Digital health and mHealth apps are a dime a dozen yet they couldn’t be hotter as the industry moves toward population health and preventative care. Consider that last year Under Armour acquired Endomondo and MyFitnessPal for a total $560 million and Adidas AG bought Runtastic at an enterprise value of 220 million Euros ($239 million). MHealth apps have the allure to help individuals take more ownership of their health.
Despite the buying frenzy and the health potentials surrounding mhealth apps, the evidence-based specialty of cardiology has been wary of such apps. “MHealth platforms are widely heterogeneous,” said Dr. Frederick Masoudi, chief science advisor, National Cardiovascular Data Registry; professor of medicine, University of Colorado at a press conference during the 65th American College of Cardiology Scientific Sessions. “If you see one mHealth platform, you see one platform and that's about it.”
But research presented at ACC16 helped chum the waters for digital health research, a field that Dr. Jay Widmer, fellow, division of cardiovascular diseases and internal medicine at Mayo Clinic, described to Healthcare Dive as limited.
“There’s very scant data that supports mobile health or digital health,” Widmer said. “As someone who does a lot with it and studies it, there’s not a lot out there for it.” Widmer’s research presented during conference found adding a digital health tool to traditional cardiac rehabilitation appears to help people recovering from a heart attack lose significantly more weight in a relatively short period of time.
Patients using specially-designed health tools on their smartphones and through an online portal lost four times as much weight (an average of 9 pounds) compared with those undergoing 12 weeks of cardiac rehabilitation alone (an average of 2 pounds). The trial was the first in the U.S. to look at how adding the use of mobile and wireless devices concurrently with cardiac rehab might improve health outcomes, according to researchers.
On a broader, international scale, Dr. Anand Ganesan, MBBS, associate professor at Flinders University in Adelaide, Australia, shared his analysis of 69,219 individuals in 64 countries who competed in small teams to increase their daily physical activity levels during a 100-day technology-based “virtual race.”
“I think there’s a lot interest in mHealth…[but] one of the real challenges in this space is that very few [apps] have had any external validation,” Ganesan told Healthcare Dive.
The race, called Stepathlon, had participants organized into workplace-based teams of five, issued a pedometer and were encouraged to increase their daily step count through an app that engaged them with emails, quizzes, and social media communication.
The event had low buy-in costs ($50 USD) and emphasized competition and camaraderie among participants. In the clinical setting, visiting the doctor or nurse holds patients accountable for their health and activity. “But in mHealth, you can't do that,” Ganesan said, adding the social aspect — participating and competing with friends and colleagues — of Stepathlon acted as a surrogate for accountability. “Camaraderie helps people contribute more.”
Their research showed on average, participants increased their amount of walking by 3,519 steps per day, exercised nearly one additional day per week, lost just over 3 pounds, and reduced their time spent sitting by about 45 minutes per day. More than 90% of participants were from low- and middle-income countries, and the results were consistent across countries of all income levels.
“To our knowledge, our study is the first to provide comparative data on the effectiveness of this kind of intervention in both the developed and developing world,” Ganesan said, adding the research demonstrates the efficacy of a self-sustaining, mass-participation workplace lifestyle program via mHealth technology as well as reproducible, statistically significant improvements in physical activity and weight seen across geographic and sociocultural/economic settings.
One limitation of the Stepathlon study is researchers relied on self-reports from participants regarding weight and other parameters, rather than objective measurements. However, the large number of people included in the study and the fact that similar benefits were seen across all three years studied offer reassurance the findings are robust, Ganesan said. In addition, Masoudi at the press conference noted the study illustrates the importance of studying such interventions and the mechanisms whereby the benefits might improve.
“It's a step in the right direction for getting big numbers of people into these big trials to try and see what works to keep people adherent and to get outcomes,” Widmer said, noting changes in mobile technology are so rapid that if you look at tool over two years, the product will change. “It took us two years to do our trial with 80 patients and we went from an iPhone 3 to an iPhone 5 [in that time],” Widmer said.
“We need to be really creative in how we design trials and really work with industry to help with that,” Widmer said. “[We need] the academic minds who understand clinical trials and medicine working with some of the bigger players.”
Ganesan added his vision to advancing mHealth research stating, “It’s relatively easy to produce an mHealth app or program [but it’s] harder to have it properly tested…That’s what’s needed to take mHealth field to the next level.”