There are thousands of health and fitness apps, and not much evidence they work: study
For a new study, researchers attempted to find evidence that popular health and fitness apps work.
They didn’t find much.
It’s not necessarily that health apps don’t work at all, according to the research recently published in the journal npj Digital Medicine, it’s that there haven’t really been very many comprehensive studies to find out.
“We believe that any app that claims to affect your health should be backed by evidence,” said lead study author Dr. Oyungerel Byambasuren, of the faculty of health sciences and medicine at Bond University in Australia.
“We found that only a very small percentage of all available medical and health and fitness apps have been tested and shown to be somewhat effective.”
Although there are 320,000 health and fitness apps on major app stores, she said, the researchers were only able to find six systematic reviews, which included only 23 randomized control trials — the gold standard for medical research — since 2008. These trials examined 22 currently-available apps that were designed to help with mental health, diabetes management and obesity.
In a few trials, calorie-counting apps didn’t seem to help much with weight loss. One top app, when tested on its own for six months according to the study, “the intervention made almost no difference to the weight of the participants.”
In one study, people simply stopped using the app after a few weeks.
They did spot a few apps that appeared to be effective in a single trial, said Byambasuren, but she felt even those required more trials before they could be recommended by healthcare professionals. As such, she didn’t want to mention any names.
For University of Toronto kinesiology professor Paul Ritvo, “the idea that apps alone are going to solve our multiple chronic disease problems is way too hopeful.”
However, since he spends much of his time developing medical apps, he does think they have a role and might even be one of the best ways to change behaviour, if they’re used correctly. He thinks that apps can be used in conjunction with counselling programs to help with many conditions.
For example, he’s working on a study to develop an exercise-related app connected to a Fitbit movement tracker. “When they don’t exercise, we know it immediately. We can comment on it immediately. We can send them a secure text message, ‘What’s happening today?’ And they can tell us what is happening.”
That way, the counsellor’s reach can be extended. Instead of just a short coaching session every few weeks, there can be constant feedback and monitoring to help people meet their goals.
Without the personal touch, “I’m very skeptical,” he said.
“The notion that everybody is just about ready, they just need a little bit of app encouragement or app intricacy, it’s a great dream, but it’s a little bit speculative.”
Byambasuren agrees. “Apps alone can’t do it. However, research also indicates that sustained use of the right apps in conjunction with professional support can certainly help achieve desired health outcomes. In other words, accountability seems to matter.”
If an app is designed to change behaviour, said Guy Faulkner, head of UBC’s Population Physical Activity Lab, it should incorporate techniques that have been shown to actually affect behaviour — not just offering exercise programs, for example.
“Unless the app has some kind of functionality where it’s trying to target these behaviour change techniques, I think they’re unlikely to be effective,” he said.
More testing before release
He thinks that there should be more research of health apps — and it could even be a marketing tool in the app store. “Having a strong evaluation you think would be helpful for marketing purposes.”
“There must be some way to develop a clearinghouse of apps that have been reviewed and declared to be theoretically sound and that have been evaluated in certain ways.”
Byambasuren says her research highlights the need for more apps testing before they’re released to market, and for conducting that testing to a rigorous standard.
“We are interested in interventions that benefit patients. Therefore, we need to find out which apps really work, so that we don’t waste our resources on things that are ineffective or can cause harm.”
Ritvo agrees that apps deserve more attention. “There’s great promise but there’s also the possibility that people are led astray and fooled into purchasing stuff that they don’t need.”
If someone keeps downloading apps and abandoning them, he said, “then they are less likely to believe they can change their behaviour.”
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