“Hello, Mrs. Jones. Your goal last time we talked was to do 30 minutes per day of brisk walking five days per week. Were you able to reach this goal?"
In 2007, Stanford researchers showed in a study of 218 older, inactive adults that computer-generated phone calls appeared to be an effective, low-cost way to encourage sedentary adults to exercise. In the trial, those participants in both the group called by trained health educators and the group called by a computer asking questions like the one above and delivering an interactive, individualized program wound up completing a regular 150-minute per week exercise program.
Now Abby King, PhD, and colleagues have found that the increases in regular physical activity seen during the year-long study were maintained in a subsequent six-month follow-up period – regardless of whether the participants had received human or automated advisor-initiated telephone contacts during those first 12 months. In looking at the trajectory of physical activity change over 18 months, the researchers also saw that the greatest physical activity increases for participants occurred during the first six months of intervention.
I recently discussed these findings with King, who told me that while advice and support is often important in maintaining healthy behaviors, "it doesn't necessarily have to be delivered in person or by a human at all." Below King talks more about the study, which appears online in the journal Health Psychology.
How significant is it that participants in the study – regardless of the intervention they received – were able to maintain their healthy habits? Were you surprised by what you found?
Given that participants in such programs tend to decrease their physical activity levels when instructor-initiated support ends, it is quite encouraging to see that both groups were able to "step up" and take charge of their programs during the maintenance period. Both groups received specific information from their physical activity advisors on how to do this during the initial program.
Your results also show the importance of the first six months of programming in establishing sustained physical activity change. How critical is this? Has this been shown in other studies, as well?
This study substantiates the observation seen in some of our prior studies as well as in those of others in the field that the initial six months of programming is a "critical period" for establishing the types of behavioral habits and skills necessary for continued behavioral success.
In your paper you and your co-authors call these automated technologies “attractive intervention tools” because of their reach, availability and cost. Can you explain how they might be beneficial in less-developed countries, where trained health educators are not in large supply?
The growing pervasiveness of mobile phones worldwide, particularly in less-developed countries, sets the stage for a "paradigm shift" with respect to how evidence-based health promotion programs can reach individuals regardless of where they live. Tele-health and the use of automated communication technologies allow for the types of "borderless health promotion" that can potentially make a substantive difference in the health promotion field worldwide.
What are your next steps? Are you conducting/planning more work in this area?
Based on this study, my group is currently collaborating with Dr. Marcia Stefanick here at Stanford and her colleagues in developing an automated tele-health physical activity coaching program specifically for older women. We have initially piloted the automated program with a group of older women here in the Bay Area, and were quite encouraged by the initial results from that effort. The goal is to be able to reach thousands of older women across the country with an easy to use automated tele-health program that is personalized to their needs and preferences.
Previously: Eat a carrot and exercise – or your iBird dies, Research shows remote weight loss interventions equally effective as face-to-face coaching programs and Monitoring patient wellness from a distance
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