Effect of Adding Telephone-Based Brief Coaching to an mHealth App (Stay Strong) for Promoting Physical Activity Among Veterans: Randomized Controlled Trial
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Abstract
Background: Though maintaining physical conditioning and a healthy weight are requirements of active military duty, many US veterans lose conditioning and rapidly gain weight after discharge from active duty service. Mobile health (mHealth) interventions using wearable devices are appealing to users and can be effective especially with personalized coaching support. We developed Stay Strong, a mobile app tailored to US veterans, to promote physical activity using a wrist-worn physical activity tracker, a Bluetooth-enabled scale, and an app-based dashboard. We tested whether adding personalized coaching components (Stay Strong+Coaching) would improve physical activity compared to Stay Strong alone. Objective: The goal of this study is to compare 12-month outcomes from Stay Strong alone versus Stay Strong+Coaching. Methods: Participants (n=357) were recruited from a national random sample of US veterans of recent wars and randomly assigned to the Stay Strong app alone (n=179) or Stay Strong+Coaching (n=178); both programs lasted 12 months. Personalized coaching components for Stay Strong+Coaching comprised of automated in-app motivational messages (3 per week), telephone-based human health coaching (up to 3 calls), and personalized weekly goal setting. All aspects of the enrollment process and program delivery were accomplished virtually for both groups, except for the telephone-based coaching. The primary outcome was change in physical activity at 12 months postbaseline, measured by average weekly Active Minutes, captured by the Fitbit Charge 2 device. Secondary outcomes included changes in step counts, weight, and patient activation. Results: The average age of participants was 39.8 (SD 8.7) years, and 25.2% (90/357) were female. Active Minutes decreased from baseline to 12 months for both groups (P<.001) with no between-group differences at 6 months (P=.82) or 12 months (P=.98). However, at 12 months, many participants in both groups did not record Active Minutes, leading to missing data in 67.0% (120/179) for Stay Strong and 61.8% (110/178) for Stay Strong+Coaching. Average baseline weight for participants in Stay Strong and Stay Strong+Coaching was 214 lbs and 198 lbs, respectively, with no difference at baseline (P=.54) or at 6 months (P=.28) or 12 months (P=.18) postbaseline based on administrative weights, which had lower rates of missing data. Changes in the number of steps recorded and patient activation also did not differ by arm. Conclusions: Adding personalized health coaching comprised of in-app automated messages, up to 3 coaching calls, plus automated weekly personalized goals, did not improve levels of physical activity compared to using a smartphone app alone. Physical activity in both groups decreased over time. Sustaining long-term adherence and engagement in this mHealth intervention proved difficult; approximately two-thirds of the trial’s 357 participants failed to sync their Fitbit device at 12 months and, thus, were lost to follow-up. Trial Registration: ClinicalTrials.gov NCT02360293; https://clinicaltrials.gov/ct2/show/NCT02360293 International Registered Report Identifier (IRRID): RR2-10.2196/12526
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These features are standard in health apps and are crucial for self-therapy, but they have limited long-term effectiveness.
“Although these features are standard in health apps and are crucial for self-therapy, they have limited long-term effectiveness [73,74].”
From Smartphone-Based Speech Therapy for Poststroke Dysarthria: Pilot Randomized Controlled Trial Evaluating Efficacy and Feasibility (2024) · cites this paper as [73]
The Discussion (Conclusions; page unavailable) reports declining physical activity and engagement over 12 months, supporting the concern about limited long-term effectiveness in this trial. The Discussion (mHealth Interventions for Physical Activity; page unavailable) says goal setting and self-monitoring matter for behavior change, but the paper does not establish that the unspecified features are standard across health apps or crucial for self-therapy. (LLM, conf=0.84)
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Størksen, H. T., Haga, S. M., Hammerstrøm, K. T., Jacobsen, H., & Drozd, F. (2022) · Acta Paediatrica · doi:10.1111/apa.16569 · Cited by 5 · see citing works
Engagement and Use of a Blended mHealth Intervention for Health Behavior Change
Zimmermann, M., Greenberg, L., & Breland, J. Y. (2023) · International Journal of Behavioral Medicine · doi:10.1007/s12529-023-10182-1 · Cited by 6 · see citing works
Zheng, S., Castro, Ó., Mair, J. L., Jabir, A. I., Tan, S. Y. X., Shenoi, A., Negi, S., Mathews, R. A., Koh, R. W. S., Yan, X., et al. (2026) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-025-01869-7 · Cited by 2 · see citing works
Mobile Apps to Improve Health Parameters in Healthy Adults: Systematic Review
Leuzzi, G., Job, M., Cosentino, C., Testa, R., Scafoglieri, A., & Testa, M. (2026) · JMIR mhealth and uhealth · doi:10.2196/66881 · Cited by 3 · see citing works
Barton, C., Hoffman, M., Cox, N. S., Glenn, L. M., Lee, J. Y. T., Cox, I. A., Goh, N. S. L., Troy, L. K., Mackintosh, J. A., Chambers, D. C., et al. (2025) · Respiratory Research · doi:10.1186/s12931-025-03442-z · Cited by 1 · see citing works
Velasco, E. R., Pedersen, H. S., & Skinner, T. C. (2022) · doi:10.2196/preprints.40058 · Cited by 1 · see citing works
Daniore, P., Nittas, V., & von Wyl, V. (2022) · doi:10.2196/preprints.39910
- Authors
- Damschroder, L. J., Buis, L. R., McCant, F. A., Kim, H. M., Evans, R., Oddone, E. Z., Bastian, L. A., Hooks, G., Kadri, R., White-Clark, C., Richardson, C. R., & Gierisch, J. M.
- Affiliations
- VA Ann Arbor Healthcare System (US)
- University of Michigan (US)
- Durham VA Health Care System (US)
- Yale University (US)
- Duke University (US)
- Corresponding author
- Damschroder, Laura J
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2020-08-04
- Volume
- 22
- Issue
- 8
- Pages
- e19216
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC7435619
- OpenAlex
- W3045358457
- Cited by
- 23
- References
- 77
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 7 · 2021: 4 · 2020: 1
- FWCI
- 4.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- U.S. Department of Veterans Affairs (CIN 13–410)
- Eli Lilly and Company
- Office of Research and Development
- Health Services Research and Development (CIN 13‐410)
- University of Michigan
- Strong
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)
- 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 › Digital Mental Health Interventions
- Keywords
- physical activity promotion, veterans, mobile health apps, personalized coaching, wearable activity trackers, Fitbit, motivational messages, goal setting, patient activation, step count
- MeSH terms
- Adult, Female, Humans, Male, Motivation, Veterans, Exercise, Telemedicine, Mobile Applications
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