title: Short-Term Effectiveness of a Mobile Phone App for Increasing Physical Activity and Adherence to the Mediterranean Diet in Primary Care: A Randomized Controlled Trial (EVIDENT II Study).
abstract: The use of mobile phone apps for improving lifestyles has become generalized in the population, although little is still known about their effectiveness in improving health.
  
  
  
  We evaluate the effect of adding an app to standard counseling on increased physical activity (PA) and adherence to the Mediterranean diet, 3 months after implementation.
  
  
  
  A randomized, multicenter clinical trial was carried out. A total of 833 participants were recruited in six primary care centers in Spain through random sampling: 415 in the app+counseling group and 418 in the counseling only group. Counseling on PA and the Mediterranean diet was given to both groups. The app+counseling participants additionally received training in the use of an app designed to promote PA and the Mediterranean diet over a 3-month period. PA was measured with the 7-day Physical Activity Recall (PAR) questionnaire and an accelerometer; adherence to the Mediterranean diet was assessed using the Mediterranean Diet Adherence Screener questionnaire.
  
  
  
  Participants were predominantly female in both the app+counseling (249/415, 60.0%) and counseling only (268/418, 64.1%) groups, with a mean age of 51.4 (SD 12.1) and 52.3 (SD 12.0) years, respectively. Leisure-time moderate-to-vigorous physical activity (MVPA) by 7-day PAR increased in the app+counseling (mean 29, 95% CI 5-53 min/week; P=.02) but not in the counseling only group (mean 17.4, 95% CI -18 to 53 min/week; P=.38). No differences in increase of activity were found between the two groups. The accelerometer recorded a decrease in PA after 3 months in both groups: MVPA mean -55.3 (95% CI -75.8 to -34.9) min/week in app+counseling group and mean -30.1 (95% CI -51.8 to -8.4) min/week in counseling only group. Adherence to the Mediterranean diet increased in both groups (8.4% in app+counseling and 10.4% in counseling only group), with an increase in score of 0.42 and 0.53 points, respectively (P<.001), but no difference between groups (P=.86).
  
  
  
  Leisure-time MVPA increased more in the app+counseling than counseling only group, although no difference was found when comparing the increase between the two groups. Counseling accompanied by printed materials appears to be effective in improving adherence to the Mediterranean diet, although the app does not increase adherence.
  
  
  
  Clinicaltrials.gov NCT02016014; https://clinicaltrials.gov/ct2/show/NCT02016014 (Archived by WebCite at http://www.webcitation.org/6mnopADbf).
authors.affiliation: Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Salamanca, Spain.|University of Salamanca, Department of Nursing and Physiotherapy, Salamanca, Spain.
authors.forename: Jose I
authors.identifier: 0000-0002-3772-8746
authors.initials: JI
authors.lastname: Recio-Rodriguez
authors.affiliation: Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Salamanca, Spain.
authors.forename: Cristina
authors.identifier: 0000-0002-9381-4024
authors.initials: C
authors.lastname: Agudo-Conde
authors.affiliation: Primary Health Care University Research Institute IDIAP-Jordi Gol, Passeig de Sant Joan Health Center, Catalan Health Service, Department of Medicine. University Autonoma of Barcelona, Barcelona, Spain.
authors.forename: Carlos
authors.identifier: 0000-0003-0656-8126
authors.initials: C
authors.lastname: Martin-Cantera
authors.affiliation: Torre Ramona Health Center, Aragon Health Service, Zaragoza, Spain.
authors.forename: Mª Natividad
authors.identifier: 0000-0003-2299-2410
authors.initials: MN
authors.lastname: González-Viejo
authors.affiliation: Casa del Barco Health Center, Castilla y León Health Service, Valladolid, Spain.
authors.forename: Mª Del Carmen
authors.identifier: 0000-0003-3541-6359
authors.initials: MD
authors.lastname: Fernandez-Alonso
authors.affiliation: Primary Health Care Research Unit of Bizkaia.Basque Health Service-Osakidetza, Bilbao, Spain.
authors.forename: Maria Soledad
authors.identifier: 0000-0001-8747-6789
authors.initials: MS
authors.lastname: Arietaleanizbeaskoa
authors.affiliation: Río Tajo Health Center, Castilla-La Mancha Health Service, University of Castilla-La Mancha, Talavera de la Reina, Spain.
authors.forename: Yolanda
authors.identifier: 0000-0001-7838-9931
authors.initials: Y
authors.lastname: Schmolling-Guinovart
authors.affiliation: Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Salamanca, Spain.
authors.forename: Jose-Angel
authors.identifier: 0000-0001-7544-8684
authors.initials: JA
authors.lastname: Maderuelo-Fernandez
authors.affiliation: Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Salamanca, Spain.|University of Salamanca, Department of Medicine, Salamanca, Spain.
authors.forename: Emiliano
authors.identifier: 0000-0003-3667-7155
authors.initials: E
authors.lastname: Rodriguez-Sanchez
authors.affiliation: Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Salamanca, Spain.|University of Salamanca, Department of Medicine, Salamanca, Spain.
authors.forename: Manuel A
authors.identifier: 0000-0003-0133-6123
authors.initials: MA
authors.lastname: Gomez-Marcos
authors.affiliation: Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Salamanca, Spain.|University of Salamanca, Department of Biomedical and Diagnostic Sciences, Salamanca, Spain.
authors.forename: Luis
authors.identifier: 0000-0001-6555-8302
authors.initials: L
authors.lastname: Garcia-Ortiz
authors.affiliation: EVIDENT Investigators. redIAPP: Spanish Research Network for Preventive Activities and Health Promotion in Primary Care, Salamanca, Spain.
mesh_terms: D003376:Counseling / Q000379:methods; D038441:Diet, Mediterranean; D015444:Exercise / Q000502:physiology*; D005260:Female; D015438:Health Behavior; D000070497:Healthy Lifestyle; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications
keywords: arterial aging; food; information and communication technologies; physical activity