A Theory-Informed, Personalized mHealth Intervention for Adolescents (Mobile App for Physical Activity): Development and Pilot Study

Background: Evidence suggests that physical activity (PA) during childhood and adolescence is crucial as it usually results in
adequate PA levels in adulthood. Given the ubiquitous use of smartphones by adolescents, these devices may offer feasible means
to reach young populations and deliver interventions aiming to increase PA participation and decrease sedentary time. To date,
very few studies have reported smartphone-based interventions promoting PA for adolescents. In addition, most available fitness
apps do not include the latest evidence-based content.
Objective: This paper described the systematic development of a behavior change, theory-informed Mobile App for Physical
Activity intervention with personalized prompts for adolescents aged 16 to 18 years. The within-subject trial results provided the
first evidence of the general effectiveness of the intervention based on the outcomes step count, sedentary time, and moderate to
vigorous PA (MVPA) minutes. The effectiveness of the intervention component personalized PA prompt was also assessed.
Methods: A 4-week within-subject trial with 18 healthy adolescents aged 16 to 18 years was conducted (mean age 16.33, SD
0.57 years). After the baseline week, the participants used the Mobile App for Physical Activity intervention (Fitbit fitness
tracker+app), which included a daily personalized PA prompt delivered via a pop-up notification. A paired 1-tailed t test was
performed to assess the effectiveness of the intervention. Change-point analysis was performed to assess the effectiveness of a
personalized PA prompt 30 and 60 minutes after prompt delivery.
Results: The results showed that the intervention significantly reduced sedentary time in adolescents during the first week of
the trial (t17=−1.79; P=.04; bootstrapped P=.02). This trend, although remaining positive, diminished over time. Our findings
indicate that the intervention had no effect on metabolic equivalent of task–based MVPA minutes, although the descriptive
increase may give reason for further investigation. Although the results suggested no overall change in heart rate–based MVPA
minutes, the results from the change-point analyses suggest that the personalized PA prompts significantly increased heart rate
per minute during the second week of the study (t16=1.84; P=.04; bootstrapped P=.04). There were no significant increases in
participants’ overall step count; however, the personalized PA prompts resulted in a marginally significant increase in step counts
per minute in the second week of the study (t17=1.35; P=.09; bootstrapped P=.05).
Conclusions: The results of the trial provide preliminary evidence of the benefit of the Mobile App for Physical Activity
intervention for modest yet significant reductions in participants’ sedentary time and the beneficial role of personalized PAprompts. These results also provide further evidence of the benefits and relative efficacy of personalized activity suggestions for
inclusion in smartphone-based PA interventions. This study provides an example of how to guide the development of
smartphone-based mobile health PA interventions for adolescents.