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

描述(申请人提供)：久坐的行为，即坐着时进行的活动，涉及低水平的能量消耗(例如，看电视，在电脑上工作等)，构成明显和重大的健康风险。参与更高水平的久坐行为--独立于体力活动--与几种不利的健康后果有关，是心血管相关和全因死亡的独立风险因素。肥胖的人尤其有可能从事高水平的久坐行为。尤其是减肥手术患者，在他们客观评估的清醒时间中，80%的时间都是久坐不动的，这一比例大大高于普通人群报告的久坐时间百分比。在K奖中，我们试图对减肥手术患者的高水平久坐行为进行干预。参与者接受了为期6周的个人策略指导(自我监控、目标设定等)。减少久坐时间，并在这段时间结束时反馈客观监测的久坐时间。然而，这种方法并没有改变久坐的时间，参与者报告在监测他们的SB方面存在困难。此外，这种方法的有效性可能因缺乏对某人的即时反馈而受到限制。拟议的R03项目结合了K01(DK083438-03)支持的研究的经验教训，采用了移动健康(MHealth)方法，该方法利用广泛采用的智能手机技术来干预减肥手术患者的久坐行为。这一新方法通过独特的功能解决了以前方法的局限性，包括：1)在自然环境中实时自动监测患者在所有环境中的久坐行为，以及2)使用实时数据提供即时的、个性化的、目标驱动的提示和反馈，以鼓励患者用步行活动取代久坐行为。此外，持续的图形反馈将以娱乐的形式显示在智能手机上，表明朝着久坐目标的进展，以鼓励遵守干预方案。将进行两项研究，以评估新的mHealth智能手机方法的可行性和可接受性。研究一将比较三种智能手机目标驱动的提示/反馈计划，以确定哪一种计划对久坐时间的遵从性最好，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/反馈计划来评估mHealth智能手机方法在4周内对长期遵从性和久坐时间的影响。该项目通过探索流行的移动智能手机技术减少肥胖手术患者久坐行为的可行性，解决了增加久坐时间的公共卫生问题。如果有效，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进行监控，并以极低的成本减少他们的久坐时间。

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.