Using hand-held computer technologies to improve dietary intake.

BACKGROUND: Portable hand-held information technology offers much promise not only in assessing dietary intake in the real world, but also in providing dietary feedback to individuals. However, stringent research designs have not been employed to examine whether it can be effective in modifying dietary behaviors. The purpose of this pilot study was to evaluate the efficacy of a hand-held computer (i.e., personal digital assistant [PDA]) for increasing vegetable and whole-grain intake over 8 weeks in mid-life and older adults, using a randomized study design. METHODS: Twenty-seven healthy adults aged > or =50 were randomized and completed the 8-week study. Intervention participants received an instructional session and a PDA programmed to monitor their vegetable and whole-grain intake levels twice per day and to provide daily individualized feedback, goal-setting, and support. Controls received standard, age-appropriate, written nutritional education materials. Dietary intake was assessed via the Block Food Frequency Questionnaire at baseline and 8 weeks. RESULTS: Relative to controls, intervention participants reported significantly greater increases in vegetable servings (1.5-2.5 servings/day; p=0.02), as well as a trend toward greater intake of dietary fiber from grains (3.7-4.5 servings/day; p=0.10). CONCLUSIONS: This study's findings provide preliminary evidence that using portable hand-held technology to provide daily individualized feedback on dietary behavior in the real world can increase the dietary intake of healthy food groups.

Promoting physical activity through hand-held computer technology.

BACKGROUND: Efforts to achieve population-wide increases in walking and similar moderate-intensity physical activities potentially can be enhanced through relevant applications of state-of-the-art interactive communication technologies. Yet few systematic efforts to evaluate the efficacy of hand-held computers and similar devices for enhancing physical activity levels have occurred. The purpose of this first-generation study was to evaluate the efficacy of a hand-held computer (i.e., personal digital assistant [PDA]) for increasing moderate intensity or more vigorous (MOD+) physical activity levels over 8 weeks in mid-life and older adults relative to a standard information control arm. DESIGN: Randomized, controlled 8-week experiment. Data were collected in 2005 and analyzed in 2006-2007. SETTING/PARTICIPANTS: Community-based study of 37 healthy, initially underactive adults aged 50 years and older who were randomized and completed the 8-week study (intervention=19, control=18). INTERVENTION: Participants received an instructional session and a PDA programmed to monitor their physical activity levels twice per day and provide daily and weekly individualized feedback, goal setting, and support. Controls received standard, age-appropriate written physical activity educational materials. MAIN OUTCOME MEASURE: Physical activity was assessed via the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire at baseline and 8 weeks. RESULTS: Relative to controls, intervention participants reported significantly greater 8-week mean estimated caloric expenditure levels and minutes per week in MOD+ activity (p<0.04). Satisfaction with the PDA was reasonably high in this largely PDA-naive sample. CONCLUSIONS: Results from this first-generation study indicate that hand-held computers may be effective tools for increasing initial physical activity levels among underactive adults.

Using electronic diaries to examine physical activity and other health behaviors of adults age 50+.

This pilot investigation used portable electronic diaries to assess the physical activity and other health behaviors of 20 adults age 50+ (mean age = 61 years). Study aims were to examine whether computerized cognitive-behavioral strategies could increase adherence to the assessments, the acceptability of electronic diaries to assess everyday health, and the relationship between computerized physical activity assessments with a standardized physical activity measure. Although approximately two thirds of participants had never used an electronic diary, results indicated that a large majority (83%) reported enjoying the use of the electronic diaries, and most (72%) reported enjoying answering all of the health questions. The cognitive-behavioral strategies employed did not enhance assessment adherence, but electronic-diary-based activity levels corresponded more strongly with the poststudy standardized activity measure than the baseline standardized measure, providing evidence of temporal convergence. Findings suggest that the use of portable electronic technology in physical activity assessment of middle-aged and older adults deserves further study.

Successful dietary changes in a cardiovascular risk reduction intervention are differentially predicted by biopsychosocial characteristics.

BACKGROUND: Psychosocial factors have demonstrated associations with both prognosis of patients with cardiovascular disease (CVD) as well as the development of CVD. Psychosocial distress may influence health behaviors (such as eating behavior) that increase cardiovascular risk. METHOD: The purpose of this research was to evaluate the role of psychosocial distress on intake of high-fat snacks and fruits and vegetables in 740 men and women, identified as high risk for cardiovascular disease, who took part in a 1-year cardiovascular risk factor reduction program. RESULTS: Participants who were more successful at decreasing or staying at an optimal level of high-fat food intake had lower levels of baseline total psychosocial distress and worry and decreases in total psychosocial distress. A greater success rate at increasing fruit and vegetable intake or staying at an optimal level of fruit and vegetable intake was associated with changes in Type A and competing behaviors. CONCLUSIONS: Results from these analyses suggest that baseline levels and changes in psychosocial variables, particularly decreased psychosocial distress, were associated with improvements in healthful eating behaviors. Further work may provide information that could be useful in tailoring health behavior interventions to specific subgroups based on psychosocial characteristics, initial health behaviors, and demographic characteristics.