Efficiency of an mHealth App and Chest-Wearable Remote Exercise Monitoring Intervention in Patients With Type 2 Diabetes: A Prospective, Multicenter Randomized Controlled Trial
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Abstract
BACKGROUND: Exercise has been recommended as a cornerstone for diabetes management. Supervised exercise is more efficient than unsupervised exercise but is less convenient and accessible. OBJECTIVE: We aimed to determine the efficiency of exercise using a fitness app and heart rate band to remotely monitor patients with type 2 diabetes in comparison with that of traditional exercise. METHODS: Patients with type 2 diabetes without severe complications or comorbidities were recruited to participate in this multicenter randomized controlled trial and were allocated to either the intervention or control group (1:1 ratio). Participants in both groups were asked to engage in moderate to vigorous physical activity for at least 150 minutes per week; each participant was prescribed individualized exercises. Participants in the intervention group were asked to follow exercise videos on the app and to wear a chest band; heart rate, exercise duration, and exercise intensity were recorded by the app. Participants in the control group self-reported exercise intensity and duration. Cardiopulmonary endurance, body composition, blood glucose level, and insulin level were assessed before and after a 3-month exercise program. RESULTS: Of the 101 participants who were enrolled, the majority of them (85/101, 84.2%) completed the study. Both groups had similar baseline characteristics, with the exception that participants in the intervention group were slightly younger and less likely to have hypertension. Self-reported exercise duration was longer than app-recorded exercise duration (control: mean 214 minutes/week; intervention: mean 193 minutes/week); in addition, a higher proportion of participants in the control group (29/41, 71%) than in the intervention group (18/44, 41%) met the 150-minute target for moderate to vigorous physical activity. However, compared with the control group, the intervention group had a larger increase in cardiopulmonary endurance (mean difference -2.0 bpm [beats per minute] vs 1.0 bpm; P=.02) and a larger decrease in body fat percentage (mean difference -1.8% vs -0.8%; P=.01). There was no difference in hemoglobin A1c level reduction between the two groups, yet more participants in the intervention group stopped taking their antidiabetic drugs or had their dosages lowered by an endocrinologist, compared with those in the control group. There were no serious adverse events in either group. CONCLUSIONS: This was the first randomized controlled trial in China, to our knowledge, to test the efficiency of exercise using a fitness app and heart rate band to remotely monitor prescribed exercise in patients with type 2 diabetes. The findings of our study suggest that exercise programs may be more efficient if participants are remotely monitored with an app and heart rate band than if participants are not monitored. TRIAL REGISTRATION: Chinese Clinical Trial Register ChiCTR1800015963; http://www.chictr.org.cn/showprojen.aspx?proj=27080.
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Li et al. indicated that remotely guided exercise may be more effective in promoting meaningful physical activity than self-reported routines, even when total duration of activity is lower.
“The study by Li et al., which implemented an mHealth application in combination with a heart-rate strap, indicated that remotely guided exercise may be more effective in promoting meaningful physical activity than self-reported routines, even when the total duration of activity is lower [32].”
Studies that assessed body composition objectively sometimes detected meaningful fat-mass reductions even when BMI remained unchanged, particularly when advanced remote monitoring devices and personalized feedback or peer support were used.
“Interestingly, the handful of studies that assessed body composition objectively (e.g., percentage body fat) sometimes detected meaningful fat-mass reductions even when BMI remained unchanged, particularly when advanced remote monitoring devices and personalized feedback or peer support were used [32,35].”
In the absence of such structure, the device's ability to support sustained clinical improvement may be significantly reduced.
“In the absence of such structure, the device’s ability to support sustained clinical improvement may be significantly reduced [8,12,20,31,32,35].”
Wearables are most effective when combined with regular prompts, personalized feedback, and adaptive communication strategies.
“The review shows that wearables are most effective when combined with regular prompts, personalized feedback, and adaptive communication strategies: features that help maintain motivation and reinforce habits [8,20,21,32,38].”
Several studies reported withdrawals due to technical issues, including software malfunctions, connectivity problems, or failures in data transmission.
“Several studies reported withdrawals due to technical issues, including software malfunctions, connectivity problems, or failures in data transmission [20,32].”
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- Authors
- Li, J., Wei, D., Liu, S., Li, M., Chen, X., Chen, L., Wu, Y., Zhou, W., Ouyang, L., Tan, C., Meng, H., & Tong, N.
- Affiliations
- West China Hospital of Sichuan University (CN)
- Sichuan University (CN)
- Chengdu Second People's Hospital (CN)
- University of South Florida (US)
- Corresponding author
- Tong, Nanwei
- ORCID
- Venue
- JMIR mhealth and uhealth
- Publisher
- JMIR Publications Inc.
- Published
- 2021-02-09
- Volume
- 9
- Issue
- 2
- Pages
- e23338
- ISSN
- 2291-5222 (ISSN-L)
- PMC
- PMC7902189
- OpenAlex
- W3119573168
- Cited by
- 44
- References
- 32
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 11 · 2023: 10 · 2022: 3 · 2021: 1
- FWCI
- 7.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR mhealth and uhealth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Department of Science and Technology of Sichuan Province
- West China Hospital, Sichuan University (ZYGD 18017)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, remote exercise monitoring, mobile health apps, wearable heart rate monitor, supervised exercise, cardiorespiratory fitness, body composition, HbA1c, antidiabetic medication reduction, physical activity adherence, exercise intensity and duration, diabetes management, China, insulin, blood glucose, body fat percentage, exercise videos, digital health
- MeSH terms
- Wearable Electronic Devices, China, Diabetes Mellitus, Type 2, Humans, Prospective Studies, Exercise, Telemedicine, Mobile Applications
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