Can technology promote physical activity?

Let's start with a real life example. A young adult with cystic fibrosis arrives at the clinic with a pedometer, a device that calculates how many steps a person takes in a day. The patient explains to me that there is a competition at his office to see which team can achieve the largest increase in the number of steps per day. When I ask him if having a pedometer helps him, he says that what encourages him the most to become more active is the feeling of being part of a team, the obligation to contribute to the success of his team, and the support of his teammates. Without the support of the group, the patient felt that the pedometer would not have given him sufficient motivation to increase his physical activity.

Today, there is considerable evidence that physical activity is good for everyone, including people with cystic fibrosis. Physical activity has obvious physical benefits: improving capacity and performance, maintaining lung function, facilitating bronchial hygiene and maintaining healthy bones. Beyond these benefits, which are already considerable, physical activity also brings a sense of well-being and self-realization.

But it often happens that we are not engaging in the level of physical activity that would be beneficial for us. For example, it is recommended that children do one hour per day of moderate to vigorous physical activity at least five days per week. Despite this, in Canada, only 40% of children are as physically active 1. If everyone mentions the lack of time
as an obstacle to the exercise of physical activities, different motivations are observed, depending on gender. Indeed, men are attracted to the physical side of exercise (sweat, shortness of breath), while women are more motivated by the idea of being accepted by their peers and improving their body image 2.

Adopting a more active lifestyle alone is often difficult. For this reason, many groups have established programs to motivate people to increase their physical activity and to maintain that level of physical activity in the future. To be successful, a program should focus on self-discipline, gradual goal setting, and personalized feedback that promotes knowledge of one's own abilities 3. In addition, the program should be flexible, so that it can be adapted, for example, to take a day off. It works best if participants can save and submit their data every day; smartphones, text messages, and the Internet promote this aspect. A follow-up method plays a fundamental role in strengthening and maintaining habits. A good program should therefore help participants build support networks, including friends and family members.

One aspect that most programs share is the use of devices to record physical activity. One of the most commonly used is the pedometer. As mentioned earlier, the pedometer records the number of steps a person takes. The pedometer has the advantage of being inexpensive. In addition, thanks to its recording function, it can offer a cumulative visual portrait that helps set goals (for example, increase activity by 1,000 steps per day) and identify personal physical activity habits 4, 5. However, the pedometer cannot record the intensity of physical activity, nor the sudden changes during the activity. In addition, it cannot be used for physical activities such as swimming or weightlifting, which do not involve walking.

As part of a personal training program, pedometers can encourage people to become more active 6. Can a pedometer program be conducted only on the Internet, without personalized contact with participants? The results of a study using an Internet-based program with healthy volunteers indicate a reduction in inactive time and a better maintenance of the level of physical activity 7.

Furthermore, pedometers have been used to monitor physical activity in patients with cystic fibrosis 8. In this study, there was an increase in the number of steps or steps per hour, as well as a decrease in the frequency of periods of inactivity (sitting or lying down) reported by patients. In addition, the number of steps per hour was higher in patients with better lung function. However, if you compare the periods when the patients were sick and had to take antibiotics to the times when they were well, almost all children increased their steps and steps per hour when they were well, while only half of the adults increased their steps or steps per hour. In addition, the results of another study using a physical activity monitor indicate an increase in physical activity in patients with cystic fibrosis between admission to hospital and discharge, when they returned to their usual health status9.

These results indicate that exercise trackers, which are often used to measure acceleration and other body functions, could provide a more accurate picture of patients' activity. Devices that measure physical activity are becoming more varied and sophisticated. Such devices were tested in a study with cystic fibrosis patients10. This study concluded that the device overestimated the energy spent in low-intensity activities, while it underestimated the energy expenditure during intense activities. With smart phones, we are witnessing a multiplication of applications intended for monitoring or motivation, often accompanied by surveillance devices. However, there is very little documentation on the degree of accuracy of these applications.

Furthermore, video games can offer positive reinforcement and are easily accessible 11. The introduction of active games at a young age could encourage the choice of such games. However, these games are more effective when the choice is personal, not imposed. An important aspect of video games in physical activity is the positive reinforcement they offer, such as points, in addition to encouraging the achievement of long-term goals, such as the acquisition of new skills.

An important question about video games is whether they provide the right training experience. A simple way to estimate whether the effort of the activity is sufficient is to use the metabolic equivalent (MET). This is the multiple of resting metabolism that is used to measure oxygen consumption. For example, moderate-intensity exercise requires 3 METs, or three times the energy consumption at rest, while vigorous activity requires 6 METs. Unfortunately, most of the popular games studied to date (for example, Dance Dance Revolution, Wii Sports Boxing) achieve a demand of 3 METs at best. Newer games and systems have not yet been studied and will need to demonstrate that they really offer adequate training. When choosing a game, personal preferences must be taken into account 12. There are differences between men and women in gaming preferences. So it's worth talking to others about their experience with games and platforms, and it's best to try out the game before buying it. Another important point about video games: interest is rapidly dwindling. Group activities, on the other hand, encourage the use of games, and social media allows such activities to take place in virtual space. Applauding your child or partner without participating yourself doesn't help them; everyone has to participate.

We know that living an active lifestyle is good for everyone's health. We all need encouragement and support. A variety of devices, smartphone apps, and video games can help, but they need to be accompanied by key elements: personal goals that change with time and progress; immediate feedback, but also through regular interactions; and the ability to maintain stimulation and enjoyment.

In conclusion, I would like to inform you that Canada will be taking part, along with seven other countries, in an international study examining the effect of a physical activity motivation program on lung function and well-being in children and adults.
with cystic fibrosis. Patients from Montreal, Toronto and Vancouver will participate in this one-year study, which is expected to start, pending funding, in spring 2013.

Larry C. Lands M.D., Ph.D. Pediatrician-Pulmonologist
Cystic Fibrosis Clinic Montreal Hospital
for children | McGill Health Center

Transplant clinic
Pulmonary Hospital Notre-Dame Hospital Center of the University of Montreal (CHUM)

Montreal (Quebec) Canada

Bibliographical references

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2. BUTT and others. J Physical Activity and Health, no. 8, 2011, p. 1074-1083.

3. TUDOR-LOCKE and LUTES. Sports Med, no. 39, 2009, p. 981-993.

4. LUBANS and others. Prevent Med, no. 48, 2009, pp. 307-315.

5. TUDOR-LOCKE and LUTES. Sports Med, no. 39, 2009, p. 981-993.

6. SCHOFIELD and others. Med Sci Sports Exer, no. 37, 2005, p. 1414-1420.

7. HURLING and others. J Med Inter Res, no. 9, 2007, p. e7.

8. QUON and others. J CF, 2012.

9. WEIBOLDT and others. J CF, 2012.

10. DWYER and others. Respir Med, no. 103, 2009, p. 1511-1517.

11. BIDISS and IRWIN. Arch Pediatri Adolesc Med, no. 164, 2010, pp. 664-672.

12. BARNETT and others. J Physical Activ Health, no. 8, 2011, p. 724-737.

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