Multiple Behavior Changes in Diet and Activity: A Randomized Controlled Trial Using Mobile Technology
Open accessAbstract
BACKGROUND: Many patients exhibit multiple chronic disease risk behaviors. Research provides little information about advice that can maximize simultaneous health behavior changes. METHODS: To test which combination of diet and activity advice maximizes healthy change, we randomized 204 adults with elevated saturated fat and low fruit and vegetable intake, high sedentary leisure time, and low physical activity to 1 of 4 treatments: increase fruit/vegetable intake and physical activity, decrease fat and sedentary leisure, decrease fat and increase physical activity, and increase fruit/vegetable intake and decrease sedentary leisure. Treatments provided 3 weeks of remote coaching supported by mobile decision support technology and financial incentives. During treatment, incentives were contingent on using the mobile device to self-monitor and attain behavioral targets; during follow-up, incentives were contingent only on recording. The outcome was standardized, composite improvement on the 4 diet and activity behaviors at the end of treatment and at 5-month follow-up. RESULTS: Of the 204 individuals randomized, 200 (98.0%) completed follow-up. The increase fruits/vegetables and decrease sedentary leisure treatments improved more than the other 3 treatments (P < .001). Specifically, daily fruit/vegetable intake increased from 1.2 servings to 5.5 servings, sedentary leisure decreased from 219.2 minutes to 89.3 minutes, and saturated fat decreased from 12.0% to 9.5% of calories consumed. Differences between treatment groups were maintained through follow-up. Traditional dieting (decrease fat and increase physical activity) improved less than the other 3 treatments (P < .001). CONCLUSIONS: Remote coaching supported by mobile technology and financial incentives holds promise to improve diet and activity. Targeting fruits/vegetables and sedentary leisure together maximizes overall adoption and maintenance of multiple healthy behavior changes.
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The old folklore that behavior cannot be changed has been dispelled by numerous randomized controlled trials of effective behavioral interventions.
“The old folklore that “behavior can’t be changed” has been dispelled by numerous randomized controlled trials of effective behavioral interventions.13–23”
From Better Population Health Through Behavior Change in Adults: A Call to Action (2013) · cites this paper as [20]
Greater improvement in health behaviors is produced by intensive behavioral treatments that incorporate multiple counseling sessions, each lasting ≥10 minutes.
“Greater improvement in health behaviors is produced by intensive behavioral treatments, that is, those that incorporate multiple counseling sessions, each lasting ≥10 minutes.18-20,22–24,29–31”
From Better Population Health Through Behavior Change in Adults: A Call to Action (2013) · cites this paper as [20]
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- Authors
- Spring, B., Schneider, K., McFadden, H. G., Vaughn, J., Kozak, A. T., Smith, M., Moller, A. C., Epstein, L. H., DeMott, A., Hedeker, D., Siddique, J., & Lloyd-Jones, D. M.
- Affiliations
- Northwestern University (US)
- University of Massachusetts Chan Medical School (US)
- Oakland University (US)
- University at Buffalo, State University of New York (US)
- University of Illinois Chicago (US)
- Corresponding author
- Spring, Bonnie
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2012-05-28
- Volume
- 172
- Issue
- 10
- Pages
- 789-96
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC3402206
- OpenAlex
- W2100695057
- Cited by
- 208
- References
- 46
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 4 · 2023: 9 · 2022: 8 · 2021: 8 · 2020: 18 · 2019: 21 · 2018: 13 · 2017: 12 · 2016: 26 · 2015: 15 · 2014: 31 · 2013: 19 · 2012: 12
- FWCI
- 43.79
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (1k07ca154862-01)
- National Heart, Lung, and Blood Institute (R01HL075451, HL075451)
- National Institute of Mental Health (F31MH070107)
- National Cancer Institute (K07-CA154862, P30CA060553)
- National Center for Research Resources (UL1RR025741)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- diet and physical activity, fruit and vegetable intake, sedentary leisure, saturated fat intake, remote coaching, financial incentives, self-monitoring, behavior maintenance
- MeSH terms
- Adult, Behavior Therapy, Diet, Female, Follow-Up Studies, Health Promotion, Humans, Life Style, Male, Middle Aged, Patient Compliance, Quality of Life, Risk-Taking, Health Behavior, Exercise, Risk Assessment, Remote Consultation, Computers, Handheld, Young Adult
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