***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: Purpose . Increase physical activity in health care employees using health messaging , and compare e-mail with mobile phone short-message service ( SMS ) as delivery channels . Design . R and omized controlled trial Setting . U.K. hospital workplace . Subjects . Two hundred ninety-six employees ( 19–67 years , 53 % of study Web site visitors ) . Intervention . Twelve-week messaging intervention design ed to increase physical activity and delivered via SMS ( n = 147 ) or e-mail ( n = 149 ) ; content tailored using theory of planned behavior ( TPB ) and limited to 160 characters . Measures . Baseline and 6 , 12 , and 16 weeks . Online measures included TPB constructs , physical activity behavior on the Global Physical Activity Question naire , and health-related quality of life on the Short-Form 12 . Analysis . General linear models for repeated measures . Results . Increase in duration ( mean h/d ) of moderate work-related activity and moderate recreational activity from baseline to 16 weeks . Short-lived increase in frequency ( d/wk ) of vigorous recreational activity from baseline to 6 weeks . Increase in duration and frequency of active travel from baseline to 16 weeks . E-mails generated greater changes than SMS in active travel and moderate activity ( work and recreational ) . Conclusion . Minimal physical activity promotion delivered by SMS or e-mail can increase frequency and duration of active travel and duration of moderate intensity physical activity at work and for leisure , which is maintained up to 1 month after messaging ends . Both channels were useful platforms for health communication ; e-mails were particularly beneficial with hospital employees Background The Internet has potential as a medium for health behavior change programs , but no controlled studies have yet evaluated the impact of a fully automated physical activity intervention over several months with real-time objective feedback from a monitor . Objective The aim was to evaluate the impact of a physical activity program based on the Internet and mobile phone technology provided to individuals for 9 weeks . Methods A single-center , r and omized , stratified controlled trial was conducted from September to December 2005 in Bedfordshire , United Kingdom , with 77 healthy adults whose mean age was 40.4 years ( SD = 7.6 ) and mean body mass index was 26.3 ( SD = 3.4 ) . Participants were r and omized to a test group that had access to an Internet and mobile phone – based physical activity program  ( n = 47 ) or to a control group ( n = 30 ) that  received no support . The test group received tailored solutions for perceived barriers , a schedule to plan weekly exercise sessions with mobile phone and email reminders , a message board to share their experiences with others , and feedback on their level of physical activity . Both groups were issued a wrist-worn accelerometer to monitor their level of physical activity ;  only the test group received real-time feedback via the Internet . The main outcome measures were accelerometer data and self-report of physical activity . Results At the end of the study period , the test group reported a significantly greater increase over baseline than did the control group for perceived control ( P < .001 ) and intention/expectation to exercise ( P < .001 ) . Intent-to-treat analyses of both the accelerometer data ( P = .02 ) and leisure time self-report data ( P = .03 ) found a higher level of moderate physical activity in the test group . The average increase ( over the control group ) in accelerometer-measured moderate physical activity was 2 h 18 min per week . The test group also lost more percent body fat than the control group ( test group : −2.18 , SD = 0.59 ; control group : −0.17 , SD = 0.81 ; P = .04 ) . Conclusions A fully automated Internet and mobile phone – based motivation and action support system can significantly increase and maintain the level of physical activity in healthy adults The main objective of this pilot study was to test the effectiveness of an  online , interactive physical activity intervention that also incorporated gaming components . The intervention design included an activity planner , progress monitoring , and gamification components and used SMS text as a secondary delivery channel and feedback to improve engagement in the intervention content . Healthy adults ( n = 21 ) recruited through ads in local newspapers ( age 35–73 ) were r and omized to the intervention or the control condition . Both groups reported physical activity using daily report forms in four registration weeks during the three-month study : only the experiment condition received access to the intervention . Analyses showed that the intervention group had significantly more minutes of physical activity in weeks five and nine . We also found a difference in the intensity of exercise in week five . Although the intervention group reported more minutes of physical activity at higher intensity levels , we were not able to find a significant effect at the end of the study period . In conclusion , this study adds to the research on the effectiveness of using the Internet and SMS text messages for delivering physical activity interventions and supports gamification as a viable intervention tool Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors . Despite an explosion of mobile phone applications aim ed at physical activity and other health behaviors , few have been based on theoretically derived constructs and empirical evidence . Eighty adults ages 45 years and older who were insufficiently physically active , engaged in prolonged daily sitting , and were new to smartphone technology , participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence . An “ analytically ” framed custom application focused on personalized goal setting , self-monitoring , and active problem solving around barriers to behavior change . A “ socially ” framed custom application focused on social comparisons , norms , and support . An “ affectively ” framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar , whose movements and behaviors reflected the physical activity and sedentary levels of the user . To explore the applications ' initial efficacy in changing regular physical activity and leisure-time sitting , behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity question naire and the Australian sedentary behavior question naire . User acceptability of and satisfaction with the applications was explored via a post-intervention user survey . The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period . Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology . Preliminary data exploring sustained use of the applications across a longer time period yielded promising results . The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors Objective To determine the feasibility and efficacy of a six-month , cell phone-based exercise persistence intervention for patients with chronic obstructive pulmonary disease ( COPD ) following pulmonary rehabilitation . Methods Participants who completed a two-week run-in were r and omly assigned to either MOBILE-Coached  ( n = 9 ) or MOBILE-Self-Monitored  ( n = 8) . All participants met with a nurse to develop an individualized exercise plan , were issued a pedometer and exercise booklet , and instructed to continue to log their daily exercise and symptoms . MOBILE-Coached also received weekly reinforcement text messages on their cell phones ; reports of worsening symptoms were automatically flagged for follow-up . Usability and satisfaction were assessed . Participants completed incremental cycle and six minute walk ( 6MW ) tests , wore an activity monitor for 14 days , and reported their health-related quality of life ( HRQL ) at baseline , three , and six months . Results The sample had a mean age of 68 ±11 and forced expiratory volume in one second 18 % predicted . Participants reported that logging their exercise and symptoms ( FEV1 ) of 40 ± was easy and that keeping track of their exercise helped them remain active . There were no differences between groups over time in maximal workload , 6MW distance , or HRQL ( p > 0.05 ) ; however , MOBILE-Self-Monitored increased total steps/day whereas MOBILE-Coached logged fewer steps over six months ( p = 0.04 ) . Conclusions We showed that it is feasible to deliver a cell phone-based exercise persistence intervention to patients with COPD post-rehabilitation and that the addition of coaching appeared to be no better than self-monitoring . The latter finding needs to be interpreted with caution since this was a purely exploratory study . Trial registration Clinical Trials.gov ( NCT00373932 ) Objectives To test the effects of adding text messages to weekly email communications on recipients ’ total physical activity ( leisure-time ; workplace ; domestic and garden ; and active transportation ) in employees of universities and colleges in the UK . Methods A r and omised trial with two study groups  ( email only or email plus text messaging for 12 weeks ) was implemented at five workplaces . Data were collected at baseline , immediately after , and four weeks after the intervention . Intervention effects on physical activity were evaluated using latent growth modelling . Results Total physical activity decreased over time in both groups but the decrease was non-significant . The only significant difference between groups was found for workplace physical activity , with the group receiving emails and text messages having a linear decrease of 2.81 Metabolic Equivalent h/week ( β = −0.31 , p = 0.035 ) compared to the email only group . Conclusions Sending employees two additional text messages result ed in less physical activity . Further investigation is needed to underst and whether text messaging may play a beneficial role in promoting physical activity in workplace setting Background 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 . Objective We evaluate the effect of adding an app to st and ard counseling on increased physical activity ( PA )  and adherence to the Mediterranean diet , 3 months after implementation . Methods A r and omized , multicenter clinical trial was carried out . A total of 833 participants were recruited in six primary care centers in Spain through r and om 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 design ed to promote PA and the Mediterranean diet over a 3-month period .  PA was measured with the 7-day  Physical Activity Recall ( PAR ) question naire and an accelerometer ;  adherence to the Mediterranean diet was assessed using the Mediterranean Diet Adherence Screener question naire . Results 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 ) . Conclusions 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 material s appears to be effective in improving adherence to the Mediterranean diet , although the app does not increase adherence . Clinical Trial Clinical trials.gov NCT02016014 ; https:// clinical trials.gov/ct2/show/NCT02016014 ( Archived by WebCite at http://www.webcitation.org/6mnopADbf Background Smartphones are ideal for promoting physical activity in those with little intrinsic motivation for exercise . This study tested three hypotheses : H1 – receipt of social feedback generates higher step-counts than receipt of no feedback ; H2 – receipt of social feedback generates higher step-counts than only receiving feedback on one ’s own walking ; H3 – receipt of feedback on one ’s own walking generates higher step-counts than no feedback ( H3 ) . Methods A parallel group r and omised controlled trial measured the impact of feedback on steps-counts .  Healthy male participants ( n = 165 ) aged 18–40 were given phones pre-installed with an app that recorded steps continuously , without the need for user activation . Participants carried these with them as their main phones for a two-week run-in and six-week trial . R and omisation was to three groups : no feedback ( control ) ; personal feedback on step-counts ; group feedback comparing step-counts against those taken by others in their group . The primary outcome measure , steps per day , was assessed using longitudinal multilevel regression analysis . Control variables included attitude to physical activity and perceived barriers to physical activity . Results Fifty-five participants were allocated to each group ; 152 completed the study and were included in the analysis : n = 49 , no feedback ; n = 53 , individual feedback ; n = 50 , individual and social feedback . The study provided support for H1 and H3 but not H2 . Receipt of either form of feedback explained 7.7 % of between-subject variability in step-count ( F =  
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Furthermore , APP-based interventions were able to increase the number of steps ( p = 0.04 ) and minutes per day of PA ( p = 0.04 ) in adults .
Conclusions Mobile phone-based PA interventions , inclusive those delivery by APP , were effective to increase minutes and steps per day in adults