Health and Fitness App Use,
Evaluation and Opportunities
American College of Sports Medicine
Annual Meeting,
World Congres...
Heather Chambliss, Ph.D., FACSM
The University of Memphis
hchmblss@memphis.edu
@HChamblissPhD
Carol Torgan, Ph.D., FACSM
K...
Disclaimers
Products, sites, and tools shown or mentioned focus on
commercially available technology, and are for illustra...
Outline
The apps landscape
Apps and behavior change
Apps in practice: Issues
Future
Discussion
WHAT, WHO, HOW
The apps landscape
What are apps?
A software application designed to run on
smartphones, tablets and other mobile devices.
FDA: They can also...
> 56% of American adults own a smartphone
http://www.pewinternet.org/2013/06/05/smartphone-ownership-2013/
Health Apps Audience
Tracking for Health, http://www.pewinternet.org/2013/01/28/tracking-for-health
1 in 5 smartphone
owne...
App Options!
Most popular iTunes store categories
Category No. of Apps (% of total)
1. Games 216,598 (19%)
2. Education 121,626 (11%)
3...
> 56,000 healthcare, fitness, medical apps
http://148apps.biz/app-store-metrics/ (As of 5-20-2014) * iTunes store
Fitness apps with > 15 million downloads*
* Sources include the company sites and press releases. Users  downloads
MyFitn...
More than 50%of mobile health apps
are downloaded
less than 500times
But …
Patient Apps for Improved Healthcare: From Nove...
Apps for consumers vs. health care providers
Number of “genuine” health and fitness or medical apps
by customer in the iTu...
Health professionals use 3 screens
Smartphone
‘Short burst’ or ‘two-click’ activities (check email, look up drug ref)
Don’...
Health care professionals and apps
“Patients currently face a dizzying array
of healthcare apps to choose from,
with littl...
Health care professionals and apps
“Physicians can see the potential benefits of mobile
healthcare apps but remain wary of...
FITNESS AT OUR FINGERTIPS?
Apps and behavior change
Arrange
Assist
Agree
Advise
Assess
A’s of Physical Activity Counseling
Meriwether et al. Physical Activity Counseling. Am ...
Assess Individual Information
 Health risks and status
 Physical activity level
 Frequency, Intensity, Time, Type
 Rea...
Advise on Behavior and Health
 Personalized plans based on health and behavioral
goal
 Weight management, increased fitn...
Education
 Tutorials
 Videos
 Blogs
Agree on Behavior Goal
Specific
Measurable
Adjustable
Realistic
Time frame
Self-directed
Evidence-based
Do Apps Address Goal Setting Problems?
 Not setting goals
 Not setting specific goals
 Not individualizing goals
 Lack...
APP FEATURES:
BEHAVIORAL CONSIDERATIONS
Assist behavior change
Customization
 Medical history
 Body data
 Behavioral target
 Goals
Physical Activity
Frequency
Duration
Distance
Calories
Steps
Points
Heart Rate
APPlication of Behavioral Concepts?
•SELF-MONITORING +++
•SOCIAL SUPPORT + +
•SUBSTITUTING ALTERNATIVES +
•ENVIRONMENTAL C...
Physical Activity Tech
Category Examples Key Features
Activity and
Nutrition Tracking
•My Fitness Pal
•Calorie Counter
•Sp...
Physical Activity Tech
Category Examples Key Features
Motivation •Charity Miles
•Zombies, Run!
•Endomondo
•Fitocracy
•GymP...
Behavioral Support
 Prompts/Reminders
 Feedback and Report Generation
 Integration with Social Media
 Competition with...
Arrange Follow Up
 Personalized Reports
 Ongoing Planning
 Professional Support
APP Frustrations and Limitations
 Bugs
 Hassle
 Boredom
 Tech Overload
 Proprietary Issues
 Missing Features
 Stora...
APP Evaluation:
Questions for Professionals
 Do recommendations follow evidence-based guidelines?
 Is the tool accurate ...
APP Selection: Questions for Users
 What is your primary behavioral goal?
 What other apps do you use?
 How often do yo...
Reality Check for the “Virtual” World
 The “look and feel” is
important
 Users may be unwilling to pay
 More options = ...
Downloaded and Used?
 Match the method to the individual
 KISS – Keep it simple and streamlined
Behavior
Technology
 ...
ISSUES AND CONSIDERATIONS
Apps in Practice
Regulation of apps by FDA
Mobile medical apps (MMAs) medical devices that are mobile apps,
meet the definition of a medica...
“MapMyFitness is Under Armour's new data
center.”
– Owen Thomas, Editor-in-Chief, ReadWriteWeb
“We know when you work out ...
Data sharing example: Alivecor
www.alivecor.com
Data selling example: Strava
http://metro.strava.com/ http://bikeportland.org
Location of tracked runs and rides
(stripped...
Literacy, numeracy issues
 Accuracy (content, measurements)
 Compliance
 Safety
 Security
 Privacy
Other Issues
The Future of Apps
The future: smartphones get smarter
Now
accelerometer, gyroscope, magnetometer
temperature, humidity, atmospheric pressure...
The future: human bioenergy harvesting
body heat
foot strikes
joint movements (knee)
sound pressure waves (inner ear)
soun...
Integrate with sensors, wearable tech
www.pinterest.com/caroltpin/wearable-tech/
Integrate with the Internet of Things (IoT)
Objects have network connectivity, can send & receive data
Lean more: www.thei...
The future of apps: collaboration?
Consumers
Researchers
App
Developers
Product Sales
Systems /
Organizations
WHAT DO YOU THINK?
Beginning a Dialogue
Should fitness & health apps be certified?
Should apps be reviewed and certified?
Why or why not?
Should an organization r...
Should health apps be prescribed?
Should apps be recommended?
By who?
For who?
What are the potential liabilities / respon...
Should app data be shared?
Who should it be shared with?
Primary care provider / EHR (Electronic Health Record)
Personal t...
What app would you design?
What features do you use the most?
What features do you need / want?
What features make you mad...
Questions or ideas? Contact us!
Heather Chambliss, Ph.D., FACSM
The University Of Memphis
hchmblss@memphis.edu
@HChambliss...
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Health and Fitness App Use, Evaluation and Opportunities

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This tutorial presentation was given by invitation at the annual meeting of the American College of Sports Medicine and World Congress on Exercise is Medicine. We welcome comments, questions, and ideas regarding this fast moving area.

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  • Aaron Smith, Smartphone Ownership 2013,
    Pew Internet Research Project
  • Tracking for Health, Susannah Fox and Maeve Duggan, Pew Internet Research Project
    http://www.pewinternet.org/2013/01/28/tracking-for-health/
  • http://www.freephotosbank.com/12492.html photo
    http://manhattanresearch.com/Products-and-Services/Physician/Taking-the-Pulse-U-S
    In-Depth: Mobile adoption among US physicians
    http://mobihealthnews.com/32232/in-depth-mobile-adoption-among-us-physicians/
  • http://www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Health%20Institute/Reports/Patient_Apps/IIHI_Patient_Apps_Report.pdf
  • http://www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Health%20Institute/Reports/Patient_Apps/IIHI_Patient_Apps_Report.pdf
  • Transcript of "Health and Fitness App Use, Evaluation and Opportunities"

    1. 1. Health and Fitness App Use, Evaluation and Opportunities American College of Sports Medicine Annual Meeting, World Congress on Exercise is Medicine Orlando, FL May 2014
    2. 2. Heather Chambliss, Ph.D., FACSM The University of Memphis hchmblss@memphis.edu @HChamblissPhD Carol Torgan, Ph.D., FACSM Kinetics Consulting carol@caroltorgan.com @ctorgan
    3. 3. Disclaimers Products, sites, and tools shown or mentioned focus on commercially available technology, and are for illustrative, educational purposes only. The views expressed in this presentation are solely those of the presenters, who do not endorse or recommend any commercial products, processes, or services. Please contact the authors for additional information and/or permissions.
    4. 4. Outline The apps landscape Apps and behavior change Apps in practice: Issues Future Discussion
    5. 5. WHAT, WHO, HOW The apps landscape
    6. 6. What are apps? A software application designed to run on smartphones, tablets and other mobile devices. FDA: They can also be accessories that attach to a smartphone or other mobile communication device, or a combination of accessories and software. www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ConnectedHealth/MobileMedicalApplications/
    7. 7. > 56% of American adults own a smartphone http://www.pewinternet.org/2013/06/05/smartphone-ownership-2013/
    8. 8. Health Apps Audience Tracking for Health, http://www.pewinternet.org/2013/01/28/tracking-for-health 1 in 5 smartphone owners has a health app More likely to download: • women • under age 50 • annual household income over $75,000 • better educated
    9. 9. App Options!
    10. 10. Most popular iTunes store categories Category No. of Apps (% of total) 1. Games 216,598 (19%) 2. Education 121,626 (11%) 3. Business 96,413 (8%) 4. Lifestyle 93,201 (8%) 5. Entertainment 89,171 (8%) 12. Healthcare & Fitness 31,599 (3%) 17. Medical 27,686 (2%) http://148apps.biz/app-store-metrics/ (As of 5-20-2014)
    11. 11. > 56,000 healthcare, fitness, medical apps http://148apps.biz/app-store-metrics/ (As of 5-20-2014) * iTunes store
    12. 12. Fitness apps with > 15 million downloads* * Sources include the company sites and press releases. Users  downloads MyFitnessPal > 40 million users (many apps) RunKeeper > 20 million users Azumio > 20 million downloads (many apps) Nike+ > 18 million users MapMyFitness > 18 million active users (many apps) Runtastic > 18 million registered users (40 million downloads) Endomondo > 16 million users
    13. 13. More than 50%of mobile health apps are downloaded less than 500times But … Patient Apps for Improved Healthcare: From Novelty to Mainstream, Oct 2013
    14. 14. Apps for consumers vs. health care providers Number of “genuine” health and fitness or medical apps by customer in the iTunes store as of June 2013 Patient Apps for Improved Healthcare: From Novelty to Mainstream, Oct 2013
    15. 15. Health professionals use 3 screens Smartphone ‘Short burst’ or ‘two-click’ activities (check email, look up drug ref) Don’t use to share info with patients (“Swivel apps”) Don’t use for deep research, videos, inputting lots of information Tablets 76% of physicians own Immersion “lean back” learning (video, eCME, journal reading) Desktop/laptops Sharing / patient-facing screens, have EHRs http://mobihealthnews.com coverage of Manhattan Research Report, April 2014
    16. 16. Health care professionals and apps “Patients currently face a dizzying array of healthcare apps to choose from, with little guidance on quality or support from their doctors.” Patient Apps for Improved Healthcare: From Novelty to Mainstream, Oct 2013
    17. 17. Health care professionals and apps “Physicians can see the potential benefits of mobile healthcare apps but remain wary of formally recommending apps to patients without: evidence of their benefit clear professional guidelines regarding their use in practice confidence in the security of personal health information that may be generated or transmitted by the app.” Patient Apps for Improved Healthcare: From Novelty to Mainstream, Oct 2013
    18. 18. FITNESS AT OUR FINGERTIPS? Apps and behavior change
    19. 19. Arrange Assist Agree Advise Assess A’s of Physical Activity Counseling Meriwether et al. Physical Activity Counseling. Am Fam Physician. 2008;77: 1029, 1138.
    20. 20. Assess Individual Information  Health risks and status  Physical activity level  Frequency, Intensity, Time, Type  Readiness for change  Precontemplation, Contemplation, Preparation, Action, Maintenance  Behavioral factors There’s an APP for that! Important for APP selection
    21. 21. Advise on Behavior and Health  Personalized plans based on health and behavioral goal  Weight management, increased fitness, posture, nutrition, stress, sleep, etc.  Options for physical activity  Decreasing sedentary time, lifestyle activity, fitness components, performance  Considerations: • User needs (health and self-stated goals) • Current behavior/Stage of change • Self-efficacy • Best practices/physical activity guidelines
    22. 22. Education  Tutorials  Videos  Blogs
    23. 23. Agree on Behavior Goal Specific Measurable Adjustable Realistic Time frame Self-directed Evidence-based
    24. 24. Do Apps Address Goal Setting Problems?  Not setting goals  Not setting specific goals  Not individualizing goals  Lack of follow up or evaluation  Not rewarding goals  Setting too many goals  Not adjusting goals  Unrealistic expectations
    25. 25. APP FEATURES: BEHAVIORAL CONSIDERATIONS Assist behavior change
    26. 26. Customization  Medical history  Body data  Behavioral target  Goals
    27. 27. Physical Activity Frequency Duration Distance Calories Steps Points Heart Rate
    28. 28. APPlication of Behavioral Concepts? •SELF-MONITORING +++ •SOCIAL SUPPORT + + •SUBSTITUTING ALTERNATIVES + •ENVIRONMENTAL CONTROL + •REINFORCEMENT + •SELF-EFFICACY +/- •PROBLEM SOLVING ? •RELAPSE PREVENTION ?
    29. 29. Physical Activity Tech Category Examples Key Features Activity and Nutrition Tracking •My Fitness Pal •Calorie Counter •SparkPeople •Livestrong Exercise and food databases; Individual calorie and weight goals; Social and website integration GPS •RunKeeper •MapMyRun •Nike+ Continuous time, distance, data; PA prompts and tracking; Training plans and maps Workout •Nike Training Club •Fitness Buddy •Pocket Yoga Exercise guidance with A/V instruction; Training plans
    30. 30. Physical Activity Tech Category Examples Key Features Motivation •Charity Miles •Zombies, Run! •Endomondo •Fitocracy •GymPact Entertainment / competition features; Charity / reward plans; Social integration Wearable Devices •Fitbit •BodyMedia •Jawbone •Nike+ Fuelband •HR monitors Physiological data tracking ; App/computer integration Exergaming •Nintendo Wii •Xbox Kinect •PlayStation Move Active games detect movement and award points
    31. 31. Behavioral Support  Prompts/Reminders  Feedback and Report Generation  Integration with Social Media  Competition with self and other users  Integration with music  Integration with other apps / devices  Variation and ongoing customization
    32. 32. Arrange Follow Up  Personalized Reports  Ongoing Planning  Professional Support
    33. 33. APP Frustrations and Limitations  Bugs  Hassle  Boredom  Tech Overload  Proprietary Issues  Missing Features  Storage Limits
    34. 34. APP Evaluation: Questions for Professionals  Do recommendations follow evidence-based guidelines?  Is the tool accurate and reliable?  Does the technology include behavioral elements?  Is the technology appropriate for user abilities, preferences, and budget?  What non-tech support does the person need?  Does the tool support data sharing and feedback?  Will the tool keep user interest and be a long-term resource?  Is the tool regularly updated?
    35. 35. APP Selection: Questions for Users  What is your primary behavioral goal?  What other apps do you use?  How often do you plan to use the device?  How much time are you willing to invest in data entry?  How much information do you want?  How much are you willing to spend?  What integration / features are most important to you?  How comfortable are you with mobile technology?
    36. 36. Reality Check for the “Virtual” World  The “look and feel” is important  Users may be unwilling to pay  More options = greater expectations  Easy come, easy go  Top lists and user reviews influence selection  Friend recommendations and “buzz” matter  Techies look for the next “best” thing
    37. 37. Downloaded and Used?  Match the method to the individual  KISS – Keep it simple and streamlined Behavior Technology  Anchor to an established habit  Keep proximal to behavior  Choose an app with “can’t live without” features
    38. 38. ISSUES AND CONSIDERATIONS Apps in Practice
    39. 39. Regulation of apps by FDA Mobile medical apps (MMAs) medical devices that are mobile apps, meet the definition of a medical device and are an accessory to a regulated medical device or transform a mobile platform into a regulated medical device. Apps that don’t need approval Provide access to information Provide simple tools to organize and track health info Help show or communicate potential conditions to clinicians Automate simple tasks for health care providers Interact with PHRs or EHRs Apps Requiring Approval (examples) Use attached sensors for diagnostic testing (EKG, EEG) Use attachment to track glucose levels Connect to bedside monitors, transfer data to viewing station for patient monitoring www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ConnectedHealth/MobileMedicalApplications
    40. 40. “MapMyFitness is Under Armour's new data center.” – Owen Thomas, Editor-in-Chief, ReadWriteWeb “We know when you work out and how you work out, and a company like Under Armour is really interested in understanding that to help them to sell apparel, help them to make you perform better, and help them to make you into a better athlete.” - Kevin Callahan, MapMyFitness co-founder, VP of Innovation Strategy Data Issues http://mobihealthnews.com, http://readwrite.com Under Armour acquired MapMyFitness Nov 2013 for $150M
    41. 41. Data sharing example: Alivecor www.alivecor.com
    42. 42. Data selling example: Strava http://metro.strava.com/ http://bikeportland.org Location of tracked runs and rides (stripped of personal info) Analyze patterns by time of day, day of week, season, local geography Oregon Dept of Transportation paid $20,000 for 1-year license of dataset Includes activities of ~17,700 riders and 400,000 individual bicycle trips logged on Strava in 2013. “… the data could revolutionize how ODOT makes decisions about their policies, plans, and projects.”
    43. 43. Literacy, numeracy issues
    44. 44.  Accuracy (content, measurements)  Compliance  Safety  Security  Privacy Other Issues
    45. 45. The Future of Apps
    46. 46. The future: smartphones get smarter Now accelerometer, gyroscope, magnetometer temperature, humidity, atmospheric pressure ambient light, camera, video, voice Next Environment around us: air, water, pollution, UV light Environment inside us: heart rate, respiratory rate …
    47. 47. The future: human bioenergy harvesting body heat foot strikes joint movements (knee) sound pressure waves (inner ear) sound vibrations (talking) breathing heart beats blood flow Image: Starner, T., Human Powered Wearable Computing, IBM Systems Journal, 35, p618, 1996. Utilize the human body as source of energy to generate and store energy to power mobile equipment and small devices (pacemakers)
    48. 48. Integrate with sensors, wearable tech www.pinterest.com/caroltpin/wearable-tech/
    49. 49. Integrate with the Internet of Things (IoT) Objects have network connectivity, can send & receive data Lean more: www.theinternetofthings.eu Image courtesy Axel Tregoning, Flickr locks thermostat frig chairs mattress flooring lights toilet forks blender barbells toothbrush pill bottles pets
    50. 50. The future of apps: collaboration? Consumers Researchers App Developers Product Sales Systems / Organizations
    51. 51. WHAT DO YOU THINK? Beginning a Dialogue
    52. 52. Should fitness & health apps be certified? Should apps be reviewed and certified? Why or why not? Should an organization rate them or give them a seal of approval? Should an organization provide developers with guidelines? If so, what categories should be reviewed? What about content accuracy, safety, security, privacy?
    53. 53. Should health apps be prescribed? Should apps be recommended? By who? For who? What are the potential liabilities / responsibilities?
    54. 54. Should app data be shared? Who should it be shared with? Primary care provider / EHR (Electronic Health Record) Personal trainer / gym Friends Family What data should be shared and how should it be used? Location Exercise amounts Health outcomes Compliance Who should decide this?
    55. 55. What app would you design? What features do you use the most? What features do you need / want? What features make you mad? What’s missing from currently available apps?
    56. 56. Questions or ideas? Contact us! Heather Chambliss, Ph.D., FACSM The University Of Memphis hchmblss@memphis.edu @HChamblissPhD Carol Torgan, Ph.D., FACSM Kinetics Consulting carol@caroltorgan.com www.caroltorgan.com @ctorgan

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