Novel Smartphone Game Improves Physical Activity Behavior in Type 2 Diabetes
Open accessAbstract
Introduction Many type 2 diabetes patients show insufficient levels of physical activity and are often unmotivated to change physical activity behaviors. This study investigated whether a newly developed smartphone game delivering individualized exercise and physical activity promotion through an elaborate storyline can generate sustained improvements in daily physical activity (steps/day).Study design Thirty-six participants were enrolled in this 24-week RCT between August 2016 and April 2018. After baseline assessment, participants were randomized in equal numbers to the intervention or control condition. Data analysis was performed in May-June 2018.Setting/participants Inactive, overweight type 2 diabetes patients, aged 45-70 years, were recruited through advertising and from hospitals and diabetes care centers in the Basel, Switzerland, metropolitan area.Intervention Participants were instructed to play the innovative smartphone game (intervention group) or to implement the recommendations from the baseline lifestyle counseling (control group) autonomously during the 24-week intervention period.Main outcome measures Primary outcomes were changes in daily physical activity (steps/day); changes in aerobic capacity, measured as oxygen uptake at the first ventilatory threshold; and changes in glycemic control, measured as HbA1c.Results Daily physical activity increased by an average of 3,998 (SD=1,293) steps/day in the intervention group and by an average of 939 (SD=1,156) steps/day in the control group. The adjusted difference between the two groups was 3,128 steps/day (95% CI=2,313, 3,943, p<0.001). The increase in daily physical activity was accompanied by an improved aerobic capacity (adjusted difference of oxygen uptake at the first ventilatory threshold of 1.9 mL/(kg·min), 95% CI=0.9, 2.9, p<0.001). Glycemic control (HbA1c) did not change over the course of the intervention.Conclusions A novel, self-developed smartphone game, delivering multidimensional home-based exercise and physical activity promotion, significantly increases daily physical activity (steps/day) and aerobic capacity in inactive type 2 diabetes patients after 24 weeks. The ability of the game to elicit a sustained physical activity motivation may be relevant for other inactive target groups with chronic diseases.Trial registration This study is registered at www.clinicaltrials.gov NCT02657018.
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Of the 27 papers, 12 focused on T2DM, with 743 patients in the intervention groups and 645 in the control groups.
“12 were focused on T2DM (743 patients in the intervention groups and 645 patients in the control groups) [50-61]”
From Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review (2021) · cites this paper as [53]
Of 11 T2DM studies that included control groups, 7 reported significant differences (mean difference: -0.78%, -1.51 to -0.35) in favor of the app intervention groups.
“Of 11 studies that included control groups in their study design, 7 studies reported significant differences (mean difference: –0.78%, –1.51 to –0.35) in favor of the app intervention groups [51,53-58]”
From Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review (2021) · cites this paper as [53]
None of the 7 T2DM studies that reported on blood pressure found significant differences either within or between groups.
“None of the 7 studies that reported on blood pressure found significant differences either within or between groups [51-53,55,57,58,61].”
From Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review (2021) · cites this paper as [53]
Cholesterol levels were reported in 7 T2DM studies (407 intervention, 348 control).
“Cholesterol levels were reported in 7 studies (407 patients in the intervention groups and 348 patients in the control groups).”
From Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review (2021) · cites this paper as [53]
HDL and LDL cholesterol were both included in 7 T2DM studies.
“High-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol were both included in 7 studies [52,53,55-58,61].”
From Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review (2021) · cites this paper as [53]
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- Authors
- Höchsmann, C., Müller, O., Ambühl, M., Klenk, C., Königstein, K., Infanger, D., Walz, S. P., & Schmidt-Trucksäss, A.
- Affiliations
- Pennington Biomedical Research Center (US)
- University of Basel (CH)
- Swinburne University of Technology (AU)
- ORCID
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 57
- Issue
- 1
- Pages
- 41-50
- ISSN
- 0749-3797 (ISSN-L)
- PMC
- PMC7719398
- OpenAlex
- W2945404953
- Cited by
- 67
- References
- 37
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 15 · 2023: 11 · 2022: 8 · 2021: 11 · 2020: 7
- FWCI
- 4.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion)
- Funders
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (166214)
- RMIT University
- Novartis Pharma
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK064584)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
- Keywords
- type 2 diabetes, mobile gaming, physical activity promotion, daily step count, cardiorespiratory fitness, glycemic control, HbA1c, exercise motivation, home-based exercise, lifestyle counseling, overweight adults, gamification, chronic disease management, individualized exercise, physical inactivity, digital health interventions
- MeSH terms
- Smartphone, Behavior Therapy, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Motivation, Switzerland, Exercise, Sedentary Behavior
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