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BACKGROUND: The high prevalence of hypertension necessitates effective, scalable interventions for blood pressure (BP) control. Self-monitoring has shown improved adherence to medication and better BP management. Mobile apps offer a promising approach with their increasing popularity and potential for large-scale implementation. Studies have demonstrated associations between mobile app interventions and lowered BP, yet real-world data on app effectiveness and engagement remain limited. OBJECTIVE: In this study, we analyzed real-world user data from the Cardi.Health mobile app, which is aimed at helping its users monitor and control their BP. Our goal was to find out whether there is an association between the use of the mobile app and a decrease in BP. Additionally, the study explored how engagement with the app may influence this outcome. METHODS: This was a retrospective chart review study. The initial study population comprised 4407 Cardi.Health users who began using the app between January 2022 and April 2022. After applying inclusion criteria, the final study cohort comprised 339 users with elevated BP at the baseline. The sample consisted of 108 (31.9%) men and 231 (68.1%) women (P=.04). This retrospective chart review study obtained permission from the Biomedical Research Alliance of New York Institutional Review Board (June 2022, registration ID 22-08-503-939). RESULTS: The study's main findings were that there is a possible relationship between use of the Cardi.Health mobile app and a decrease in systolic BP. Additionally, there was a significant association between active use of the app and systolic BP decrease (χ21=5.311; P=.02). Finally, active users had an almost 2 times greater chance of reducing systolic BP by 5 mm Hg or more over 4 weeks (odds ratio 1.932, 95% CI 1.074-3.528; P=.03). CONCLUSIONS: This study shows a possible relationship between Cardi.Health mobile app use and decreased BP. Additionally, engagement with the app may be related to better results-active use was associated with an almost 2-fold increase in the odds of reducing BP by 5 or more mm Hg.
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BACKGROUND: An increase in depression, anxiety, and stress symptoms worldwide, attributed to the COVID-19 pandemic, has been reported. If not treated, it may negatively affect a person's everyday life by altering physical and social well-being and productivity and increasing expenditure on health care. Cognitive behavioral therapy (CBT)-based interventions are gaining popularity as a means to reduce stress and alleviate anxiety and depression symptoms. Moreover, CBT delivered through a mobile app has the same elements as traditional CBT training (eg, guided discovery). However, unlike conventional training, users of mobile apps are allowed to tailor their own experience at their own speed and schedule. OBJECTIVE: This study aims to analyze Sensa users' retrospective data and explore the dose-duration effect to find the optimal usage time when the user showed results. METHODS: The study cohort comprised 381 consecutive community-based nonclinical users who started using Sensa between October 2021 and March 2022. All users included in the study took the Depression Anxiety Stress Scale-21 (DASS-21) assessment at least 2 times. Other parameters from the database containing all self-reported data were gender, number of active days, total time of use, and age. The primary outcome of the study was a change in the DASS-21 score. Statistical analyses were performed using GraphPad Prism (version 9, GraphPad Software). In addition, a logistic regression model was created to predict how the obtained independent parameters influenced the DASS-21 score. RESULTS: The main finding of our study was that the majority of participants who started using Sensa were experiencing depression, anxiety, and stress symptoms (92.13%, 80.05%, and 87.93%, respectively). There was a statistically significant decrease of the DASS-21 subdomain scores after the use of the application (anxiety: mean 7.25, SD 4.03 vs mean 6.12, SD 4.00; P=.001; depression: mean 11.05, SD 4.26 vs mean 9.01, SD 4.77; P=.001; stress: mean 11.42, SD 3.44 vs mean 9.96, SD 3.65; P<.001). Finally, the logistic regression model showed that users who were using the app for more than 24 days and had at least 12 active days during that time had 3.463 (95% CI 1.142-11.93) and 2.644 (95% CI 1.024-7.127) times higher chances to reduce their DASS-21 subdomain scores of depression and anxiety, respectively. CONCLUSIONS: Using the Sensa mobile app was related to decreased depression, anxiety, and stress symptoms.
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BACKGROUND: Intermittent fasting (IF) has gained popularity in recent years for its effect on weight loss and supposed additional health benefits, such as a positive effect on body composition and metabolic markers. Mobile apps can act as platforms that help deliver dietary interventions by improving adherence and motivation. Although the effect of IF on weight loss has been demonstrated in earlier trials, there is not much research about the engagement and weight loss results with IF apps. OBJECTIVE: Our main objective was to compare how a nudging platform (including smart scales) influences engagement (the extent to which users interact with the app measured by the number of active days) with the app among users who had obesity at the beginning of use. The secondary objectives were to evaluate the body weight changes among active and nonactive users and, finally, to evaluate the body composition changes of users possessing smart scales during app usage. Through this study, we hope to provide (1) more insight into how nudging (using smart scales as a nudging platform) is associated with engagement with the mobile app, (2) how engagement with the mobile app is associated with weight loss, and (3) how IF is associated with body composition. METHODS: We performed a retrospective analysis of data from 665 users with obesity (BMI≥30) who started using the IF app DoFasting. Of them, 244 used body composition scales that estimated body fat and body muscle values. Users were stratified into engagement groups in accordance with their activity ratio (number of active days divided by the total time of use). Baseline and final users' weight (in kg), body fat (in %), and body muscle (in %) were compared. RESULTS: Our findings suggest an association between the nudging platform (smart scales) and better engagement with the app. Smart scale users had a significantly higher activity ratio than regular users. Additionally, active DoFasting users lost significantly more weight. Further, body composition analysis showed that app usage might be related to body fat loss and an increase in muscle mass. CONCLUSIONS: We found a possible association between the nudging and gamified elements and higher app engagement. Additionally, increased app engagement is associated with increased weight loss. Thus, nudging and gamified elements of mobile health apps, such as interactive tools, goals, challenges, and progress tracking, are suggested to affect engagement positively and should be investigated further in future research. Finally, the IF regime delivered through the DoFasting app might be related to the body muscle mass gain and reduced fat mass.
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BACKGROUND: The purpose of this study was to investigate the efficacy of intermittent fasting (IF) guidance, delivered through a smartphone application, in terms of engagement and weight loss. METHODS: We performed a retrospective chart-review study of all consecutive users with overweight or obesity of the DoFasting mobile application, which integrates IF solutions for people looking to lose weight. Users with overweight and obesity at the beginning of application use, who met the inclusion criteria (entered their gender, height, and starting weight; had more than one weight entry; used the app for at least a month; had at least one active day per week with valid app-related activities) and used the application for weight loss were included in the study. RESULTS: The final study cohort comprised 22,022 consecutive users. The short-term cohort comprised 17,221 users (8585 females and 8636 males), while 4801 users (2983 females and 1818 males) were in the long-term cohort. Long-term active users of the application lost a statistically significant amount of weight over the study period and lost more than inactive users did (2.2 [3.5] vs 1.4 [3.2], p < 0.0001; the results are shown in kilograms as medians with the interquartile range in brackets). Active and long-term users were also more likely to reduce their BMI class (p < 0.05) in comparison to non-active short-term users. A multiple regression model showed that the total length of use and active days were the most significant predictors of weight loss. In-app activities such as total fasting hours, weight logging, completing challenges, and providing feedback were also statistically significant predictors of weight loss with varying contributions. CONCLUSION: We found that the DoFasting mobile application that implements IF is an effective tool for weight loss if used actively and sufficiently. TRIAL REGISTRATION: This retrospective chart review study was approved by BRANY IRB in January 2022 (study ID.: 22-08-034-939).
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BACKGROUND: The ketogenic diet is one of the oldest diets that has been used for more than a centennial in the clinical setting, and it is gaining popularity as a measure to fight obesity, which is a major predisposing factor for many diseases to manifest, including diabetes mellitus, chronic heart disease, cancer, and others. Thus, we designed this retrospective investigation to determine if users of the mobile application KetoCycle achieved statistically significant weight loss outcomes. METHODS: The initial study cohort comprised 12,965 consecutive users who started using KetoCycle between January 2020 and December 2020. The final cohort comprised 10,269 users. The main parameters obtained from the database containing all self-reported data were gender, number of active days (AD), total time of use (TT), height, initial weight, and last recorded weight. The primary outcome of the study was weight loss. Statistical analyses were performed using IBM SPSS Statistics, version 26 (IBM Corp., Armonk, NY, USA). In addition, a standard multiple regression model was created to predict weight loss from significant actions. RESULTS: A retrospective analysis of KetoCycle user data showed that 87.3% of KetoCycle users lost some of their initial weight. Of those, 1645 users (18.3%) lost more than 10% of their initial body weight, 3528 (39.3%) users lost between 5 and 10% of their initial body weight, and 3796 (42.3%) users lost less than 5% of their body weight. When user activity was taken into account, it was found that active users lost statistically significantly more weight than non-active users (p < 0.05). App engagement was also associated with losing > 5% of initial weight. Using water tracking, weight tracking, and creation of a meals list within KetoCycle statistically significantly predicted weight loss in a multiple regression model. CONCLUSIONS: We concluded that KetoCycle appeared as a promising mobile application suited for weight loss and weight control. TRIAL REGISTRATION: This retrospective chart review study was approved by BRANY IRB in January 2022 (registration ID.: 21-08-564-939).