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      What to Build for Middle-Agers to Come? Attractive and Necessary Functions of Exercise-Promotion Mobile Phone Apps: A Cross-Sectional Study

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          Abstract

          Background

          Physical activity is important for middle-agers to maintain health both in middle age and in old age. Although thousands of exercise-promotion mobile phone apps are available for download, current literature offers little understanding regarding which design features can enhance middle-aged adults’ quality perception toward exercise-promotion apps and which factor may influence such perception.

          Objectives

          The aims of this study were to understand (1) which design features of exercise-promotion apps can enhance quality perception of middle-agers, (2) whether their needs are matched by current functions offered in app stores, and (3) whether physical activity (PA) and mobile phone self-efficacy (MPSE) influence quality perception.

          Methods

          A total of 105 middle-agers participated and filled out three scales: the International Physical Activity Questionnaire (IPAQ), the MPSE scale, and the need for design features questionnaire. The design features were developed based on the Coventry, Aberdeen, and London—Refined (CALO-RE) taxonomy. Following the Kano quality model, the need for design features questionnaire asked participants to classify design features into five categories: attractive, one-dimensional, must-be, indifferent, and reverse. The quality categorization was conducted based on a voting approach and the categorization results were compared with the findings of a prevalence study to realize whether needs match current availability. In total, 52 multinomial logistic regression models were analyzed to evaluate the effects of PA level and MPSE on quality perception of design features.

          Results

          The Kano analysis on the total sample revealed that visual demonstration of exercise instructions is the only attractive design feature, whereas the other 51 design features were perceived with indifference. Although examining quality perception by PA level, 21 features are recommended to low level, 6 features to medium level, but none to high-level PA. In contrast, high-level MPSE is recommended with 14 design features, medium level with 6 features, whereas low-level participants are recommended with 1 feature. The analysis suggests that the implementation of demanded features could be low, as the average prevalence of demanded design features is 20% (4.3/21). Surprisingly, social comparison and social support, most implemented features in current apps, were categorized into the indifferent category. The magnitude of effect is larger for MPSE because it effects quality perception of more design features than PA. Delving into the 52 regression models revealed that high MPSE more likely induces attractive or one- dimensional categorization, suggesting the importance of technological self-efficacy on eHealth care promotion.

          Conclusions

          This study is the first to propose middle-agers’ needs in relation to mobile phone exercise-promotion. In addition to the tailor-made recommendations, suggestions are offered to app designers to enhance the performance of persuasive features. An interesting finding on change of quality perception attributed to MPSE is proposed as future research.

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          Most cited references 55

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          Apps to promote physical activity among adults: a review and content analysis

          Background In May 2013, the iTunes and Google Play stores contained 23,490 and 17,756 smartphone applications (apps) categorized as Health and Fitness, respectively. The quality of these apps, in terms of applying established health behavior change techniques, remains unclear. Methods The study sample was identified through systematic searches in iTunes and Google Play. Search terms were based on Boolean logic and included AND combinations for physical activity, healthy lifestyle, exercise, fitness, coach, assistant, motivation, and support. Sixty-four apps were downloaded, reviewed, and rated based on the taxonomy of behavior change techniques used in the interventions. Mean and ranges were calculated for the number of observed behavior change techniques. Using nonparametric tests, we compared the number of techniques observed in free and paid apps and in iTunes and Google Play. Results On average, the reviewed apps included 5 behavior change techniques (range 2–8). Techniques such as self-monitoring, providing feedback on performance, and goal-setting were used most frequently, whereas some techniques such as motivational interviewing, stress management, relapse prevention, self-talk, role models, and prompted barrier identification were not. No differences in the number of behavior change techniques between free and paid apps, or between the app stores were found. Conclusions The present study demonstrated that apps promoting physical activity applied an average of 5 out of 23 possible behavior change techniques. This number was not different for paid and free apps or between app stores. The most frequently used behavior change techniques in apps were similar to those most frequently used in other types of physical activity promotion interventions.
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            Changes in physical activity, mortality, and incidence of coronary heart disease in older men.

            We studied the relations between physical activity and changes in physical activity, all-cause mortality, and incidence of major coronary-heart-disease events in older men. In 1978-80 (Q1), 7735 men aged 40-59 were selected from general practices in 24 British towns, and enrolled in a prospective study of cardiovascular disease, which included physical activity data. In 1992 (Q92), 12-14 years later, 5934 of the men (91% of available survivors, mean age 63 years) gave further information on physical activity and were then followed up for a further 4 years. The main endpoints were all-cause mortality during 4 years of follow-up from Q92, and major fatal and non-fatal coronary-heart-disease events during 3 years of follow-up from Q92. Among 4311 men with no history of coronary heart disease, stroke, or "other heart trouble" by Q92 and who did not report "poor health", there were 219 deaths. In the inactive/occasionally active, light, moderate, and moderately vigorous/vigorous activity groups there were 101 (18.5/1000 person-years) 48 (11.4), 23 (7.3), and 47 (9.1) deaths, respectively (adjusted risk ratios 1.00, 0.61 [95% CI 0.48-0.86], 0.50 [0.31-0.79], 0.65 [0.45-0.94]). Men who were sedentary at Q1 and who began at least light activity by Q92 had significantly lower all-cause mortality than those who remained sedentary, even after adjustment for potential confounders (risk ratio=0.55 [0.36-0.84]). Physical activity improved both cardiovascular mortality (0.66 [0.35-1.23]) and non-cardiovascular mortality (0.48 [0.27-0.85]). The relation between physical activity at Q92, changes in physical activity, and mortality were similar for men with pre-existing cardiovascular disease. Maintaining or taking up light or moderate physical activity reduces mortality and heart attacks in older men with and without diagnosed cardiovascular disease. Our results support public-health recommendations for older sedentary people to increase physical activity, and for active middle-aged people to continue their activity into old age.
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              Selection of appropriate Chinese terms to represent intensity and types of physical activity terms for use in the Taiwan version of IPAQ.

              In order to analyze the health risks of insufficient activity by international comparisons, the first author obtained the permission to translate and develop a Taiwan version of the International Physical Activity Questionnaire (IPAQ). The objective was to determine culturally sensitive Chinese translations for the terms "moderate", "vigorous" and "physical activity" as well as to identify representative types of physical activity for Taiwanese. This study used discussions by 12 expert focus groups, 6 expert audits, a scale survey, field study, Cognitive Aspect Survey Methodology (CASM), dual independent translation and back-translation to establish a consensus on physical activity-related concepts, terminologies and types that define the intensity of common activities of Taiwanese by integrating both local and foreign studies. The Chinese terms "fei li", "zhong deng fei li" and "shen ti huo dong", respectively, were identified as suitable and adequate translations for the English terms "vigorous", "moderate" and "physical activity". The common Taiwanese activities were accurately categorized and listed in questionnaires, forming culturally sensitive scales. Taiwan versions of IPAQ's self-administered long version (SL), self-administered short version (SS), and telephone interview short version (TS) were developed. Their content validity indices were .992, .994, and .980, as well as .994, .992, and .994 for language equivalence and meaning similarity between the English and Chinese versions of the IPAQ-LS, IPAQ-SS, and IPAQ-TS, respectively. Consistency values for the English and Chinese versions in terms of intraclass correlation coefficients were .945, .704, and .894, respectively. The IPAQ-Taiwan is not only a sensitive and precise tool, but also shows the effectiveness of the methodology (CASM) used in tool development. Subjects who did not regularly exercise and had an education less than a junior high school level underestimated the moderate-intensity physical activity.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                May 2017
                25 May 2017
                : 5
                : 5
                Affiliations
                1Department of Information Management Chang Gung University Taoyuan CityTaiwan
                2Dept of Nursing Chang Gung Memorial Hospital, Taoyuan Branch Taoyuan CityTaiwan
                3Department of Information Management National Taiwan University TaipeiTaiwan
                4Department of Nursing Chang Gung University of Science of Technology Guishan District, Taoyuan CityTaiwan
                5Division of Chinese Gynecology, Center for Traditional Chinese Medicine Chang Gung Memorial Hospital, Taoyuan, Taiwan Kwei-Shan Tao-YuanTaiwan
                Author notes
                Corresponding Author: Gen-Yih Liao gyliao@ 123456acm.org
                Article
                v5i5e65
                10.2196/mhealth.6233
                5465381
                28546140
                ©Gen-Yih Liao, Yu-Tai Chien, Yu-Jen Chen, Hsiao-Fang Hsiung, Hsiao-Jung Chen, Meng-Hua Hsieh, Wen-Jie Wu. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 25.05.2017.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

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