Accepted for/Published in: JMIR Formative Research
Date Submitted: May 17, 2021
Date Accepted: Nov 27, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Use of a Smartphone Application versus Motivational Interviewing to Increase Walking Distance and Weight Loss in Overweight/Obese Adults with Peripheral Artery Disease: A Pilot Randomized Trial
ABSTRACT
Background:
Walking therapy improves functional outcomes in peripheral artery disease (PAD). Less is known about the additive benefit of a dietary intervention.
Objective:
Our objective was to explore the efficacy of a smartphone application (App) versus motivational interviewing (MI) to increase walking distance and promote weight loss in overweight/obese adults with PAD.
Methods:
We conducted a 3-month, 2-arm randomized pilot study at the University of Kansas. Participants had a body mass index (BMI) > 27 kg/m2 and symptomatic PAD, defined by an ankle-brachial index (ABI) < 0.9. Patients were randomized into two groups: 1) MI, delivered through in-person and telephone counseling, or 2) App, a mobile smartphone application. Both interventions encouraged walking for exercise and and healthy dietary habits (increasing fruits and vegetables as well as whole grains while reducing fat and sugary drinks). We assessed medical history at baseline. At baseline and 3 months, participants completed a BMI assessment, 6-minute walking distance, dietary habits, quality of life, and exercise behaviors. The primary outcome was 3-month change in walking distance. Secondary outcomes were changes in BMI, and quality of life.
Results:
We randomized 29 participants with a mean age of 66.03 (SD 8.12) years. At baseline, mean walking distance was 283.48 meters (SD 70.18) and 320.66 meters (SD 70.46) for MI and App participants, respectively. At three months, the mean walking distance was 333.77 meters (SD 50.63) and 323.16 meters (SD 55.06) for MI and App participants, respectively (p-value = 0.05, adjusting for baseline). At baseline, mean body weight was 248.87 lbs. (SD 55.78) and 226.74 lbs. (SD 61.86) for MI and App participants, respectively. At three months, mean body weight was 233.83 (SD 48.27) and 225.18 (SD 62.46) for MI and App, respectively (p < 0.01, adjusting for baseline).
Conclusions:
Our study demonstrates that MI can promote weight loss in overweight/obese adults with PAD. There was no statistically significant increase in walking distance with the use of MI or a smartphone App in overweight/obese adults with PAD. Future large-scale studies are needcd to determine the efficacy of MI to promote weight loss in overweight or obese adults with PAD. Clinical Trial: The clinical trial registration for this study is NCT03694652 (https://clinicaltrials.gov/).
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