean - Engaging, but not burdensome - Easy to follow - Captures/motivates users to keep using it: provide incentives - Utilize social characteristics of groups - Has a successful business plan - Generally, fun and engaging

Correlate

- Statistical relationship between two variables. - The relationship, however does not determine causality (i.e. X causes Y or Y causes X)

Promoting PA via the Built Environment

- Strategies should target aspects of the built environment that do not support PA such as walking and biking. - Use of passive strategies include the following: Providing walking trails, Providing adequate street lights, Posting (and enforcing) speed limits, Creating policies that promote PA behavior

Ecological Momentary Assessment

- Tailored messages and prompts sent to participants at different times throughout the day - Can ask participants to take a picture or text current feelings, behavior - Use GPS alert or accelerometer apps to track movement & speed - Data are continuously collected!!

Natural Environment

- The surroundings or conditions in which an organism lives or operates - affected by human activity

Community-scale urban design

- Uses land use policies to alter physical features in whole towns or cities. - Includes: Street connectivity Aesthetic landscaping Constructing trails, parks, bike lanes, sidewalks

individual behavior

- amount of walking - social isolation - diet choices - recreation

urban form patterns

- density mix - transport options - access to parks and schools

population health impacts

- physical fitness - pollution exposure - traffic crashes - social cohesion

planning and investment policies

- provincial initiatives - regional and municipal plans - zoning and development rules

Public Policy

- refers to a system of laws, regulatory measures, courses of action and funding priorities concerning a given topic promulgated by a governmental entity of its representatives. - It can include what the government chooses not to do

Future Trends

2010 to 2050 - Population growth: 42% - New housing: 52 million units - Replacement housing: 37 million units One estimate of acres that will be lost between 1997 and 2060: - Rural land: 60-85 million acres - Forests: 24-38 million acres - Cropland: 19-28 million acres - Rangeland: 8-11 million acres

lack of connectivity

A major impediment for bike transportation in sprawled suburbs is....

Steps, energy expenditure, intensity, and distance

A tri-axial accelerometer measures:

1

According to the Connected Intelligence Report in 2014, ___ in 10 U.S. adults own a wearable fitness tracker

BCTs that are absent in wearable activity trackers

Barrier identification or problem solving, Use of follow-up prompts, Relapse prevention or coping planning, and Motivational interviewing

Yes, but there is limited research (Behavioral PA interventions have shown success in increasing activity levels, but are costly to implement face-to-face)

Can Wearable activity trackers independently Influence PA behavior?

recreational facilities

Centers for Disease Control and Prevention (CDC) recommend access to _____________ _____________ as one of 24 environmental- and policy-level strategies to reduce obesity in its Common Community Measures for Obesity Prevention Project

Buildings, land use, public resources, zoning regulations, and public transportation

Components of the Built Environment

Walkability Framework

Connectivity, Land-Use, Density, Traffic Safety, Surveillance, Parking, Experience, Greenspace, and Community

20; 3

Delaware Child Care Centers must abide by a state policy that requires children have the opportunity for a minimum of ____ minutes of moderate to vigorous physical activity indoors or outdoors, for every ____ hours a child attends a child care center between the hours of 7 a.m. to 7 p.m.

Yes (This could be potentially dangerous for individuals with existing cardiovascular disease.)

Does the Fitbit device consistently underestimate HR?

2

During continuous exercise, Fitbit Charge HR produced a mean error of ~__%, well within the threshold for clinical validity.

Photoplethysmography (PPG) technology

Estimates heart rate: - Sensors measure blood flow, which is then applied to another proprietary algorithm to calculate HR

Social, personal, natural environment, and built environment

Factors that influence PA

Tailored health messages to increase knowledge, awareness, and motivation

In the future, it is recommended that health apps include what?

Active Living

Integration of PA within everyday activities such as walking to the store or biking to work.

Yes

Is more research needed to improve measurement accuracy of wearable activity devices?

Photoplethysmography

Many of the new wearable activity devices measure heart rate via

Heart Rate, Steps, Distance, Activity Level, and Energy Expenditure

Measurement Properties of Most Consumer-Based Wearable Activity Monitors

proprietary algorithms

Measurement differences for intensity are likely due to the use of what?

overestimate; underestimate

Most consumer-based activity trackers tend to ________________ time in MVPA (moderate/vigorous) and ________________ time in sedentary and light activity

E

Passive strategies to promote PA via the built environment include all of the following except... a. Provide walking trails b. Provide adequate street lights c. Posting (and reinforcing speed limits) d. Improving the aesthetics of an area. e. All of the following are passive strategies to promote PA via the built environment

Common BCTs used by PA apps

Provide feedback on performance, Prompt self-monitoring of behavior, Prompt specific goal setting, Plan social support or social change, and provide contingent rewards

higher physical activity levels

Proximity to places with recreational opportunities is associated with what?

planning and investment policies -> urban form patterns -> individual behavior -> population health impacts

Ripple Effect of How Planning and Design Affect Health

access to recreational facilities

Strong relationship between _______________________ and physical activity among adults and children

True

T/F Approximately one-quarter of people who download health apps report using them only once.

True

T/F Most consumer-based activity trackers tend to overestimate time in MVPA (Moderate to Vigorous Physical Activity) and underestimate time in sedentary and light activity

True

T/F: Validity and Reliability of most health/fitness apps is essentially unknown

Weather conditions

The built environment includes all of the following except.. a. Transport safety b. Weather conditions c. Aesthetics d. Land use e. All of the above

150; 75

The current national PA guidelines recommends that healthy adults engage in a minimum of ____ minutes of moderate intensity aerobic physical activity per week or ____ minutes of vigorous intensity aerobic physical activity per week.

Urban Sprawl

The growth of residential suburbs a long way from a town centeris known as:

21

To date, over __% of US adults use technology to track aspects of their health

Yes

Was there an increase in steps taken between those who used the FitBit mobile app vs. those that did not?

individually-tailored behavioral interventions that promote active (vs. passive) behavioral self-monitoring

Wearables may be more effective when combined with...

26

What % of people who download health apps report using them only once?

Green Space

What Reduces Health disparities?

Low street connectivity

What environmental factors will most likely impede walking-based physical activity?

Can change driving patterns and behaviors, increase accessibility to opportunities for PA, and impact population-level behaviors

Why are policy-level changes a good intervention strategy for promoting PA?

25

____ % of all trips made are one mile or less, but most of these short trips are made by car