title: Apps for IMproving FITness and Increasing Physical Activity Among Young People: The AIMFIT Pragmatic Randomized Controlled Trial.
abstract: BACKGROUND
  Given the global prevalence of insufficient physical activity (PA), effective interventions that attenuate age-related decline in PA levels are needed. Mobile phone interventions that positively affect health (mHealth) show promise; however, their impact on PA levels and fitness in young people is unclear and little is known about what makes a good mHealth app.
  
  
  OBJECTIVE
  The aim was to determine the effects of two commercially available smartphone apps (Zombies, Run and Get Running) on cardiorespiratory fitness and PA levels in insufficiently active healthy young people. A second aim was to identify the features of the app design that may contribute to improved fitness and PA levels.
  
  
  METHODS
  Apps for IMproving FITness (AIMFIT) was a 3-arm, parallel, randomized controlled trial conducted in Auckland, New Zealand. Participants were recruited through advertisements in electronic mailing lists, local newspapers, flyers posted in community locations, and presentations at schools. Eligible young people aged 14-17 years were allocated at random to 1 of 3 conditions: (1) use of an immersive app (Zombies, Run), (2) use of a nonimmersive app (Get Running), or (3) usual behavior (control). Both smartphone apps consisted of a fully automated 8-week training program designed to improve fitness and ability to run 5 km; however, the immersive app featured a game-themed design and narrative. Intention-to-treat analysis was performed using data collected face-to-face at baseline and 8 weeks, and all regression models were adjusted for baseline outcome value and gender. The primary outcome was cardiorespiratory fitness, objectively assessed as time to complete the 1-mile run/walk test at 8 weeks. Secondary outcomes were PA levels (accelerometry and self-reported), enjoyment, psychological need satisfaction, self-efficacy, and acceptability and usability of the apps.
  
  
  RESULTS
  A total of 51 participants were randomized to the immersive app intervention (n=17), nonimmersive app intervention (n=16), or the control group (n=18). The mean age of participants was 15.7 (SD 1.2) years; participants were mostly NZ Europeans (61%, 31/51) and 57% (29/51) were female. Overall retention rate was 96% (49/51). There was no significant intervention effect on the primary outcome using either of the apps. Compared to the control, time to complete the fitness test was -28.4 seconds shorter (95% CI -66.5 to 9.82, P=.20) for the immersive app group and -24.7 seconds (95% CI -63.5 to 14.2, P=.32) for the nonimmersive app group. No significant intervention effects were found for secondary outcomes.
  
  
  CONCLUSIONS
  Although apps have the ability to increase reach at a low cost, our pragmatic approach using readily available commercial apps as a stand-alone instrument did not have a significant effect on fitness. However, interest in future use of PA apps is promising and highlights a potentially important role of these tools in a multifaceted approach to increase fitness, promote PA, and consequently reduce the adverse health outcomes associated with insufficient activity.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry: ACTRN12613001030763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12613001030763 (Archived by WebCite at http://www.webcitation.org/6aasfJVTJ).
authors: Faculty of Medical and Health Sciences, National Institute for Health Innovation, University of Auckland, Auckland, New Zealand. a.direito@auckland.ac.nz.
authors: Artur
authors: http://orcid.org/0000-0002-2236-8506
authors: A
authors: Direito
authors: Yannan
authors: http://orcid.org/0000-0002-7663-9164
authors: Y
authors: Jiang
authors: Robyn
authors: http://orcid.org/0000-0003-0901-9149
authors: R
authors: Whittaker
authors: Ralph
authors: http://orcid.org/0000-0001-8564-5518
authors: R
authors: Maddison
mesh_terms: D000293:Adolescent; D001315:Australia; D003142:Communication; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D063731:Mobile Applications; D009043:Motor Activity; D009520:New Zealand; D020377:Self Efficacy; D000068997:Smartphone; D012985:Software Design; D017216:Telemedicine
keywords: adolescent; exercise; health promotion; mHealth; mobile applications; motor activity; physical activity; physical fitness; smartphone; telemedicine