1. The Effects of a Mobile Fitness Application on Weight Management and Physical Activity Amongst University Students Erica Deenihan, BSN, RN, DNP Student
Background
Results of Evidence Appraisal
Level
Design
Quality
Included I
Systematic Reviews & Meta-Analysis
High 6 II
Randomized Controlled Trials
Good 2
III
Cohort Studies 1 VI
Descriptive Surveys
Fair 3
Evaluation
The prevalence of obesity, and obesity-related diseases throughout America, especially among the college student population, has steadily climbed due largely in part to the increase in sedentary lifestyle behaviors, amongst other factors (Swanson, 2016).
Physical activity has been widely recognized as a valid means of combatting obesity and negative weight gain while promoting health and quality of life (Swanson, 2016).
Strategies aimed at increasing physical fitness in college students in an attempt to control weight management are imperative to promoting improved health outcomes.
Although college students perceive several barriers to engaging in exercise, including prolonged inactivity during screen time, technology-based interventions have been developed and shown to promote physical activity amongst users (Lee & Cho, 2017).
Participant Demographics
Major(s): Nursing (n=21) Sex: Female (n=19) Male (n=2)
Age: (M=22.95) Physical Activity: (M=190.48)
BMI: (M=23.70)
Grade Level: Sophomores (n=7), Juniors (n=10), Seniors (n=4)
Example of mobile fitness application caloric expenditure input by project participant:
“Burned 352 calories doing 55 minutes of cardio exercises including bicycling kph, moderate (cycling, biking, bike-riding)”.
Decision to Change Practice
Mobile fitness applications (apps) can be used to improve weight related outcomes and/or increase physical activity amongst university students.
Mobile fitness application utilization yielded the best results when there was a duration of use greater than 8 weeks.
Users perceive the apps as easy to use, rank their usefulness as high in terms of motivating them to engage in physical activity, find the technology to be helpful in tracking their fitness goals, and would recommend use to others (Aguilar-Martinez et al., 2014; Allen et al., 2013; Bond et al., 2014; Bort-Roig et al., 2014; Fanning et al., 2016; Sarcona et al., 2017).
Interventions that are successful at increasing exercise levels also empower individuals to recognize the health benefits they can receive from such actions (Allen et al., 2013; Fanning et al., 2016; Litman et al., 2015).
There appears to be a directly proportional relationship between fitness app usage and favorable physical outcomes (Aguliar-Martinez et al., 2014; Muntaner et al., 2015).
Individuals that engage in higher self-recording activities or greater app usage achieved greater weight loss results (Aguliar-Martinez et al., 2014;Bort-Roig et al., 2014; Schoeppe et al., 2016).
PICOT Question
No statistical significance exists between pre and post intervention BMI values (p=.388, p=1.00)
What is the effect of using the mobile fitness application “My Fitness Pal” (I), as compared to current practice of provider recommendation (C) on weight management (O) in university college students (P) over the course of a 12 week period (T)?
No statistical significance exists between pre and post intervention caloric expenditure data (p=.331)
Review of the Literature
Key Terms: "physical activity" OR "Exercise" OR "physical fitness" AND "World Wide Web Applications+“ OR "applications" OR "Mobile Applications“ OR "app*” OR "device*” OR "tracker* OR "smartphone*) OR "fitness tracker" OR "mobile fitness apps" OR "cell phones“.
Inclusion Criteria: Peer reviewed; Published between ; and written in English.
Implementation
Statistical significance was exhibited in pre and post intervention exercise self-efficacy scores (p=.050)
Setting: Private Lutheran University in Indiana
Sample: Full-time undergraduate students eligible to establish care at the student health center (N = 141, n = 21).
Implementation Timeframe: 12 weeks
Design: Descriptive pre-test post-test design
Tool: Exercise Self-Efficacy Screening
(Neupert, Lachman & Whitbourne, 2009)
Intervention:
Participants downloaded the “My Fitness Pal” application, provided a baseline weight measurement, completed a pre-exercise self efficacy screening questionnaire, and logged their physical activity for 1 week.
Educational materials and “fitness tips” on how to increase physical activity around campus were provided by the project facilitator after week 1.
After 6 weeks duration of continued tracking of physical activity within the app, participants provided a mid project weigh-in.
At the 12 week conclusion of the project, participants provided a final weight and completed a post exercise self-efficacy screening questionnaire.
Theoretical Framework: Health belief model (George, 2011)
Evidence-Based Practice Model: Stetler Model for evidence based practice (Stetler, 2001)
Conclusion & Recommendations
Results of Literature Search
Database
Yielded
Reviewed
Duplicates
Accepted
Cochrane 53 8 1
CINAHL 92 19 3
MEDLINE
157 27 2 6
PsycINFO
136
Total
438 73 4 12
Conclusion: Primary outcomes of this EBP project such as BMI and caloric expenditure did not provide statistical significance to support the evidence from the literature review. The project did support the use of the intervention for promotion of exercise self-efficacy.
Implication for APN practice: APNs can use this intervention for patients who have overweight BMIs and are motivated to lose weight in the clinical practice setting.
Implication for future research: Future projects could benefit from analyzing data from sedentary individuals from other university majors who are specifically overweight or obese according to BMI values, and are interested in weight loss.
Limitations of project: Enrolled participants had BMIs within normal limits and were fairly physically active at baseline. Project duration spanned throughout half of the Fall and Spring semester. Participants were offered extra credit to participate at the beginning of the project and many were lost to attrition after credit was obtained.
Synthesis of Evidence
Articles for Inclusion: 12
Level: Rating System for Hierarchy of Evidence
(Melnyk & Fineout-Overholt, 2015)
Quality: Johns Hopkin Research Evidence Appraisal Tool
(Dang, & Dearholt, 2017)
Acknowledgements: Lindsay Munden, DNP, RN, FNP-BC, Project Advisor; Julie Koch, DNP, RN, FNP-BC, Clinical Site Coordinator/Interim Project Advisor; Kelley Eshenaur, MSN, FNP-BC, Clinical Site Supervisor.