title: Smartphone apps to improve fitness and increase physical activity among young people: protocol of the Apps for IMproving FITness (AIMFIT) randomized controlled trial.
abstract: BACKGROUND
  Physical activity is a modifiable behavior related to many preventable non-communicable diseases. There is an age-related decline in physical activity levels in young people, which tracks into adulthood. Common interactive technologies such as smartphones, particularly employing immersive features, may enhance the appeal and delivery of interventions to increase levels of physical activity in young people. The primary aim of the Apps for IMproving FITness (AIMFIT) trial is to evaluate the effectiveness of two popular "off-the-shelf" smartphone apps for improving cardiorespiratory fitness in young people.
  
  
  METHODS
  A three-arm, parallel, randomized controlled trial will be conducted in Auckland, New Zealand. Fifty-one eligible young people aged 14-17 years will be randomized to one of three conditions: 1) use of an immersive smartphone app, 2) use of a non-immersive app, or 3) usual behavior (control). Both smartphone apps consist of an eight-week training program designed to improve fitness and ability to run 5 km, however, the immersive app features a game-themed design and adds a narrative. Data are collected at baseline and 8 weeks. The primary outcome is cardiorespiratory fitness, assessed as time to complete the one mile run/walk test at 8 weeks. Secondary outcomes are physical activity levels, self-efficacy, enjoyment, psychological need satisfaction, and acceptability and usability of the apps. Analysis using intention to treat principles will be performed using regression models.
  
  
  CONCLUSIONS
  Despite the proliferation of commercially available smartphone applications, there is a dearth of empirical evidence to support their effectiveness on the targeted health behavior. This pragmatic study will determine the effectiveness of two popular "off-the-shelf" apps as a stand-alone instrument for improving fitness and physical activity among young people. Adherence to app use will not be closely controlled; however, random allocation of participants, a heterogeneous group, and data analysis using intention to treat principles provide internal and external validity to the study. The primary outcome will be objectively assessed with a valid and reliable field-based test, as well as the secondary outcome of physical activity, via accelerometry. If effective, such applications could be used alongside existing interventions to promote fitness and physical activity in this population.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry: ACTRN12613001030763. Registered 16 September 2013.
authors.affiliation: National Institute for Health Innovation, University of Auckland, 261 Morrin Road, Auckland, 1072, New Zealand. artur.direito@auckland.ac.nz.
authors.forename: Artur
authors.initials: A
authors.lastname: Direito
authors.affiliation: National Institute for Health Innovation, University of Auckland, 261 Morrin Road, Auckland, 1072, New Zealand. y.jiang@auckland.ac.nz.
authors.forename: Yannan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: National Institute for Health Innovation, University of Auckland, 261 Morrin Road, Auckland, 1072, New Zealand. r.whittaker@auckland.ac.nz.
authors.forename: Robyn
authors.initials: R
authors.lastname: Whittaker
authors.affiliation: National Institute for Health Innovation, University of Auckland, 261 Morrin Road, Auckland, 1072, New Zealand. r.maddison@auckland.ac.nz.
authors.forename: Ralph
authors.initials: R
authors.lastname: Maddison
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001315:Australia; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D063731:Mobile Applications; D009520:New Zealand; D010809:Physical Fitness; D000068997:Smartphone