Andre Matthias Müller

Past, present, and future of ehealth and mhealth research to improve physical activity and dietary behaviors

Because physical inactivity and unhealthy diets are highly prevalent, there is a need for cost-effective interventions that can reach large populations. Electronic health (eHealth) and mobile health (mHealth) solutions have shown promising outcomes and have expanded rapidly in the past decade. The purpose of this report is to provide an overview of the state of the evidence for the use of eHealth and mHealth in improving physical activity and nutrition behaviors in general and special populations. The role of theory in eHealth and mHealth interventions is addressed, as are methodological issues. Key recommendations for future research in the field of eHealth and mHealth are provided.

Non-face-to-face physical activity interventions in older adults: a systematic review

Physical activity is effective in preventing chronic diseases, increasing quality of life and promoting general health in older adults, but most older adults are not sufficiently active to gain those benefits. A novel and economically viable way to promote physical activity in older adults is through non-face-to-face interventions. These are conducted with reduced or no in-person interaction between intervention provider and program participants. The aim of this review was to summarize the scientific literature on non-face-to-face physical activity interventions targeting healthy, community dwelling older adults (≥ 50 years). A systematic search in six databases was conducted by combining multiple key words of the three main search categories “physical activity”, “media” and “older adults”. The search was restricted to English language articles published between 1st January 2000 and 31st May 2013. Reference lists of relevant articles were screened for additional publications. Seventeen articles describing sixteen non-face-to-face physical activity interventions were included in the review. All studies were conducted in developed countries, and eleven were randomized controlled trials. Sample size ranged from 31 to 2503 participants, and 13 studies included 60% or more women. Interventions were most frequently delivered via print materials and phone (n = 11), compared to internet (n = 3) and other media (n = 2). Every intervention was theoretically framed with the Social Cognitive Theory (n = 10) and the Transtheoretical Model of Behavior Change (n = 6) applied mostly. Individual tailoring was reported in 15 studies. Physical activity levels were self-assessed in all studies. Fourteen studies reported significant increase in physical activity. Eight out of nine studies conducted post-intervention follow-up analysis found that physical activity was maintained over a longer time. In the six studies where intervention dose was assessed the results varied considerably. One study reported that 98% of the sample read the respective intervention newsletters, whereas another study found that only 4% of its participants visited the intervention website more than once. From this review, non-face-to-face physical activity interventions effectively promote physical activity in older adults. Future research should target diverse older adult populations in multiple regions while also exploring the potential of emerging technologies.

Physical Activity and Aging Research: A Bibliometric Analysis

Physical activity and aging research has burgeoned in the past few decades. However, despite the increase in scholarly publications, no attempts have been made to summarize the publication landscape and identify work that has had great impact on physical activity and aging research. We conducted a bibliometric analysis and collected publication data from 1980 to February 6, 2015, in the Web of Science Core Collection. Of 9,935 publications, most were published after 2007 and almost 60% were in the category of geriatrics and gerontology or sport sciences. Highly cited publications (n = 45) were mostly authored by researchers from US institutions and were quantitative in nature. Publications that reported on the associations between physical activity and health, or effects of physical activity on health, in older adults made up 60% of the highly cited publications. We expect more scholars from various backgrounds and geographical regions to join the conversation on physical activity and aging.

Text messaging for exercise promotion in older adults from an upper-middle-income country: randomized controlled trial

Background Mobile technology to promote exercise is effective; however, most evidence is from studies of younger groups in high-income countries. Investigating if short message service (SMS) texting can affect exercise participation in older adults from an upper-middle-income country is important considering the proliferation of mobile phones in developing regions and the increased interest of older adults in using mobile phones. Objective The main objective was to examine the short- and long-term effects of SMS text messaging on exercise frequency in older adults. Secondary objectives were to investigate how SMS text messages impact study participants’ exercise frequency and the effects of the intervention on secondary outcomes. Methods The Malaysian Physical Activity for Health Study (myPAtHS) was a 24-week, 2-arm, parallel randomized controlled trial conducted in urban Malaysia. Participants were recruited via health talks in resident associations and religious facilities. Older Malaysians (aged 55-70 years) who used mobile phones and did not exercise regularly were eligible to participate in the study. Participants randomly allocated to the SMS texting arm received an exercise booklet and 5 weekly SMS text messages over 12 weeks. The content of the SMS text messages was derived from effective behavior change techniques. The non-SMS texting arm participants received only the exercise booklet. Home visits were conducted to collect outcome data: (1) exercise frequency at 12 and 24 weeks, (2) secondary outcome data (exercise self-efficacy, physical activity–related energy expenditure, sitting time, body mass index, grip and leg strength) at baseline and at 12 and 24 weeks. Intention-to-treat procedures were applied for data analysis. Semistructured interviews focusing primarily on the SMS text messages and their impact on exercise frequency were conducted at weeks 12 and 24. Results In total, 43 participants were randomized into the SMS texting arm (n=22) and the non-SMS texting arm (n=21). Study-unrelated injuries forced 4 participants to discontinue after a few weeks (they were not included in any analyses). Overall retention was 86% (37/43). After 12 weeks, SMS texting arm participants exercised significantly more than non-SMS texting arm participants (mean difference 1.21 times, bias-corrected and accelerated bootstrap [BCa] 95% CI 0.18-2.24). Interview analysis revealed that the SMS text messages positively influenced SMS texting arm participants who experienced exercise barriers. They described the SMS text messages as being encouraging, a push, and a reminder. After 24 weeks, there was no significant difference between the research arms (mean difference 0.74, BCa 95% CI –0.30 to 1.76). There were no significant effects for secondary outcomes. Conclusions This study provides evidence that SMS text messaging is effective in promoting exercise in older adults from an upper-middle-income country. Although the effects were not maintained when SMS text messaging ceased, the results are promising and warrant more research on behavioral mobile health interventions in other regions. Trial Registration Clinicaltrials.gov NCT02123342; http://clinicaltrials.gov/ct2/show/NCT02123342 (Archived by WebCite at http://www.webcitation.org/6eGSsu2EI).

Review of Physical Activity Prevalence of Asian School-Age Children and Adolescents

Overweight and obese populations in Asia are high and increasing rapidly. Physical activity prevalence studies have found low physical activity rates among Asian school-age children and adolescents. The purpose of this review is to establish a baseline for physical activity rates in Asian school-age children and adolescents and serve as a platform for additional research. Thirty articles published between 2000 and 2011 on physical activity prevalence of school-age children and adolescents were included in the review. Fourteen studies were conducted in East Asia, 10 in Southeast Asia, 2 in South Asia, and 2 in West Asia. Studies used subjective methods (questionnaires or diaries) and objective methods (accelerometers or heart rate monitors). Although nearly all studies found low physical activity levels, it was not possible to provide an accurate picture due to an absence of standardized, reliable, and economically viable measurement tools.

Aging in Multi-ethnic Malaysia

Multiethnic Malaysia provides a unique case study of divergence in population aging of different sociocultural subgroups within a country. Malaysia represents 3 major ethnicities in Asia-the Malay, Chinese, and Indian. The 3 ethnic groups are at different stages of population aging, as they have undergone demographic transition at different pace amidst rapid social and economic changes. Between 1991 and 2010, the Malaysian population aged 60 and over has more than doubled from about 1 million to 2.2 million, and this is projected to rise to about 7 million or 17.6% of the projected population of 40 million by 2040. In 2010, the aging index ranged from 22.8% among the Bumiputera (Malays and other indigenous groups), to 31.4% among the Indians and 55.0% among the Chinese. Population aging provides great challenges for Malaysias social and economic development. The increasing prevalence of noncommunicable diseases in older adults, coupled with the erosion of the traditional family support system has increased demands on health care services with an overwhelming need for multidisciplinary and specialized geriatric care. Following the adoption of the National Policy for the Elderly in 1995, issues of population aging have gained increasing attention, especially among researchers. There is an urgent need to increase public awareness, develop infrastructure, as well as support action oriented research that will directly translate to comprehensive and cohesive social strategies, policies, and legislation to protect not just the current older Malaysians but the future of all Malaysians.

Environmental Tax Reforms in Switzerland A Computable General Equilibrium Impact Analysis

SummaryThe Swiss energy strategy until 2050 envisages ambitious CO2 emission reduction targets along with substantial cutbacks in electricity consumption to establish a low-carbon economy without nuclear energy. Our computable general equilibrium analysis finds that compliance with stringent CO2 constraints requires high CO2 taxes on economic activities which are not eligible for international emissions trading; likewise, electricity consumers are burdened with substantial electricity taxes. Environmental tax reforms are not likely to generate welfare gains without accounting for the benefits of improved environmental quality. However, economic adjustment costs to a low carbon economy without nuclear energy remain modest and can be markedly reduced through revenue-neutral cuts of initial distortionary taxes. On the other hand, alternative recycling strategies pose a trade-off between efficiency and distributional justice which has to be resolved on normative grounds.

Physical Activity, Sedentary Behavior, and Diet-Related eHealth and mHealth Research: Bibliometric Analysis

Background Electronic health (eHealth) and mobile health (mHealth) approaches to address low physical activity levels, sedentary behavior, and unhealthy diets have received significant research attention. However, attempts to systematically map the entirety of the research field are lacking. This gap can be filled with a bibliometric study, where publication-specific data such as citations, journals, authors, and keywords are used to provide a systematic overview of a specific field. Such analyses will help researchers better position their work. Objective The objective of this review was to use bibliometric data to provide an overview of the eHealth and mHealth research field related to physical activity, sedentary behavior, and diet. Methods The Web of Science (WoS) Core Collection was searched to retrieve all existing and highly cited (as defined by WoS) physical activity, sedentary behavior, and diet related eHealth and mHealth research papers published in English between January 1, 2000 and December 31, 2016. Retrieved titles were screened for eligibility, using the abstract and full-text where needed. We described publication trends over time, which included journals, authors, and countries of eligible papers, as well as their keywords and subject categories. Citations of eligible papers were compared with those expected based on published data. Additionally, we described highly-cited papers of the field (ie, top ranked 1%). Results The search identified 4805 hits, of which 1712 (including 42 highly-cited papers) were included in the analyses. Publication output increased on an average of 26% per year since 2000, with 49.00% (839/1712) of papers being published between 2014 and 2016. Overall and throughout the years, eHealth and mHealth papers related to physical activity, sedentary behavior, and diet received more citations than expected compared with papers in the same WoS subject categories. The Journal of Medical Internet Research published most papers in the field (9.58%, 164/1712). Most papers originated from high-income countries (96.90%, 1659/1717), in particular the United States (48.83%, 836/1712). Most papers were trials and studied physical activity. Beginning in 2013, research on Generation 2 technologies (eg, smartphones, wearables) sharply increased, while research on Generation 1 (eg, text messages) technologies increased at a reduced pace. Reviews accounted for 20 of the 42 highly-cited papers (n=19 systematic reviews). Social media, smartphone apps, and wearable activity trackers used to encourage physical activity, less sedentary behavior, and/or healthy eating were the focus of 14 highly-cited papers. Conclusions This study highlighted the rapid growth of the eHealth and mHealth physical activity, sedentary behavior, and diet research field, emphasized the sizeable contribution of research from high-income countries, and pointed to the increased research interest in Generation 2 technologies. It is expected that the field will grow and diversify further and that reviews and research on most recent technologies will continue to strongly impact the field.

Carbon Tariffs Revisited

Concerns about adverse impacts on domestic energy-intensive and trade-exposed (EITE) industries are at the fore of the political debate about unilateral climate policies. Tariffs on the carbon embodied in imported goods from countries without emission pricing appeal as a measure to reduce carbon leakage and protect domestic EITE industries. We show that the introduction of carbon tariffs can do more harm than good to domestic EITE industries. Two determinants drive the sign and magnitude of EITE impacts. First, the composition of embodied emissions in intermediate inputs to EITE production: if a large share of embodied carbon is imported in intermediate inputs, industries might suffer from cost increases due to carbon tariffs. Second, the share of domestic output that is supplied to the export market: while carbon tariffs level the playing field on domestic markets, they increase the cost disadvantage vis-à-vis competitors from abroad in foreign markets.

The conceptualization of a Just-In-Time Adaptive Intervention (JITAI) for the reduction of sedentary behavior in older adults

Low physical activity and high sedentary behavior in older adults can be addressed with interventions that are delivered through modern technology. Just-In-Time Adaptive Interventions (JITAIs) are an emerging technology-driven behavior-change intervention type and capitalize on data that is collected via mobile sensing technology (e.g., smartphones) to trigger appropriate support in real-life. In this paper we integrated behavior change and aging theory and research as well as knowledge around older adults technology use to conceptualize a JITAI targeting the reduction of sedentary behavior in older adults. The JITAIs ultimate goal is to encourage older adults to take regular activity breaks from prolonged sitting. As a proximal outcome, we suggest the number of daily activity breaks from sitting. Support provided to interrupt sitting time can be based on tailoring variables: (I) the current accumulated sitting time; (II) the location of the individual; (III) the time of the day; (IV) the frequency of daily support prompts; and (V) the response to previous support prompts. Data on these variables can be collected using sensors that are commonly inbuilt into smartphones (e.g., accelerometer, GPS). Support prompts might be best delivered via traditional text messages as older adults are usually familiar and comfortable with this function. The content of the prompts should encourage breaks from prolonged sitting by highlighting immediate benefits of sitting time interruptions. Additionally, light physical activities that could be done during the breaks should also be presented (e.g., walking into the kitchen to prepare a cup of tea). Although the conceptualized JITAI can be developed and implemented to test its efficacy, more work is required to identify ways to collect, aggregate, organize and immediately use dense data on the proposed and other potentially important tailoring variables. Machine learning and other computational modelling techniques commonly used by computer scientists and engineers appear promising. With this, to develop powerful JITAIs and to actualize the full potential of modern sensing technologies transdisciplinary approaches are required.