A Mobile Health Approach to Reducing Sedentary Time in Bariatric Surgery Patients

描述（由申请人提供）：久坐行为，坐着时进行的活动，涉及低水平的能量消耗（例如，看电视、在电脑上工作等），对健康构成明显的重大风险。从事高水平的久坐行为-独立于体力活动-与几种不良健康结果相关，是心血管相关和全因死亡的独立风险因素。 肥胖的人特别容易从事高水平的久坐行为。特别是减肥手术患者，他们客观评估的清醒时间中有80%是久坐不动的，远远高于一般人群中久坐不动的时间比例。 在K奖中，我们试图干预减肥手术患者的高水平久坐行为。参与者接受了6周的策略（自我监控，目标设定等）个人指导。以减少久坐时间，并在该时段结束时对客观监测的久坐时间进行反馈。然而，这种方法并没有改变久坐的时间，参与者报告说难以监测他们的SB。此外，由于缺乏对SB的即时反馈，这种方法的有效性可能受到限制。拟议的R 03项目包括了从K 01项目支持的研究中吸取的经验教训（DK 083438 -03），其通过采用移动的健康（mHealth）方法来干预减肥手术患者的久坐行为，所述方法利用广泛采用的智能手机技术。这种新方法通过独特的能力解决了先前方法的局限性，包括：1）在自然环境中真实的实时自动监测患者在所有情况下的久坐行为，以及2）使用实时数据来提供即时的个性化定制的、目标驱动的提示和反馈，以鼓励患者用步行活动代替久坐行为。此外，将在智能手机上以娱乐形式呈现指示久坐目标进展的持续图形反馈，以鼓励遵守干预方案。将进行两项研究，以评估新的移动健康智能手机方法的可行性和可接受性。研究1将比较三个智能手机目标驱动的提示/反馈时间表，以确定哪一个时间表产生最好的遵守，并对久坐时间的影响最大。研究2将使用研究1中确定的最佳提示/反馈时间表来评估移动健康智能手机方法对4周内长期坚持和久坐时间的影响。 该项目通过探索流行的移动的智能手机技术的可行性来解决久坐时间增加的公共卫生问题，以减少肥胖手术患者（高度久坐的人群）的久坐行为。如果有效的话，这种方法也可以广泛使用，以帮助其他人使用他们已经拥有的设备来监测和减少他们的久坐时间。 公共卫生相关性：久坐不动的时间越长，无论身体活动水平如何，都会增加发病和死亡的风险。客观评估表明，减肥手术患者花费大量的时间在久坐行为。这项拟议中的研究是第一个测试移动的健康（mHealth）方法，该方法采用广泛采用的智能手机技术来监测和修改久坐行为，因为它们发生是一个可行的和可接受的方法，减少这些患者的久坐时间。

DESCRIPTION (provided by applicant): Sedentary behaviors, activities performed while sitting and that involve low levels of energy expenditure (e.g., watching TV, working on a computer, etc.), pose a distinct and significant health risk. Engagement in higher levels of sedentary behavior-independent of physical activity-is associated with several adverse health outcomes, and is an independent risk factor for cardiovascular-related and all-cause mortality. Obese individuals are at particular risk for engagement in high levels of sedentary behavior. Bariatric surgery patients, in particular, spend 80% of their objectively-assessed waking hours being sedentary, considerably higher than the percentage of time sedentary reported in the general population. In the K award, we attempted to intervene on bariatric surgery patients' high levels of sedentary behavior. Participants received 6 weeks of individual instruction in strategies (self-monitoring, goal setting, etc.) to reduce sedentary time and feedback on objectively-monitored sedentary time at the end of this period. However, this approach did not change sedentary time and participants reported difficulty in monitoring their SB. Additionally, the efficacy of this approach may have been limited by the lack of immediate feedback on SB. The proposed R03 project incorporates lessons learned from research supported in the K01 (DK083438-03) by employing a mobile health (mHealth) approach that utilizes widely adopted smartphone technology to intervene on sedentary behaviors in bariatric surgery patients. This new approach addresses limitations of the previous approach via unique capabilities, including: 1) automatic monitoring of patients' sedentary behaviors across all contexts in real time in their natural environment, and 2) use of real-time data to provide immediate individually-tailored, goal-driven prompts and feedback to encourage patients to substitute sedentary behavior with walking activity. Additionally, persistent graphical feedback indicating progress toward sedentary goals will be presented on the smartphone in an entertaining format to encourage adherence to the intervention protocol. Two studies will be conducted to evaluate the feasibility and acceptability of the new mHealth smartphone approach. Study 1 will compare three smartphone goal-driven prompting/feedback schedules to determine which schedule produces the best adherence and has the greatest impact on sedentary time. Study 2 will use the best prompting/ feedback schedule identified in Study 1 to assess the impact of the mHealth smartphone approach on longer-term adherence and sedentary time over a 4-week period. This project addresses the public health problem of increasing sedentary time by exploring the viability of popular mobile smartphone technology for reducing sedentary behaviors in bariatric surgery patients, a highly sedentary population. If efficacious, this approach could also be made widely available to help other individuals monitor and decrease their sedentary time for very little cost using a device they already own. PUBLIC HEALTH RELEVANCE: Greater time spent in sedentary behaviors, independent of physical activity level, can increase risk of morbidity and mortality. Objective assessments indicate that bariatric surgery patients spend large amounts of time in sedentary behaviors. The proposed study is the first to test whether a mobile health (mHealth) approach that employs widely adopted smartphone technology to monitor and modify sedentary behaviors as they occur is a feasible and acceptable method of reducing sedentary time in these patients.