Hand-Held Computers Prod Older Adults to Exercise More, Stanford Study Shows

STANFORD, Calif.--(Business Wire)--
Today's younger generation may reckon that "ne'er the twain shall
meet" where technology and their elders are concerned. However,
ongoing research by Abby King, PhD, professor of health research and
policy and of medicine at the Stanford Prevention Research Center,
appears to be gradually dispelling that notion.

In a study that appears in the February issue of the American
Journal of Preventive Medicine, King showed that specially programmed
PDAs, or personal digital assistants, can prod middle-aged and older
Americans--the most sedentary segment of the U.S. population--into
increasing their physical activity levels. This first-generation study
follows on the heels of King's research report in the December issue
of Health Psychology, in which she showed that automated computer
calls were almost as effective as live health educators in coaxing
people previously less active to get more of a spring in their step.

King and colleagues feel that developing approaches to help people
increase their exercise frequency, while taking into account an
individual's schedule and environment, is particularly important.

"Portable computer devices are useful because they can be carried
around throughout a person's day," King said. "Such devices represent
one kind of strategy for being able to provide individuals with the
help and support they need, in a convenient, real-time context."

The researchers invited the public to participate in this new
study through local mass-media outlets, like the Palo Alto Daily News
and the San Jose Mercury News. Out of 69 callers who were screened for
eligibility, 37 were invited to be study participants and randomly
assigned to an eight-week program in which they either received a Dell
Axim X5 PDA, or traditional handouts related to physical activity.

"Then we let 'em roll," King said.

The Dell Axim X5, chosen for its large-sized, easy-to-read screen
and good contrast, was fitted with a program that asked participants
approximately three minutes' worth of questions. Among the questions:
Where are you now? Who are you with? What barriers did you face in
doing your physical activity routine? The device automatically beeped
once in the afternoon and once in the evening; if participants ignored
it the first time, it beeped three additional times at 30-minute
intervals. During the second (evening) session, the device also asked
participants about their goals for the next day.

With this program, participants could set goals, track their
physical activity progress twice a day and get feedback on how well
they were meeting their goals. After eight weeks, the researchers
found that while participants assigned to the PDA group devoted
approximately five hours each week to exercise, those in the control
group spent only about two hours on physical activities--in other
words, the PDA users were more than twice as active.

One surprise was the participants' positive response to the
program's persistence. The PDA users liked the three additional
"reminder" beeps that went off if they failed to respond to the first
one. In fact, almost half of them wound up responding to the PDA only
after being beeped for the fourth time.

"The PDAs can really keep on you," King observed with wry humor.
"We were surprised by that; we thought by the time they heard the
fourth beep, they might find it annoying and not respond at all."

The study targeted people interested in health changes, but with
little if any knowledge of portable computer devices. During the
eligibility screening, 93 percent said they had never used a PDA
before. So there could have been difficulties in grasping the
technology, or participants refusing to deal with it and giving up
entirely. This, however, did not turn out to be a problem.

"They were very curious about PDAs, and that's why some of them
signed up," King said. Several participants, she added, were aware of
PDAs because their children were using the device, and so they wanted
to learn more about the technology.

King and colleagues are also working with researchers from MIT,
Northeastern University, Brown University and Boston Medical Center to
evaluate the ability of other types of computer-based, automated and
interactive devices to help people change their health behavior.

So what's next, after PDAs?

"Cell phones, for sure," King said. "Especially now that we have
the iPhone; its big screen would be very useful for providing visual
feedback." She and her colleagues are also continuing to focus on
developing portable devices capable of interacting with accelerometers
(activity monitors), so that the necessary information--for example,
the amount of walking in a day--automatically transmits to the device.

"With the PDA study, evaluations made were based almost entirely
on the participants' self-report," King explained. "We'd like our
devices to be able to provide real-time feedback using objective
activity as well."

In a companion study to be published later this year, King and
colleagues have also evaluated the usefulness of PDAs in modifying
dietary behavior. Results indicate that similar "probing" and feedback
by a computer program--about a person's eating habits rather than
activity level--can nudge participants towards increasing their
vegetable and whole-grain intake.

"Physical activity is only one piece of the puzzle; another is
dietary intake," King noted. She would like to eventually harness the
tracking power of GPS, so that willing participants, "if they're
walking past a Fresh Choice restaurant, can be prompted to go there
instead of the fast-food outlet next door."

Maybe that's technical intervention, not divine--but it could be
helpful, especially when you can't get that vision of french fries out
of your head.

King's co-authors on the PDA study were David Ahn, PhD, research
software developer; Cynthia Castro, PhD, research associate, and
Christopher Gardner, PhD, associate professor of medicine at the
Stanford Prevention Research Center.

Stanford University Medical Center integrates research, medical
education and patient care at its three institutions -- Stanford
University School of Medicine, Stanford Hospital & Clinics and Lucile
Packard Children's Hospital at Stanford. For more information, please
visit the Web site of the medical center's Office of Communication &
Public Affairs at http://mednews.stanford.edu.

Stanford University Medical Center
Susan Ipaktchian, 650-725-5375 (Print Media)
susani@stanford.edu
Margarita Gallardo, 650-723-7897 (Broadcast Media)
mjgallardo@stanford.edu

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