title: International Mobile-Health Intervention on Physical Activity, Sitting, and Weight: The Stepathlon Cardiovascular Health Study.
abstract: Although proof-of-concept for mobile health (mHealth) life-style programs targeting physical inactivity and overweight/obesity has been established in randomized trials, the feasibility and effect of a globally distributed, large-scale, mass-participation mHealth implementation has not been investigated.
  
  
  
  The purpose of this study was to determine the effect of Stepathlon, an international, low-cost, mass-participation mHealth intervention, on physical activity, sitting, and weight.
  
  
  
  We prospectively collected cohort data from participants completing Stepathlon, an annual 100-day global event in 2012, 2013, and 2014. Participants were organized in worksite-based teams, issued pedometers, and encouraged to increase daily steps and physical activity as part of the team-based race. The program was conducted via an interactive multiplatform application available on mobile devices and the Internet. Analysis was performed according to a pre-specified plan.
  
  
  
  A total of 69,219 subjects participated (481 employers, 1,481 cities, 64 countries, all populated continents, age 36 ± 9 years, 23.9% female, 8.0% high-income countries, and 92.0% lower-middle income countries). After Stepathlon completion, participants recorded improved step count (+3,519 steps/day; 95% confidence interval [CI]: 3,484 to 3,553 steps/day; p < 0.0001), exercise days (+0.89 days; 95% CI: 0.87 to 0.92 days; p < 0.0001), sitting duration (-0.74 h; 95% CI: -0.78 to -0.71 h; p < 0.0001) and weight (-1.45 kg; 95% CI: -1.53 to -1.38 kg; p < 0.0001). Improvements occurred in women and men, in all geographic regions, and in both high and lower-middle income countries, and the results were reproduced in 2012, 2013, and 2014 cohorts. Predictors of weight loss included step increase, sitting duration decrease, and increase in exercise days (all p < 0.0001).
  
  
  
  Distributed mHealth implementation of a low-cost life-style intervention is associated with short-term, reproducible, large-scale improvements in physical activity, sitting, and weight. (Effect of the Stepathlon Pedometer Program on Physical Activity, Weight and Well-Being; ACTRN12615001310550).
authors.affiliation: School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia. Electronic address: anand.ganesan@flinders.edu.au.
authors.forename: Anand N
authors.initials: AN
authors.lastname: Ganesan
authors.affiliation: Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia.
authors.forename: Jennie
authors.initials: J
authors.lastname: Louise
authors.affiliation: Health Systems Research, South Australian Health and Medical Research Institute, Adelaide, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Horsfall
authors.affiliation: Stepathlon Private Limited, Mumbai, India.
authors.forename: Shane A
authors.initials: SA
authors.lastname: Bilsborough
authors.affiliation: Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Health Systems Research, South Australian Health and Medical Research Institute, Adelaide, Australia.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hendriks
authors.affiliation: School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: McGavigan
authors.affiliation: School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia; Health Systems Research, South Australian Health and Medical Research Institute, Adelaide, Australia.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Selvanayagam
authors.affiliation: School of Medicine, Flinders University of South Australia, Adelaide, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia; Health Systems Research, South Australian Health and Medical Research Institute, Adelaide, Australia.
authors.forename: Derek P
authors.initials: DP
authors.lastname: Chew
mesh_terms: D061725:Accelerometry / Q000295:instrumentation; D000328:Adult; D001835:Body Weight; D015331:Cohort Studies; D015444:Exercise; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D038622:Internationality; D008297:Male; D009765:Obesity / Q000517:prevention & control; D057185:Sedentary Behavior; D017216:Telemedicine; D015431:Weight Loss
keywords: mobile health; physical activity; prevention; sitting; weight loss