***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Office workers engage in high levels of sitting time . Effective , context -specific , and scalable strategies are needed to support widespread sitting reduction . This study aim ed to evaluate organisational-support strategies alone or in combination with an activity tracker to reduce sitting in office workers . Methods From one organisation , 153 desk-based office workers were cluster-r and omised ( by team ) to organisational support only ( e.g. , manager support , emails ; ‘ Group ORG ’ , 9 teams , 87 participants ) , or organisational support plus LUMOback activity tracker ( ‘ Group ORG + Tracker ’ , 9 teams , 66 participants ) . The waist-worn tracker provided real-time feedback and prompts on sitting and posture . ActivPAL3 monitors were used to ascertain primary outcomes ( sitting time during work- and overall hours ) and other activity outcomes : prolonged sitting time ( ≥30 min bouts ) , time between sitting bouts , st and ing time , stepping time , and number of steps . Health and work outcomes were assessed by question naire . Changes within each group ( three- and 12 months ) and differences between groups were analysed by linear mixed models . Missing data were multiply imputed . Results At baseline , participants ( 46 % women , 23–58 years ) spent ( mean ± SD ) 74.3 ± 9.7 % of their workday sitting , 17.5 ± 8.3 % st and ing and 8.1 ± 2.7 % stepping . Significant ( p < 0.05 ) reductions in sitting time ( both work and overall ) were observed within both groups , but only at 12 months . For secondary activity outcomes , Group ORG significantly improved in work prolonged sitting , time between sitting bouts and st and ing time , and overall prolonged sitting time ( 12 months ) , and in overall st and ing time ( three- and 12 months ) ; while Group ORG + Tracker , significantly improved in work prolonged sitting , st and ing , stepping and overall st and ing time ( 12 months ) . Adjusted for confounders , the only significant between-group differences were a greater stepping time and step count for Group ORG + Tracker relative to Group ORG ( + 20.6 min/16 h day , 95 % CI : 3.1 , 38.1 , p = 0.021 ; + 846.5steps/16 h day , 95 % CI : 67.8 , 1625.2 , p = 0.033 ) at 12 months . Observed changes in health and work outcomes were small and not statistically significant . Conclusions Organisational-support strategies with or without an activity tracker result ed in improvements in sitting , prolonged sitting and st and ing ; adding a tracker enhanced stepping changes . Improvements were most evident at 12 months , suggesting the organisational-support strategies may have taken time to embed within the organisation . Trial registration Australian New Zeal and Clinical Trial Registry : ACTRN12614000252617 . Registered 10 March 2014 A disconcerting proportion of Canadian nurses are physically inactive and report poor cardiovascular health . Web-based interventions incorporating feedback and group features may represent opportune , convenient , and cost-effective methods for encouraging physical activity ( PA ) in order to improve the levels of PA and cardiovascular health of nurses . The purpose of this parallel-group r and omized trial was to examine the impact of an intervention providing participants with feedback from an activity monitor coupled with a web-based individual , friend or team PA challenge , on the PA and cardiovascular health of nurses working in a cardiovascular setting . Methods : Nurses were r and omly assigned in a 1:1:1 ratio to one of the following intervention “ challenge ” groups : ( 1 ) individual , ( 2 ) friend or ( 3 ) team . Nurses wore a Tractivity ® activity monitor throughout a baseline week and 6-week intervention . Height , body mass , body fat percentage , waist circumference , resting blood pressure ( BP ) and heart rate were assessed , and body mass index ( BMI ) was calculated , during baseline and within 1 week post-intervention . Data were analyzed using descriptive statistics and general linear model procedures for repeated measures . Results : 76 nurses ( 97 % female ; age : 46 ± 11 years ) participated . Weekly moderate-to-vigorous intensity PA ( MVPA ) changed over time ( F = 4.022 , df = 4.827 , p = 0.002 , η2 = 0.055 ) , and was greater during intervention week 2 when compared to intervention week 6 ( p = 0.011 ) . Daily steps changed over time ( F = 7.668 , df = 3.910 , p < 0.001 , η2 = 0.100 ) , and were greater during baseline and intervention weeks 1 , 2 , 3 , and 5 when compared to intervention week 6 ( p < 0.05 ) . No differences in weekly MVPA or daily steps were observed between groups ( p > 0.05 ) . No changes in body mass , BMI or waist circumference were observed within or between groups ( p > 0.05 ) . Decreases in body fat percentage ( −0.8 ± 4.8 % , p = 0.015 ) and resting systolic BP ( −2.6 ± 8.8 mmHg , p = 0.019 ) were observed within groups , but not between groups ( p > 0.05 ) . Conclusions : A web-based intervention providing feedback and a PA challenge initially impacted the PA , body fat percentage and resting systolic BP of nurses working in a cardiovascular setting , though increases in PA were short-lived . The nature of the PA challenge did not differentially impact outcomes . Alternative innovative strategies to improve and sustain  nurses ' PA  should be developed and their effectiveness evaluated Purpose : To evaluate the effect of lottery-based financial incentives in increasing physical activity . Design : R and omized , controlled trial . Setting : University of Pennsylvania Employees . Participants : A total of 209 adults with body mass index ≥27 . Interventions : All participants used smartphones to track activity , were given a goal of 7000 steps per day , and received daily feedback on performance for 26 weeks . Participants r and omly assigned to 1 of the 3 intervention arms received a financial incentive for 13 weeks and then were followed for 13 weeks without incentives . Daily lottery incentives were design ed as a “ higher frequency , smaller reward ” ( 1 in 4 chance of winning $ 5 ) , “ jackpot ” ( 1 in 400 chance of winning $ 500 ) , or “ combined lottery ” ( 18 % chance of $ 5 and 1 % chance of $ 50 ) . Measures : Mean proportion of participant days step goals were achieved . Analysis : Multivariate regression . Results : During the intervention , the unadjusted mean proportion of participant days that goal was achieved was 0.26 in the control arm , 0.32 in the higher frequency , smaller reward lottery arm , 0.29 in the jackpot arm , and 0.38 in the combined lottery arm . In adjusted models , only the combined lottery arm was significantly greater than control ( P = .01 ) . The jackpot arm had a significant decline of 0.13 ( P < .001 ) compared to control . There were no significant differences during follow-up . Conclusions : Combined lottery incentives were most effective in increasing physical activity Background The benefits of physical activity are well documented , but scalable programs to promote activity are needed . Interventions that assign tailored and dynamically adjusting goals could effect significant increases in physical activity but have not yet been implemented at scale . Objective Our aim was to examine the effectiveness of an open access , Internet-based walking program that assigns daily step goals tailored to each participant . Methods A two-arm , pragmatic r and omized controlled trial compared the intervention to no treatment .  Participants were recruited from a workplace setting and r and omized to a no-treatment control ( n=133 ) or to treatment ( n=132 ) . Treatment participants received a free wireless activity tracker and enrolled in the walking program , Walkadoo .  Assessment s were fully automated : activity tracker recorded primary outcomes ( steps ) without intervention by the participant or investigators . The two arms were compared on change in steps per day from baseline to follow-up ( after 6 weeks of treatment ) using a two-tailed independent sample s t test . Results Participants ( N=265 ) were 66.0 % ( 175/265 ) female with an average age of 39.9 years . Over half of the participants ( 142/265 , 53.6 % ) were sedentary ( < 5000 steps/day ) and 44.9 % ( 119/265 ) were low to somewhat active ( 5000 - 9999 steps/day ) . The intervention group significantly increased their steps by 970 steps/day over control ( P<.001 ) , with treatment effects observed in sedentary ( P=.04 ) and low-to-somewhat active ( P=.004 ) participants alike . Conclusions The program is effective in increasing daily steps .  Participants benefited from the program regardless of their initial activity level . A tailored , adaptive approach using wireless activity trackers is realistically implementable and scalable . Trial Registration Clinical trials.gov NCT02229409 , https:// clinical trials.gov/ct2/show/NCT02229409 ( Archived by WebCite at http://www.webcitation.org/6eiWCvBYe BACKGROUND Despite the increasing popularity of activity trackers , little evidence exists that they can improve health outcomes . We aim ed to investigate whether use of activity trackers , alone or in combination with cash incentives or charitable donations , lead to increases in physical activity and improvements in health outcomes . METHODS In this r and omised controlled trial , employees from 13 organisations in Singapore were r and omly assigned ( 1:1:1:1 ) with a computer generated assignment schedule to control ( no tracker or incentives ) , Fitbit Zip activity tracker , tracker plus charity incentives , or tracker plus cash incentives .  Participants had to be English speaking , full-time employees , aged 21 - 65 years , able to walk at least ten steps continuously , and non-pregnant . Incentives were tied to weekly steps , and the primary outcome , moderate-to-vigorous physical activity ( MVPA ) bout min per week , was measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months ( end of intervention ) and 12 months ( after a 6 month post-intervention follow-up period ) . Other outcome measures included steps , participants meeting 70 000 steps per week target , and health-related outcomes including weight , blood pressure , and quality -of-life measures . This trial is registered at Clinical Trials.gov , number NCT01855776 . FINDINGS Between June 13 , 2013 , and Aug 15 , 2014 , 800 participants were recruited and r and omly assigned to the control ( n=201 ) , Fitbit ( n=203 ) , charity ( n=199 ) , and cash ( n=197 ) groups . At 6 months , compared with control , the cash group logged an additional 29 MVPA bout min per week ( 95 % CI 10 - 47 ; p=0·0024 ) and the charity group an additional 21 MVPA bout min per week ( 2 - 39 ; p=0·0310 ) ; the difference between Fitbit only and control was not significant ( 16 MVPA bout min per week [ -2 to 35 ; p=0·0854 ] ) . Increases in MVPA bout min per week in the cash and charity groups were not significantly greater than that of the Fitbit group . At 12 months , the Fitbit group logged an additional 37 MVPA bout min per week ( 19 - 56 ; p=0·0001 ) and the charity group an additional 32 MVPA bout min per week ( 12 - 51 ; p=0·0013 ) compared with control ; the difference between cash and control was not significant ( 15 MVPA bout min per week [ -5 to 34 ; p=0·1363 ] ) . A decrease in physical activity of -23 MVPA bout min per week ( 95 % CI -42 to -4 ; p=0·0184 ) was seen when comparing the cash group with the Fitbit group . There were no improvements in any health outcomes ( weight , blood pressure , etc ) at either assessment . INTERPRETATION The cash incentive was most effective at increasing MVPA bout min per week at 6 months , but this effect was not sustained 6 months after the incentives were discontinued . At 12 months , the activity tracker with or without charity incentives were effective at stemming the reduction in MVPA bout min per week seen in the control group , but we identified no evidence of improvements in health outcomes , either with or without incentives , calling into question the value of these devices for health promotion . Although other incentive strategies might generate greater increases in step activity and improvements in health outcomes , incentives would probably need to be in place long term to avoid any potential decrease in physical activity result ing from discontinuation . FUNDING Ministry of Health , Singapore Background Self – reported physical activity has been inversely associated with mortality but the effect of objective ly measured step activity on mortality has never been evaluated . The objective is to determine the prospect i ve association of daily step activity on mortality  among free-living adults . Methods and Findings Cohort study of free-living adults residing in Tasmania , Australia between 2000 and 2005 who participated in one of three cohort studies ( n = 2 576 total participants ) . 
    Output:
    
While overall acceptability was high , a large decline in technology use and engagement was observed over time .
Conclusions While method ological quality was generally weak , there is reasonable evidence for mHealth in a workplace context as a feasible , acceptable and effective tool to promote PA .
The impact in the longer term and on SB is less clear .