Multiple behavior changes in diet and activity: a randomized controlled trial using mobile technology.
BACKGROUND
Many patients exhibit multiple chronic disease risk behaviors. Research provides little information about advice that can maximize simultaneous health behavior changes.


METHODS
To test which combination of diet and activity advice maximizes healthy change, we randomized 204 adults with elevated saturated fat and low fruit and vegetable intake, high sedentary leisure time, and low physical activity to 1 of 4 treatments: increase fruit/vegetable intake and physical activity, decrease fat and sedentary leisure, decrease fat and increase physical activity, and increase fruit/vegetable intake and decrease sedentary leisure. Treatments provided 3 weeks of remote coaching supported by mobile decision support technology and financial incentives. During treatment, incentives were contingent on using the mobile device to self-monitor and attain behavioral targets; during follow-up, incentives were contingent only on recording. The outcome was standardized, composite improvement on the 4 diet and activity behaviors at the end of treatment and at 5-month follow-up.


RESULTS
Of the 204 individuals randomized, 200 (98.0%) completed follow-up. The increase fruits/vegetables and decrease sedentary leisure treatments improved more than the other 3 treatments (P < .001). Specifically, daily fruit/vegetable intake increased from 1.2 servings to 5.5 servings, sedentary leisure decreased from 219.2 minutes to 89.3 minutes, and saturated fat decreased from 12.0% to 9.5% of calories consumed. Differences between treatment groups were maintained through follow-up. Traditional dieting (decrease fat and increase physical activity) improved less than the other 3 treatments (P < .001).


CONCLUSIONS
Remote coaching supported by mobile technology and financial incentives holds promise to improve diet and activity. Targeting fruits/vegetables and sedentary leisure together maximizes overall adoption and maintenance of multiple healthy behavior changes.
Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Chicago, IL 60611, USA. bspring@northwestern.edu
Bonnie
B
Spring
Kristin
K
Schneider
H Gene
HG
McFadden
Jocelyn
J
Vaughn
Andrea T
AT
Kozak
Malaina
M
Smith
Arlen C
AC
Moller
Leonard H
LH
Epstein
Andrew
A
Demott
Donald
D
Hedeker
Juned
J
Siddique
Donald M
DM
Lloyd-Jones
D000328:Adult; D001521:Behavior Therapy / Q000379:methods; D034201:Computers, Handheld / Q000706:statistics & numerical data; D004032:Diet; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011788:Quality of Life; D019114:Remote Consultation / Q000295:instrumentation* / Q000379:methods; D018570:Risk Assessment; D012309:Risk-Taking; D055815:Young Adult