The Relationship Between Alcohol Use And Burnout · technologies to promote a more healthy lifestyle including decreased sedentary activity, increased exercise, and dietary change

6th Canadian Obesity Summit, Ottawa, Ont.

April 26, 2019

Disclosure InformationBradley Tanner, MD, ME

Owner and Employee of Clinical Tools, Inc.

6th Canadian Obesity SummitApril 23-26, 2019, The Westin, Ottawa, Ont.

Elements of Successful Mobile Apps and Serious Games to Instill Lifestyle Change


Objectives

1)Assess the meaning and value of studies of stand alone digital technologies to promote a more healthy lifestyle including decreased sedentary activity, increased exercise, and dietary change.

2)Recognize standards that enhance the potential success of electronically delivered health interventions that provide self-monitoring of weight, food intake, and physical activity.

3)Summarize the potential role of newer technology to enhance motivation, and engage difficult to reach audiences.


The Need for an Intervention






What is Causing the Problem?● Caloric

● excess food quantity - Not the age-old calories in versus calories out

● excess food selection options● poor food selection (sugar/high calorie)● bad match in composition for an individual

(low fat, low carb, etc.)● Activity

● lack of activity,● minimal activity● physical inability to exercise● excessive sitting,● the wrong type of activity,● decreased muscle mass

● Environment● working habits/requirements● light,● media/advertising● lack of exercise options● lack of healthy food options

● Psychological● isolation/Emotional disconnect● emotional eating● eating disorders

● Genetic/prenatal● Mitochondria● maternal diet/weight


What do we know?

● Different interventions address different causes and thus don't fit all users.

● There is not one cause that explains all of obesity

● There are individual causes for obesity in an individual


Audience Input 1

● Have You Used a Fitness or Diet Tracker● Did it work?● Would you recommend it others?


What do we Know about the Value of Technology Interventions

● Tedesco Salvatore, Barton John, O’Flynn Brendan. A Review of Activity Trackers for Senior Citizens: Research Perspectives, Commercial Landscape and the Role of the Insurance Industry. Sensors. June 2017;17(6):1277. doi:10.3390/s17061277.MD

● Robert H Shmerling. Activity trackers: Can they really help you get fit?. Harvard Health Blog. October 23, 2017.● Ellingson Laura D, Lansing Jeni E, DeShaw Kathryn J, et al. Evaluating Motivational Interviewing and Habit Formation to Enhance the Effect of

Activity Trackers on Healthy Adults’ Activity Levels: Randomized Intervention. JMIR Mhealth Uhealth. February 14, 2019;7(2):e10988. Doi:10.2196/10988.

● McCallum Claire, Rooksby John, Gray Cindy M. Evaluating the Impact of Physical Activity Apps and Wearables: Interdisciplinary Review. JMIR Mhealth Uhealth. March 23, 2018;6(3):e58. doi:10.2196/mhealth.9054.

● Jang Il-Young, Kim Hae Reong, Lee Eunju, et al. Impact of a Wearable Device-Based Walking Programs in Rural Older Adults on Physical Activity and Health Outcomes: Cohort Study. JMIR Mhealth Uhealth. November 21, 2018;6(11):e11335. Doi:10.2196/11335.

● Schaben Jodee A, Furness Stacy. Investing in college students: the role of the fitness tracker. DIGITAL HEALTH. January 1, 2018;4:2055207618766800. doi:10.1177/2055207618766800.

● Buckingham Sarah Ann, Williams Andrew James, Morrissey Karyn, Price Lisa, Harrison John. Mobile Health Interventions to Promote Physical Activity and Reduce Sedentary Behaviour in the Workplace: A Systematic Review. Digit Health. December 2019;5:2055207619839883. doi:10.1177/2055207619839883.

● Henriksen André, Haugen Mikalsen Martin, Woldaregay Ashenafi Zebene, et al. Using Fitness Trackers and Smartwatches to Measure Physical Activity in Research: Analysis of Consumer Wrist-Worn Wearables. J Med Internet Res. 22 2018;20(3):e110. doi:10.2196/jmir.9157.

● Walden C, Sell A. Wearables and Wellness for the Young Elderly - Transforming Everyday Lives?. 2017.


What About the Studies?● Wise Jacqui. Activity trackers, even with cash incentives, do not improve health. BMJ. October 5, 2016;355:i5392. doi:10.1136/bmj.i5392.● Jakicic John M, Davis Kelliann K, Rogers Renee J, et al. Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight

Loss: The IDEA Randomized Clinical Trial. JAMA. September 20, 2016;316(11):1161-1171. doi:10.1001/jama.2016.12858.● Finkelstein Eric A, Haaland Benjamin A, Bilger Marcel, et al. Effectiveness of activity trackers with and without incentives to increase physical activity

(TRIPPA): a randomised controlled trial. The Lancet Diabetes & Endocrinology. December 1, 2016;4(12):983-995. doi:10.1016/S2213-8587(16)30284-4.● Polgreen Linnea A, Anthony Christopher, Carr Lucas, et al. The Effect of Automated Text Messaging and Goal Setting on Pedometer Adherence and

Physical Activity in Patients with Diabetes: A Randomized Controlled Trial. PLoS ONE. 2018;13(5):e0195797. doi:10.1371/journal.pone.0195797.● Sloan Robert A, Kim Youngdeok, Sahasranaman Aarti, Müller-Riemenschneider Falk, Biddle Stuart JH, Finkelstein Eric A. The Influence of a

Consumer-Wearable Activity Tracker on Sedentary Time and Prolonged Sedentary Bouts: Secondary Analysis of a Randomized Controlled Trial. BMC Res Notes. March 22, 2018;11(1):189. doi:10.1186/s13104-018-3306-9.

● Buis Lorraine R, McCant Felicia A, Gierisch Jennifer M, et al. Understanding the Effect of Adding Automated and Human Coaching to a Mobile Health Physical Activity App for Afghanistan and Iraq Veterans: Protocol for a Randomized Controlled Trial of the Stay Strong Intervention. JMIR Res Protoc. January 29, 2019;8(1). doi:10.2196/12526.

● Brakenridge Charlotte L, Healy Genevieve N, Winkler Elisabeth Ah, Fjeldsoe Brianna S. Usage, Acceptability, and Effectiveness of an Activity Tracker in a Randomized Trial of a Workplace Sitting Intervention: Mixed-Methods Evaluation. Interact J Med Res. March 2, 2018;7(1):e5. doi:10.2196/ijmr.9001.

● DiFrancisco-Donoghue Joanne, Jung Min-Kyung, Stangle Alexander, et al. Utilizing Wearable Technology to Increase Physical Activity in Future Physicians: A Randomized Trial. Prev Med Rep. December 2018;12:122-127. doi:10.1016/j.pmedr.2018.09.004.


Why don’t they work?

● Neuroscience – Change is hard!


Technological Solutions Disappoint or Fail – Until they Succeed

● 1900s - Everything has been invented● Internet crash - “all a bubble” -> Google/Facebook ● Phone -> iPhone● Car -> Uber -> Autonomous Car● VR/AR, Multiplayer Games/Alexa/Ok Google


What is so Great About Technology?

● less expensive● capture data● interactive● adaptive● consistent experience● scalable

● already there● potentially useful elsewhere● patient● science-based● reliable● 24 hour model. I'd say

24/7/365 model


We Need an Individually Tailored Technological Solution

● Customizing the lifestyle change to the needs and capabilities of the intended user– activity– dietary choice– water/hydration– sleep


Potential Solution

● Engages older adults (aged 65 to 75, no major chronic illness) in an online simulation to build a plan for long-lasting change related to diet and physical activity.

● This population is in a life transition period and need to establish dietary/exercise habits that maximize health.


● A PC/Unity interface identifies specific personal/provider-based health concerns to target.

● The software is essential to creating a comprehensive, and tailored experience that adjusts for individual, age, gender, and racial/ethnic variation.

The Power Of Unity/C#


● User completes 5 to 8 brief (approximately 5 minute) scenario-based PC experiences patterned after “first/third-person thinker” games.

● Each includes role-playing characters, challenges, and decision-making opportunities for choices based on their health concerns.

User Experience


1) Before starting the scenario, older adults complete a short activity to specify concerns or barriers and customize the scenario experience. For example, before ● activity scenarios, they may highlight inexperience, exercise

intolerance, health conditions, or anxiety. ● scenarios on healthy eating, they may specify concerns

about food allergies, expense, or availability.

Scenario-based PC experiences


1) Before starting the scenario,

2) In the scenario, the user faces challenges in making changes and decisions that affect in-game health. In the process, they experience a mirror of how these health factors, hurdles, and potential outcomes may play out in real life as they identify strategies and develop confidence.



1) Before starting the scenario,

2) In the scenario,

3) After each scenario a debriefing summarizes the experience and solidifies lessons learned. The user adds potential lifestyle changes to an evolving list of real-world goals and changes.



● Prioritize and select from the list created in the debriefing to form a lifestyle-change strategy and action plan.

Artificial Intelligence and Pulling it Together


● Voice-first technology (Amazon Alexa) to support positive diet and lifestyle choices for prevention in older adults

We Need a Novel Way to Deliver the Intervention


● Interact with the Alexa system to enhance real-world habit formation and longer-term changes through prompts, daily check-ins, and resources

Alexa Experience Overview


1) Time-based prompts to implement a change, such as to exercise, get up and move, eat at a particular time, prepare a specific type of food, track vital signs, or implement other changes.

2) Immediate positive feedback and reminders to address dietary health risks, nutritional choices, and physical inactivity or low physical activity.

3) Progress reports showing changes over time and goal accomplishments including visual support if the older adult has the video version of Alexa.

4)I Social connection to enhance support.

Alexa Experience Elements


Current Status

● Concept – Funding proposal submitted● Consultants and Academic Partners

Welcome!


Don’t Give Up Hope! Thanks!

Documents

The Relationship Between Alcohol Use And Burnout · technologies to promote a more healthy lifestyle including decreased sedentary activity, increased exercise, and dietary change