A Walking Intervention Supplemented With Mobile Health Technology in Low-Active Urban African American Women With Asthma: Proof-of-Concept Study

Sharmilee M Nyenhuis, Guilherme Moraes Balbim, Jun Ma, David X Marquez, JoEllen Wilbur, Lisa K Sharp, Spyros Kitsiou, Sharmilee M Nyenhuis, Guilherme Moraes Balbim, Jun Ma, David X Marquez, JoEllen Wilbur, Lisa K Sharp, Spyros Kitsiou

Abstract

Background: Physical inactivity is associated with worse asthma outcomes. African American women experience disparities in both physical inactivity and asthma relative to their white counterparts. We conducted a modified evidence-based walking intervention supplemented with mobile health (mHealth) technologies to increase physical activity (PA).

Objective: This study aimed to assess the preliminary feasibility of a 7-week walking intervention modified for African American women with asthma.

Methods: African American women with suboptimally controlled asthma were identified from a health system serving low-income minorities. At a baseline data collection visit, participants performed spirometry and incremental shuttle walk test, completed questionnaires, and were given an accelerometer to wear for 1 week. The intervention comprised an informational study manual and 3 in-person group sessions over 7 weeks, led by a nurse interventionist, in a community setting. The supplemental mHealth tools included a wearable activity tracker device (Fitbit Charge HR) and one-way text messages related to PA and asthma 3 times per week. A secure Web-based research platform, iCardia, was used to obtain Fitbit data in real time (wear time, moderate-to-vigorous physical activity [MVPA] and sedentary time) and send text messages. The feasibility of the intervention was assessed in the domains of recruitment capability, acceptability (adherence, retention, engagement, text messaging, acceptability, complaints, and concerns), and preliminary outcome effects on PA behavior (change in steps, duration, and intensity).

Results: We approached 22 women, of whom 10 were eligible; 7 consented, enrolled and completed the study. Group session attendance was 71% (5/7), 86% (6/7), and 86% (6/7), respectively, across the 3 sessions. All participants completed evaluations at each group session. The women reported being satisfied or very satisfied with the program (eg, location, time, and materials). None of them had concerns about using, charging, or syncing the Fitbit device and app. Participants wore their Fitbit device for at least 10 hours per day in 44 out of the 49 intervention days. There was an increase in Fitbit-measured MVPA from week 1 (19 min/week, SD 14 min/week) to the last week of intervention (22 min/week, SD 12 min/week; Cohen d=0.24, 95% CI 0.1 to 6.4). A slight decrease in step count was observed from week 1 (8926 steps/day, SD 2156 steps/day) to the last week of intervention (8517 steps/day, SD 1612 steps/day; Cohen d=-0.21, 95% CI -876.9 to 58.9).

Conclusions: The initial feasibility results of a 7-week community-based walking intervention tailored for African American women with asthma and supplemented with mHealth tools are promising. Modifications to recruitment, retention, and the intervention itself are needed. These findings support the need to conduct a further modified pilot trial to collect additional data on feasibility and estimate the efficacy of the intervention on asthma and PA outcomes.

Keywords: African-American; activity trackers; asthma; mHealth; mobile phone; physical activity; smartphone; text message; women.

Conflict of interest statement

Conflicts of Interest: None declared.

©Sharmilee M Nyenhuis, Guilherme Moraes Balbim, Jun Ma, David X Marquez, JoEllen Wilbur, Lisa K Sharp, Spyros Kitsiou. Originally published in JMIR Formative Research (http://formative.jmir.org), 11.03.2020.

Figures

Figure 1
Figure 1
iCardia platform.
Figure 2
Figure 2
CONSORT flow diagram.
Figure 3
Figure 3
Mean, standard deviation, and individual Fitbit wear time over the 7-week intervention period.
Figure 4
Figure 4
Mean weekly goal achievement over the 7-week intervention period.
Figure 5
Figure 5
Mean weekly goal achievement over the 7-week intervention period.
Figure 6
Figure 6
Weekly mean, standard deviation, and individual time spent in MVPA over the 7-week intervention period.
Figure 7
Figure 7
Comparison of the weekly mean time spent in total and adjusted sedentary behavior over the 7-week intervention period.

References

    1. Akinbami LM, Moorman JE, Bailey C, Zahran HS, King M, Johnson CA, Liu X. Trends in asthma prevalence, health care use, and mortality in the United States, 2001-2010. NCHS Data Brief. 2012 May;(94):1–8.
    1. Northridge ME, Meyer IH, Dunn L. Overlooked and underserved in Harlem: a population-based survey of adults with asthma. Environ Health Perspect. 2002 Apr;110(Suppl 2):217–20. doi: 10.1289/ehp.02110s2217.
    1. Sherman C, Tollerud DJ, Heffner LJ, Speizer FE, Weiss ST. Airway responsiveness in young black and white women. Am Rev Respir Dis. 1993 Jul;148(1):98–102. doi: 10.1164/ajrccm/148.1.98.
    1. Dogra S, Kuk JL, Baker J, Jamnik V. Exercise is associated with improved asthma control in adults. Eur Respir J. 2011 Feb;37(2):318–23. doi: 10.1183/09031936.00182209.
    1. Mancuso CA, Choi TN, Westermann H, Wenderoth S, Wells MT, Charlson ME. Improvement in asthma quality of life in patients enrolled in a prospective study to increase lifestyle physical activity. J Asthma. 2013 Feb;50(1):103–7. doi: 10.3109/02770903.2012.743150.
    1. Carson K, Chandratilleke MG, Picot J, Brinn MP, Esterman AJ, Smith BJ. Physical training for asthma. Cochrane Database Syst Rev. 2013 Sep 30;(9):CD001116. doi: 10.1002/14651858.CD001116.pub4.
    1. Avallone KM, McLeish AC. Asthma and aerobic exercise: a review of the empirical literature. J Asthma. 2013 Mar;50(2):109–16. doi: 10.3109/02770903.2012.759963.
    1. Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, Celli B, Engelen M, Fahy B, Garvey C, Goldstein R, Gosselink R, Lareau S, MacIntyre N, Maltais F, Morgan M, O'Donnell D, Prefault C, Reardon J, Rochester C, Schols A, Singh S, Troosters T, ATS/ERS Pulmonary Rehabilitation Writing Committee American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006 Jun 15;173(12):1390–413. doi: 10.1164/rccm.200508-1211ST.
    1. American College of Sports Medicine. Moore GE, Durstine JL, Painter PL. ACSM's Exercise Management for Persons With Chronic Diseases and Disabilities. Champaign, IL: Human Kinetics; 2009.
    1. Mälkiä E, Impivaara O. Intensity of physical activity and respiratory function in subjects with and without bronchial asthma. Scand J Med Sci Sports. 1998 Feb;8(1):27–32. doi: 10.1111/j.1600-0838.1998.tb00225.x.
    1. Banks-Wallace J, Conn V. Interventions to promote physical activity among African American women. Public Health Nurs. 2002;19(5):321–35. doi: 10.1046/j.1525-1446.2002.19502.x.
    1. Whitt-Glover MC, Brand DJ, Turner ME, Ward SA, Jackson EM. Increasing physical activity among African-American women and girls. Curr Sports Med Rep. 2009;8(6):318–24. doi: 10.1249/JSR.0b013e3181c27ade.
    1. Boyd A, Yang CT, Estell K, Ms CT, Gerald LB, Dransfield M, Bamman M, Bonner J, Atkinson T, Schwiebert LM. Feasibility of exercising adults with asthma: a randomized pilot study. Allergy Asthma Clin Immunol. 2012 Aug 3;8(1):13. doi: 10.1186/1710-1492-8-13.
    1. Mancuso CA, Sayles W, Robbins L, Phillips EG, Ravenell K, Duffy C, Wenderoth S, Charlson ME. Barriers and facilitators to healthy physical activity in asthma patients. J Asthma. 2006 Mar;43(2):137–43. doi: 10.1080/02770900500498584.
    1. Janevic MR, Ellis KR, Sanders GM, Nelson BW, Clark NM. Self-management of multiple chronic conditions among African American women with asthma: a qualitative study. J Asthma. 2014 Apr;51(3):243–52. doi: 10.3109/02770903.2013.860166.
    1. Nyenhuis SM, Shah N, Ma J, Marquez DX, Wilbur J, Cattamanchi A, Sharp LK. Identifying barriers to physical activity among African American women with asthma. Cogent Med. 2019;6(1):pii: 1582399. doi: 10.1080/2331205x.2019.1582399.
    1. Wilbur J, Chandler P, Dancy B, Choi J, Plonczynski D. Environmental, policy, and cultural factors related to physical activity in urban, African American women. Women Health. 2002;36(2):17–28. doi: 10.1300/J013v36n02_02.
    1. Jenkins F, Jenkins C, Gregoski MJ, Magwood GS. Interventions promoting physical activity in African American women: an integrative review. J Cardiovasc Nurs. 2017;32(1):22–9. doi: 10.1097/JCN.0000000000000298.
    1. Wilbur J, Miller AM, Fogg L, McDevitt J, Castro CM, Schoeny ME, Buchholz SW, Braun LT, Ingram DM, Volgman AS, Dancy BL. Randomized clinical trial of the women's lifestyle physical activity program for African-American women: 24- and 48-week outcomes. Am J Health Promot. 2016 May;30(5):335–45. doi: 10.1177/0890117116646342.
    1. Nyenhuis SM. Midwestern Regional Meeting. J Investig Med. 2018;66(4):784–886. doi: 10.1136/jim-2018-000745.1.
    1. Baptist AP, Islam N, Joseph CL. Technology-based interventions for asthma-can they help decrease health disparities? J Allergy Clin Immunol Pract. 2016;4(6):1135–42. doi: 10.1016/j.jaip.2016.04.024.
    1. Reese JM, Joseph RP, Cherrington A, Allison J, Kim Y, Spear B, Childs G, Simpson T, Durant NH. Development of participant-informed text messages to promote physical activity among African American women attending college: a qualitative mixed-methods inquiry. J Transcult Nurs. 2017 May;28(3):236–42. doi: 10.1177/1043659616644959.
    1. Joseph RP, Keller C, Adams MA, Ainsworth BE. Print versus a culturally-relevant Facebook and text message delivered intervention to promote physical activity in African American women: a randomized pilot trial. BMC Womens Health. 2015 Mar 27;15:30. doi: 10.1186/s12905-015-0186-1.
    1. McCoy P, Leggett S, Bhuiyan A, Brown D, Frye P, Williams B. Text messaging: an intervention to increase physical activity among African American participants in a faith-based, competitive weight loss program. Int J Environ Res Public Health. 2017 Mar 29;14(4):pii: E326. doi: 10.3390/ijerph14040326.
    1. Kim BH, Glanz K. Text messaging to motivate walking in older African Americans: a randomized controlled trial. Am J Prev Med. 2013 Jan;44(1):71–5. doi: 10.1016/j.amepre.2012.09.050.
    1. Schatz M, Kosinski M, Yarlas AS, Hanlon J, Watson ME, Jhingran P. The minimally important difference of the Asthma Control Test. J Allergy Clin Immunol. 2009 Oct;124(4):719–23.e1. doi: 10.1016/j.jaci.2009.06.053.
    1. Troiano RP, McClain JJ, Brychta RJ, Chen KY. Evolution of accelerometer methods for physical activity research. Br J Sports Med. 2014 Jul;48(13):1019–23. doi: 10.1136/bjsports-2014-093546.
    1. Nyenhuis S, Ma J, Sharp L. Applying the COM-B model to designing a tailored physical activity intervention for sedentary African American women with asthma. Am J Respir Crit Care Med. 2017;195:A3336.
    1. Kitsiou S, Thomas M, Marai GE, Maglaveras N, Kondos G, Arena R, Gerber B. Development of an Innovative mHealth Platform for Remote Physical Activity Monitoring and Health Coaching of Cardiac Rehabilitation Patients. Proceedings of the 2017 IEEE EMBS International Conference on Biomedical & Health Informatics; BHI'17; February 16-19, 2017; Orlando, FL. 2017.
    1. Fokkema T, Kooiman TJ, Krijnen WP, van der Schans CP, de Groot M. Reliability and validity of ten consumer activity trackers depend on walking speed. Med Sci Sports Exerc. 2017 Apr;49(4):793–800. doi: 10.1249/MSS.0000000000001146.
    1. Mishra A, Nieto A, Kitsiou S. Systematic Review of mHealth Interventions Involving Fitbit Activity Tracking Devices. Proceedings of the 2017 IEEE International Conference on Healthcare Informatics; ICHI'17; August 23-26, 2017; Park City, UT, USA. 2017.
    1. Lim WK, Davila S, Teo JX, Yang C, Pua CJ, Blöcker C, Lim JQ, Ching J, Yap JJL, Tan SY, Sahlén A, Chin CW, Teh BT, Rozen SG, Cook SA, Yeo KK, Tan P. Beyond fitness tracking: the use of consumer-grade wearable data from normal volunteers in cardiovascular and lipidomics research. PLoS Biol. 2018 Feb;16(2):e2004285. doi: 10.1371/journal.pbio.2004285.
    1. Duncan MJ, Vandelanotte C, Trost SG, Rebar AL, Rogers N, Burton NW, Murawski B, Rayward A, Fenton S, Brown WJ. Balanced: a randomised trial examining the efficacy of two self-monitoring methods for an app-based multi-behaviour intervention to improve physical activity, sitting and sleep in adults. BMC Public Health. 2016 Jul 30;16:670. doi: 10.1186/s12889-016-3256-x.
    1. Wilde BE, Sidman CL, Corbin CB. A 10,000-step count as a physical activity target for sedentary women. Res Q Exerc Sport. 2001 Dec;72(4):411–4. doi: 10.1080/02701367.2001.10608977.
    1. Gell NM, Wadsworth DD. The use of text messaging to promote physical activity in working women: a randomized controlled trial. J Phys Act Health. 2015 Jun;12(6):756–63. doi: 10.1123/jpah.2013-0144.
    1. MacDonell K, Gibson-Scipio W, Lam P, Naar-King S, Chen X. Text messaging to measure asthma medication use and symptoms in urban African American emerging adults: a feasibility study. J Asthma. 2012 Dec;49(10):1092–6. doi: 10.3109/02770903.2012.733993.
    1. Ghasemi A, Zahediasl S. Normality tests for statistical analysis: a guide for non-statisticians. Int J Endocrinol Metab. 2012;10(2):486–9. doi: 10.5812/ijem.3505.
    1. Juniper E, O'Byrne PM, Guyatt G, Ferrie P, King D. Development and validation of a questionnaire to measure asthma control. Eur Respir J. 1999 Oct;14(4):902–7. doi: 10.1034/j.1399-3003.1999.14d29.x.
    1. Juniper E, Guyatt G, Cox F, Ferrie P, King D. Development and validation of the Mini Asthma Quality of Life Questionnaire. Eur Respir J. 1999 Jul;14(1):32–8. doi: 10.1034/j.1399-3003.1999.14a08.x.
    1. Olaguibel J, Quirce S, Juliá B, Fernández C, Fortuna A, Molina J, Plaza V, MAGIC Study Group Measurement of asthma control according to Global Initiative for Asthma guidelines: a comparison with the Asthma Control Questionnaire. Respir Res. 2012 Jun 22;13:50. doi: 10.1186/1465-9921-13-50.
    1. Majd S, Hewitt SM, Bradding P, Singh SJ, Green RH, Evans RA. Repeatability and validity of the Incremental shuttle walk test (ISWT) distance among adults with severe asthma. Eur Respir J. 2016;48(Suppl 60):PA1575. doi: 10.1183/13993003.congress-2016.PA1575.
    1. Team V, Bugeja L, Weller CD. Barriers and facilitators to participant recruitment to randomised controlled trials: a qualitative perspective. Int Wound J. 2018 Dec;15(6):929–42. doi: 10.1111/iwj.12950.
    1. Durant RW, Wenzel JA, Scarinci IC, Paterniti DA, Fouad MN, Hurd TC, Martin MY. Perspectives on barriers and facilitators to minority recruitment for clinical trials among cancer center leaders, investigators, research staff, and referring clinicians: enhancing minority participation in clinical trials (EMPaCT) Cancer. 2014 Apr 1;120(Suppl 7):1097–105. doi: 10.1002/cncr.28574. doi: 10.1002/cncr.28574.
    1. Ejiogu N, Norbeck JH, Mason MA, Cromwell BC, Zonderman AB, Evans MK. Recruitment and retention strategies for minority or poor clinical research participants: lessons from the Healthy Aging in Neighborhoods of Diversity across the Life Span study. Gerontologist. 2011 Jun;51(Suppl 1):S33–45. doi: 10.1093/geront/gnr027.
    1. Toennesen LL, Soerensen ED, Hostrup M, Porsbjerg C, Bangsbo J, Backer V. Feasibility of high-intensity training in asthma. Eur Clin Respir J. 2018;5(1):1468714. doi: 10.1080/20018525.2018.1468714.
    1. Renolleau-Courtois D, Lamouroux-Delay A, Delpierre S, Badier M, Lagier-Tessonnier F, Palot A, Gouitaa M, Tummino C, Charpin D, Molinari N, Chanez P. Home-based respiratory rehabilitation in adult patients with moderate or severe persistent asthma. J Asthma. 2014 Jun;51(5):552–8. doi: 10.3109/02770903.2014.885039.
    1. Kocherginsky M, Huisingh-Scheetz M, Dale W, Lauderdale DS, Waite L. Measuring physical activity with hip accelerometry among US older adults: how many days are enough? PLoS One. 2017;12(1):e0170082. doi: 10.1371/journal.pone.0170082.
    1. Cadmus-Bertram L, Marcus BH, Patterson RE, Parker BA, Morey BL. Use of the Fitbit to measure adherence to a physical activity intervention among overweight or obese, postmenopausal women: self-monitoring trajectory during 16 weeks. JMIR Mhealth Uhealth. 2015 Nov 19;3(4):e96. doi: 10.2196/mhealth.4229.
    1. Emtner M, Finne M, Stålenheim G. High-intensity physical training in adults with asthma. A comparison between training on land and in water. Scand J Rehabil Med. 1998 Dec;30(4):201–9. doi: 10.1080/003655098443940.
    1. Rich C, Griffiths LJ, Dezateux C. Seasonal variation in accelerometer-determined sedentary behaviour and physical activity in children: a review. Int J Behav Nutr Phys Act. 2012 Apr 30;9:49. doi: 10.1186/1479-5868-9-49.
    1. Arnardottir NY, Oskarsdottir ND, Brychta RJ, Koster A, van Domelen DR, Caserotti P, Eiriksdottir G, Sverrisdottir JE, Johannsson E, Launer LJ, Gudnason V, Harris TB, Chen KY, Sveinsson T. Comparison of summer and winter objectively measured physical activity and sedentary behavior in older adults: age, gene/environment susceptibility Reykjavik study. Int J Environ Res Public Health. 2017 Oct 21;14(10):pii: E1268. doi: 10.3390/ijerph14101268.
    1. Sweet S, Fortier MS, Blanchard CM. Investigating motivational regulations and physical activity over 25 weeks. J Phys Act Health. 2014 Jul;11(5):1052–6. doi: 10.1123/jpah.2012-0057.
    1. Cadmus-Bertram LA, Marcus BH, Patterson RE, Parker BA, Morey BL. Randomized trial of a Fitbit-based physical activity intervention for women. Am J Prev Med. 2015 Sep;49(3):414–8. doi: 10.1016/j.amepre.2015.01.020.
    1. Scarapicchia TM, Sabiston CM, O'Loughlin E, Brunet J, Chaiton M, O'Loughlin JL. Physical activity motivation mediates the association between depression symptoms and moderate-to-vigorous physical activity. Prev Med. 2014 Sep;66:45–8. doi: 10.1016/j.ypmed.2014.05.017.
    1. Stults-Kolehmainen MA, Sinha R. The effects of stress on physical activity and exercise. Sports Med. 2014 Jan;44(1):81–121. doi: 10.1007/s40279-013-0090-5.

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