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August 2007

Project HealthDesign:

ActivHealth

Technology Scan

Presented to

Robert Wood Johnson Foundation

Project HealthDesign Program Office

Prepared by

RTI International

3040 Cornwallis Road

Research Triangle Park, NC 27709

RTI Project Number 0210505.001

August 2007

Project HealthDesign:

ActivHealth

Technology Scan

Presented to

Robert Wood Johnson Foundation

Project HealthDesign Program Office

Prepared by

RTI International

Yuying (Ann) Zhang, MS

Craig R. Hollingsworth, MA

Murrey G. Olmsted, PhD

RTI Project Number 0210505.001

TABLE OF CONTENTS 1.Introduction1

Possible Role of Technology 2

Approach for the Technology Scan3

2.Online Exercise, Diet, and Weight Management Programs1

Podfitness1

Peer Trainer1

Traineo1

Selected Weight Management Web Sites1

3.Mobile Persuasion Technology1

Captology1

Fitness Phones1

myFoodPhone2

4.Weight Management Software1

BODYFITdb1

Performance Diet1

Weight-by-Date1

5.Physical Activity Monitoring Gadgets1

Physical Activity Monitoring Devices1

6.Video Games1

GameRunner1

Exer-Station 1

EnterTRAINER 2

Dance Dance Revolution2

EyeToy Kinetic2

Tetris Weightlifting3

Nintendo Wii3

JumpSnap Virtual Jump Roping3

7.Motivation and Monitoring Programs1

Aristotle1

Health Hero Network1

Neuro-VISION2

Map My Fitness2

8.Virtual Coaching1

9.Applying Wireless Communication Technology to Fitness Devices1

10.Social Networking1

MySpace1

Facebook1

11.Sensors, Wireless Sensor Network1

12.Radio Frequency Identification1

13.Nanotechnology1

14.Discussion1

Using Technology to Support Behavior Change1

Weight Loss Tools and Sedentary Adults2

Motivating Sedentary Adults2

15.References1= Introduction = Project HealthDesign is a national program designed to support the development and testing of an integrated set of next-generation personal health record (PHR) systems that can assist consumers with managing their health and health care. The program is funded by the Robert Wood Johnson Foundation, with additional support from the California HealthCare Foundation. Grantees to Project HealthDesign have all been challenged to develop PHRs that address current health problems in novel ways.

As part of Project HealthDesign, RTI International is leading an effort, Project ActivHealth, to evaluate development of a PHR tool that will help sedentary adults become more physically active. RTI is assisted in this effort by the Cooper Institute, a leader in research on exercise and nutrition.

To encourage older, more sedentary adults to become active, The State of Aging and Health in America 2007 (CDC & Merck, 2007 ) includes a “Call To Action” encouraging physical activity by promoting changes to the physical environment. Because walking is the most common form of exercise, the report calls for the following measures: “sidewalk repairs and making sure sidewalks [are] available; protecting citizens from traffic, and protecting older adults from crime.” The report adds, “In addition to such environmental enhancements, older adults also may benefit from programs that encourage leisure-time activities” (CDC & Merck, 2007, p. 12).

The report notes that “being physically active contributes substantially to healthy aging,” and that “regular physical activity can help prevent or control many of the health problems (e.g., high blood pressure; depression; obesity; and diabetes) that often reduce the quality and length of life for older adults” (p. 12). It further states that “strength training is of particular importance to older adults, as it can provide relief from arthritis pain; improve balance and reduce the risk of falling; strengthen bones; and reduce blood glucose levels.” “Adults in the United States,” the report points out, “tend to become less active as they age”(p. 12).

In an effort to address the problems related to sedentary lifestyles and aging, the specific aims of Project ActivHealth include the following:


 * recruiting individual members of an adult population with an interest in increasing physical activity to serve as end user representatives in the design process;
 * engaging end user representatives in a facilitated design process to capture needs and preferences, and to identify challenges;
 * contributing to the development of a preliminary set of common requirements for a platform with the capability of supporting multiple personal health applications;
 * producing a functional design of a personal health application to assist individuals in becoming more physically active;
 * developing prototypes of a personal health application to assist individuals in becoming more physically active;
 * evaluating the feasibility and usability of the prototype among end user population representatives; and
 * reporting the results and responses of application testing among end user representatives in a final design specification document that will describe all aspects of the proposed system.

To meet these aims, the project team has created two advisory groups. First, a group of end users (or consumers) were recruited to work with the team to explore user needs, desires, and a wide variety of practical issues related to the adoption of an activity-based PHR. The project team recruited 27 end users aged 30 years or older who live a predominantly sedentary lifestyle. This group was split into three different working groups comprising those with or without some type of chronic disease.

Second, health care providers were selected to represent potential users of the system within the medical establishment. This group consisted of eight health care providers representing a variety of roles, including physicians and nurses (in primary practice) and physical therapists. In addition, 6 personal trainers were selected for structured interviews regarding their work with clients on physical activity and the possible integration of a PHR into their work. A portion of this work has already been carried out; the results of the focus group interviews are in the Report of Findings from the Round 1 Interviews of Phase 1 (Olmsted, Carpenter, Wright, Huber, & Massoudi, 2007).

As noted in Olmsted et al. (2007), there already seem to be bases for developing a PHR. First, most respondents felt the need to engage in regular exercise but cited regular schedule conflicts with other activities that they felt took precedence over regular physical activity. Second, most of the consumer participants and many of the health care providers indicated that they did not know the appropriate physical activity for the participants’ age, gender, or health status. Boredom with current exercises was cited, together with a lack of information about alternative exercises or activities. Third, both consumers and health care providers expressed the need to be accountable to someone or something to maintain physical activity once it has been started. Both thought that having friends or family members support the participant’s physical activity would be beneficial.

In addition, most participants said they regularly used technologies that the PHR could probably utilize. For instance, most participants regularly used cell phones, computers, and the Internet. Most also believed they could become comfortable with and use other devices currently unfamiliar but just as easy to use.

Possible Role of Technology 

Technology may offer new ways of encouraging both physical activity and leisure pursuits that involve physical activity. The more general use of computers, cell phones, electronic personal assistants, and the Internet is opening new ways of encouraging people from all age groups to start and maintain a schedule of physical activity.

Software tools may offer some of the best help to consumers by integrating various motivational techniques that in past research have proven successful for supporting behavior change. This software may be embedded in small devices or cell phones, or it may be usable by personal computers. In particular, devices and software may use various techniques such as decisional balance, values clarification, problem solving, and motivational interviewing. We briefly describe each of these various methods below:


 * Decisional balance. This method reminds people about the personal benefits of physical activity and reminds them to identify any perceived barriers to it. For example, the Aristotle program described below actually telephones messages to remind the participant of his or her plans and goals.
 * Values clarification. This process helps people sort through what is important to them (including health and physical activity) and reminds them when they are not living their value: “Can I play with my grandchildren comfortably if I do not work out? Can I be comfortable going to a restaurant and sitting if I miss too much exercise?” Reflecting on the values associated with activity can help someone keep active. Participating in a social network with peers may help individuals keep up with their goals. There are a number of social networks available through the Internet that can provide the peer interaction that may help people remain active.
 * Problem solving. This method asks if there is a way to use technology to help the person engage in the problem-solving process: “How can I add an exercise routine to my already busy schedule?” One solution may include using the Nike + iPod system on a walk at work during lunchtime.
 * Motivational interviewing. This method is based on a highly successful method developed in counseling and is becoming more common in health promotion. Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence (Rollnick & Miller, 2007).

Approach for the Technology Scan

To assist in developing the PHR, the project team conducted a noncomprehensive scan of current technology to determine what devices, software, or other technology might be available to help users develop a more active lifestyle. In addition, the team looked at possible future technologies, including sensors and nanotechnology. The scan was completed over the Internet, using various key words aimed specifically at identifying current technology, both hardware and software, that could be used to either track physical activity behavior or serve as a motivational aid. It was intended to identify technologies that could assist consumers by helping them to


 * set and meet achievable goals,
 * plan out a personal program of exercise,
 * keep track of exercise activities,
 * provide reminders and motivation,
 * provide a social network or social support, and
 * determine what program would be best for the individual.

The scan was an attempt to include samples of most available products and services; it located aids in several areas and formats, including online exercise, diet and weight management programs, mobile persuasion technology, video games, activity monitoring gadgets, motivation programs, social networking sites, and future technologies. This report is not meant to be all inclusive, but rather a sample of what is currently available in the market and a glimpse of possible future offerings. Inclusion of products or services does not imply endorsement: we made no attempt to review or test any of the items listed. It also provides the project team parameters for designing a PHR that both consumers and health care providers will find useful. Products and their descriptions are included under each heading; a reference list contains the Web sites accessed.

= Online Exercise, Diet, and Weight Management Programs = There are many online programs related to health and wellness. A few are strictly exercise sites, some are strictly focused on diet, and most combine exercise and diet for an emphasis on weight management.

Podfitness

The Podfitness site offers video and audio training with world-class fitness trainers, customized music, and personalized workouts (Podfitness, 2007). The program integrates music from each consumer’s own MP3 music collection with workouts that are matched to that consumer’s fitness goals. The initial account setup is free, offering consumers a trial account for a month. If consumers wish to continue beyond the trial period, they are required to pay monthly fees.

Peer Trainer

The Peer Trainer Web site describes itself as an online method of helping consumers be accountable for their diet and exercise goals. This free service helps partner consumers with other members into small groups in which all members report to each other their daily logs regarding diet, physical activity, and other behaviors that are related to health. “Buddy up, slim down” is how the method is described by the service. It allows the participant to join a group or a team; if the participant does not find one he or she likes, he or she can start one. The site endorses recordkeeping, saying that daily logging is the cornerstone of effective weight loss (PEERTrainer, 2007).

Traineo

The Traineo Web site allows users to develop physical activity and diet plans online. These plans are then tracked on the Web site via journaling tools that help users understand the dynamics of their food intake, calories burned, and progress toward goals. The service also allows users to add friends and family members to a “Traineo motivators” team; the “motivators” team regularly receives reports on the user’s progress and is given the opportunity to send motivating messages to the person to help him or her maintain focus on fitness and weight loss goals (HDO Group, 2007).

Selected Weight Management Web Sites

The Internet has significantly improved the possibility for consumers to connect to resources and other social supports. These online resources offer a variety of opinions, methods, and materials for consumers to support behavior change. In particular, there has been an explosion of online weight management, healthy eating, and exercise tools and support groups. The popular health care Web site, WebMD (Bouchez, 2005), provides the following introduction to online weight management and support groups:

Online dieting programs are the electronic incarnation of the group approach to losing weight. While their offerings vary widely—from meal plans and cooking tips to counseling, group support, and more—what they all have in common is the power of a virtual community to support your weight loss goals.

For a set fee, members get a password to a members-only Web site. Here you’ll find an eating plan (some but not all are planned by nutritionists and/or medical experts) as well as recipes, and cooking and dieting tips. Depending on which program you choose, extras include everything from email counseling by nutritionists, psychologists, and other weight specialists; to message boards, group chats, and motivational tools; to articles addressing weight loss concerns, and fashion and beauty advice to help you look great while you’re losing weight. Some programs also feature meal plans and nutrition information that’s downloadable to your PDA or cell phone. (p. 3)

WebMD indicates that many of these programs are moderately effective, especially if consumers receive e-mail counseling.

Some of the most popular weight management Web sites include chat rooms, diet challenges, individualized diet coaches, physical activity information, and other incentives designed to support consumer behavior change. Some good examples of sites offering these services include the following:


 * Caloriescount.com
 * Ediets.com
 * Healthmedia.com
 * Weightwatchers.com

Each of these Web sites offers a similar set of features. As with almost all of the Web sites listed, consumers can use them on a fee basis, paying weekly or monthly.

= Mobile Persuasion Technology = Technology offers the possibility of greater mobility for consumers who may benefit from being able to take with them advice regarding exercise, and their health. In particular, as consumers seek to change habits, software or technology devices that can help them stay motivated may help to improve their chances of success in making behavior change. This section describes mobile persuasion technologies that can accompany consumers to provide reminders and motivation.

Captology

Stanford University now teaches courses in captology, a new discipline—so new that it is not yet included in Wikipedia: a captology class for credit, Persuading People Online and Via Mobile Phones, was offered by Stanford just this past year (Carpenter, 2006b). The Stanford Web site defines captology as “the study of computers as persuasive technologies.” The site further explains that captology “includes the design, research, and analysis of interactive computing products created for the purpose of changing people’s attitudes or behaviors” (Carpenter, 2006a ; for more information, see the program Web site at http://captology.stanford.edu/).

Currently Stanford is pursuing study in this multidisciplinary field at the Center for the Study of Language and Information (CSLI), an independent research center founded in the early 1980s by researchers from Stanford University, SRI International, and Xerox PARC. The university and CSLI hope to develop both theory and best practices in captology, enabling technology providers to leverage their software and devices to support behavior change.

Fitness Phones

An article appearing on MedicineNet.com, a popular source for information on health and wellness on the Internet, describes two high-tech programs that use cell phones to encourage consumers to exercise. The programs—one from Nokia and the other from Siemens—use cell phone technology to help consumers meet their fitness goals (Bouchez, 2005). They offer various services, including a rudimentary electronic coach, calorie counters, body mass index calculators, heart rate monitors, and a fitness scheduler.

The Nokia phone comes preloaded with software that allows one to program in personal fitness information and exercise goals (Dybwad, 2007). Then the phone works out a training schedule for the user, helps him or her keep track of personal workouts, and maintains a personal fitness database. The Siemens cell phone provides a similar set of features, as well as an animated fitness instructor that demonstrates various recommended exercises. Extras with this phone include various monitors and calculators (body fat, calories, etc.).

As cell phones increasingly take on the roles of personal computers and other electronic devices, additional companies are likely to enter the market with other products. For instance, a new fitness phone from Samsung will be coming out in the next year that allows one to measure body fat with the touch of a button and includes quick links to fitness counselors (Bouchez, 2006, pp. 1–3).

myFoodPhone

MyFoodPhone is a mobile application that allows users to keep track of their food intake by taking a picture of their meal and uploading it to a service that monitors food intake (myFoodPhone Nutrition Inc., 2007). The goal of the program is to help consumers pay more attention to what they eat so they can modify their eating habits. Users of this service can take pictures of food they eat throughout the day. These pictures are posted to a visual Web food journal or diary on the site. Users’ food journals are reviewed by nutrition advisors who give them feedback on their intake and recommendations for change. The journals allow users to self-monitor, compare each week’s food intake, view graphs of biometric data changes over time, and access a number of other personalized dieting tools (Bouchez, 2005).

= Weight Management Software = We conducted a Google search using the search term dieting software, which resulted in approximately 1,200,000 hits. A random sample of the hits and software packages mentioned in the search results showed most of them to be similar in that they offered various combinations of food and exercise journaling, calorie counters, calendars, charts, and connections to other electronic devices to help people design and keep track of their diet program.

These programs can vary widely, however, ranging from providing simple nutritional data—like calorie counts, nutrient breakdowns, and meal planning—to sophisticated tracking of both dieting and fitness goals. Some also offer meal suggestions, exercise regimens, and daily progress reports to users. Many also offer good mobility, working with many popular personal digital assistants (PDAs), Smartphones, or portable computers. A few of the better-designed software tools found are described briefly in this section.

BODYFITdb

BODYFITdb is fitness training software that provides what the authors present as a comprehensive training program. The software contains numerous features, including diet advice focused on nutrition and calorie needs, a diet journal, and a database of Internet fitness sites. It also features a sophisticated tracking and feedback system called VITALS; this system tracks users’ weight, body fat, blood pressure, cholesterol, metabolism, heart rate, measurements, strength and cardio stats, and other health measures, displaying them in more than 50 full-color graphs and tables. The software is designed to be used daily by users to track their daily meals, exercise, and recipes. In addition, the software will help users create daily menus matched to their diet and fitness goals (San Juan Software, n.d.).

Performance Diet

Performance Diet software helps users record and analyze their food and alcohol intake so they can self-monitor their consumption behavior. In addition, the software prompts users to track other related information, such as water intake, blood pressure, physical attributes, and exercise. The focus of this software is helping users match their calorie, food, and liquid intake to their physical performance needs, while helping them over time reduce overall calorie intake (Healthkeeper, 2002).

Weight-by-Date

Weight-by-Date software provides a variety of weight loss tools (including a calorie counter, carbohydrate counter, personal trainer, and personal pedometer) that help users manage their weight loss with focus on a particular date. Users select a goal and date, and then the software provides a personalized plan to help the user achieve his or her weight loss goal. The software is available for PC and a variety of different mobile platforms, including Java-enabled cell phones and PDAs. By entering personal information (like height, weight, and dieting goals), users can further customize each program to provide detailed information to help them meet their goals (Quite Healthy Technologies, 2006).

= Physical Activity Monitoring Gadgets = People are increasingly willing to spend money on gadgets that provide a wide variety of conveniences. The Tech Chronicles in January 2007 stated the following: “The average U.S. household is projected to spend nearly $2,000 on consumer electronic devices in 2007. That’s up from $1,251 per household in 2005 and way, way up from the average of just $84 spent in 1975. The entire U.S. consumer electronics industry is expected to ship a record $155 billion in products this year” (Evangelista, 2007).

This pattern is also true in the diet and exercise world, where consumers are spending record amounts on devices to assist them with weight loss and fitness. The field started with simple devices like pedometers but has continued to evolve by incorporating the latest technology available. For example, the Garmin product will monitor heart rate and calories burned while using a sensitive global positioning system (GPS) receiver to track one’s speed, distance, and pace; this data can be viewed on the device or uploaded to a PC for a detailed postworkout analysis.

Several gadgets in this section also offer the option of uploading data to a Web site and then analyzing it by producing charts, graphs, and other modes of monitoring. In this section, we provide a brief overview of some promising gadgets to support monitoring and behavior change in physical activity.

Physical Activity Monitoring Devices

Pedometer (Step Counter)

There are now many simple pedometers on the market that range from simple step counters to sophisticated devices that track other health information and integrate with wellness programs. The basic function of a pedometer is to track the steps taken by a user over a given period of time (a day) to give the user a sense of how much physical activity he or she has engaged in over time.

A good example of the high end of this group of products is the New Lifestyles NL-2000 Activity Monitor Pedometer. The device tracks steps taken, like other pedometers, but also offers a packaged program kit containing health education resources, both paper and software-based tracking logs, and incentives and rewards. The complete kit is designed to help foster lifestyle change in users by encouraging them to change diet, exercise, sleeping, and other health behavior patterns (New Lifestyles, 2007).

Forerunner 305 (GPS Pedometer)

Garmin is one of the leading manufacturers of GPS technology. Garmin designs, manufactures, and markets navigation and communications equipment for the aviation and consumer markets, including general recreation applications. The Forerunner 305 is designed to monitor heart rate, speed, distance, pace, and calories burned during workouts. The devices resemble a large digital watch (Figure 1). The device was originally developed for runners but can be used by those who walk or do other active exercise, including cycling if used with an appropriate adapter. The device is designed to store several workouts in memory and can be uploaded to a PC with a USB interface. When used with a PC, the Forerunner 305 provides users a wealth of postworkout analytic capabilities (Garmin International, 2007).



'''Figure 1. Garmin Forerunner 305'''

Pam Personal Activity Monitor

One of the problems with pedometers is that they can be triggered by movements not related to calorie-burning exercise. To overcome this weakness, some technology companies have explored the use of accelerometers as an alternative method of measuring physical activity. Accelerometers use a different type of sensor than a standard pedometer and more sophisticated software to detect movement that burns calories.

An example of this technology is the Pam Personal Activity Monitor. The Pam uses an accelerometer to measure motion and the intensity of user’s activity, rather than the raw steps logged by most pedometers. The Pam device is a bit larger than most pedometers, measuring 2.3 x 1.7 inches, but it is flat and comfortable to wear on the waistband all day. The device is intended for use with a PC, which is used to upload, store, and analyze the data for use by the Pam Coach. The Pam Coach helps users choose fitness goals, helps users monitor those goals, and gives users advice and feedback to help them adhere to their own personalized program (Bumgardner, 2007a, 2007b).

BioTrainer Activity Monitor 

The BioTrainer device measures users’ physical activity (frequency, duration, and intensity of movements) by their weight and current fitness level. Data are uploaded to a PC daily and are used to track weight, calorie intake, metabolism, and diet. Users are given daily reports that help them understand how many calories they are burning during exercise and other daily movements like walking, gardening, and even folding laundry. The only activities it does not measure well are swimming and resistance training. The package includes bundled software that provides diet, nutrition, exercise, and lifestyle advice designed to encourage behavior change and weight loss (Waehner, 2007).

Nike + iPod Sport Kit

Many consumers enjoy listening to music while they exercise—music on tape players, radios, and now dozens of different types of MP3 players. Apple, the maker of the most popular MP3 player, partnered with the large fitness corporation Nike to develop an exercise tracking device for runners. The device, which can be used for tracking running or walking, integrates a shoe-based accelerometer with a small receiver that plugs into the base of the iPod nano (a sport model of the iPod MP3 player). Together, the sensor and receiver work with the iPod nano to track users’ time, distance, pace, and calories burned during exercise (Figure 2). The device also includes real-time spoken feedback that can be invoked at any time during the workout and notification when users meet milestones. The Nike + iPod kit also includes full integration with the music player capabilities of the iPod, allowing users to listen to their favorite music while exercising. Users of the device also receive free access to a special Web site that allows them to set exercise goals, upload their exercise data, track exercise over time, sign up for challenges, and connect with other consumers (Apple, 2007).



'''Figure 2. Nike + iPod Sport Kit'''

Polar Heart Rate Monitor

The heart rate monitor has been the focus of many workout routines, including running, cycling, and other outdoor sports. The typical monitor includes a chest harness that is worn by the users and that wirelessly transmits heart rate data to a receiver built into a watch, a computer, or exercise equipment (e.g., treadmill, stationary bicycle). A leader in the development and use of heart rate monitors, Polar has manufactured monitoring devices for years. It currently offers more than a dozen different monitors. The devices notify users when they hit their target zone for exercise intensity, in order help them meet fitness and other goals. Recently, Polar has also developed a program called BodyAge, which involves fitness and weight loss. The program allows users to upload their workout data to software that tracks their heart rate, weight, and other biometric data. The software allows a user to view this data and to view reports that estimate how many years off the user’s BodyAge score he or she has achieved by meeting goals (Polar, 2007).

Bodybugg

Bodybugg, a device made by BodyMedia, is a calorie management device designed to monitor total energy expenditure (BodyMedia, 2007). Throughout the day, the user wears the device on an armband. Using a variety of sensors, the device estimates caloric intake, estimates current metabolism, and measures physical activity with an accelerometer. Data are stored in the Bodybugg and then wirelessly transferred each day to the user’s PC. From the user’s PC, data are uploaded to BodyMedia’s servers, where they are stored and available for review at any time. Using a Web site specifically designed for users of the Bodybugg, consumers receive diet, exercise, and other health advice. Users of the service can also sign up for weekly coaching sessions with a diet and exercise coach who both helps the user set up a plan and encourages him or her continue to follow it to achieve success (Sharma, 2007).

Alive Heart Monitor 

The Alive Heart Monitor is a wireless health monitoring system originally developed for screening, diagnosis, and management of chronic diseases; however, it has more recently come into use as a health and fitness product for consumers interested in cardiac health. The device is capable of recording real-time electrocardiogram, heart rate, speed, altitude, and location. During and after a workout, the device connects to a mobile phone or PC, using the Bluetooth communication protocol; it then transmits the heart rate and activity data to a central server, where the data are stored and analyzed. The device can also be used for remote real-time monitoring of exercise programs via the Internet. By linking the device with a GPS-capable mobile phone, one can send real-time data to a coach or monitor who is remotely located. The accompanying software allows users to review their exercise data and to assist in making change to their workout routines (Alive Technologies, 2005).

Top 10 Walking Gadgets

“Top 10 Walking Gadgets,” an article on About.com, lists pedometers and related high-technology gadgets. Many of them rely on GPS technology and can record time, distance, and calories burned; several have heart rate monitors (Bumgardner, 2007b).

Shape Up Advisor

The Shape Up Advisor helps consumers track and record their daily caloric intake on a small device that fits on a keychain. The device allows users to input information about the food they consumed during the day. Also, at regular intervals throughout the day, the device reminds users that they are overweight and that they need to exercise. The small screen on the device shows cartoon-like pictures of people exercising and tells the user to go exercise; exercises are shown on the screen, with information about the recommended intensity and duration. The device is widely available in Japan and should be making its debut in the United States and Europe soon (Rameriz, 2006).

WatchMinder 

WatchMinder is a digital wristwatch used as a motivational tool for a variety of lifestyle changes. Originally developed by Dr. Laurence Becker to address memory and motivational problems in children with attention-deficit/hyperactivity disorder, the watch contains up to 30 different alarms. The alarms can be programmed to either sound or vibrate and can be customized with messages that scroll across the screen. The current version of the device, WatchMinder 2, has added features, such as diet reminder module. The watch can be programmed with reminders to eat well and exercise, and it can enjoin users to make healthy choices (WatchMinder, 2004).

= Video Games = Video games are no longer the province of children: the children who began playing the first generation of available games are aging. Michael Dolan, deputy editor of FHM Magazine, writes in a recent essay for the Public Broadcast System (PBS) that the “average age of the gamer is rapidly approaching 30.” “As people in their 30s and 40s continue to play video games into their senior years,” predicts Dolan, “the genres of games will expand to accommodate those audiences and their discretionary income” (Dolan, 2006).

Because playing games tends to be a sedentary activity, it will be important for the large number of adults who play video (and computer) games to find ways to increase activity. Various game companies have begun to explore applications of their products in other markets. One promising area is the use of video games to support physical activity and fitness. The following video games all offer connections between the gaming world and physical fitness.

GameRunner

GameRunner combines a treadmill and game controller into one device that encourages users to exercise while they are playing computer or video games. It was originally designed for games that require walking rather than much running. This product therefore ensures that the consumer using it will play a longer time than if he or she ran on the device. According to the manufacturer, GameRunner works best with first-person shooter games that are played with keyboard and mouse; it claims that the GameRunner is supported by nearly every first-person shooter game ever made. The treadmill is fully adjustable and comes with a standard treadmill computer attached. This arrangement allows users to track their treadmill activity—such as distance, pace, and calories burned—throughout their game play (GameRunner, 2007).

Exer-Station 

The Exer-Station combines a video game controller, a specially positioned upright seat, and sensors to help gamers achieve some level of exercise. The Exer-Station forces users to stand upright on a small platform that contains a controller and sensors. The sensors located in the alloy steel tube that connects the controller to the base measure how hard users are pushing and pulling on the controller and translates this measure into movement in the game. Instead of just using their fingers to play a game, users are required to push and pull on the controller with their entire body. The makers of the device, Interaction Laboratories, claim that users receive a full-body workout from using the device. After playing a game, users can upload their data to a PC to track their workout with information such as time spent, calories burned, and the like (Interaction Laboratories, 2004).

EnterTRAINER 

The EnterTRAINER combines an automated coach and monitoring devices with its own television and exercise equipment. The EnterTRAINER consists of a heart rate monitor, sensor device, and a TV controller, which all work together to monitor a user’s exercise and provide feedback on whether effort is sufficient. The device works on the presumption that people find watching TV rewarding and that they therefore will work harder at exercise if it is tied to TV. The user can set up exercise (or performance) goals that take into account age, weight, and other health factors; then the user wears a heart rate monitor that wirelessly communicates with the controller device. As the user’s pace slows or drifts further from his or her exercise goals, the volume on the TV (and any attached peripherals, such as CD players, cable TV signal processor, or video game consoles) decreases to inaudibility and the picture is eventually shut off; conversely, as users increase their heart rate or exceed their fitness goals, they can hear the TV at full volume (PowerUp Fitness, 2006).

Dance Dance Revolution

The video game Dance Dance Revolution was first introduced to video arcades in Japan in the late 1990s. The game requires users to make complicated dance moves on a pressure-sensitive floor-mounted game controller in response to prompts they receive on the screen. The goal of the game is to more accurately match the increasingly complicated dance moves shown on the screen to beat either the computer or an opponent. Since the introduction of the game in video arcades, several other versions of the game have been released for home game consoles like the Xbox 360™.

The game was not originally designed as a physical fitness device but rather as a competitive arcade game; however, as it has become a popular game it has been recognized as a device that may encourage children, adolescents, and young adults to exercise while having fun playing a game. For instance, DDRfitness (http://www.ddrfitness.com), a Web site devoted to the fitness aspect of the game, indicates that the game has been shown to offer some benefits for boys with attention-deficit/hyperactivity disorder. Regardless of its clinical utility, the game appears to be popular with young people and offers them an opportunity to include some physical activity while having fun (DDRfitness, 2007).

EyeToy Kinetic

EyeToy is a game controller consisting of a color digital camera and microphone, similar to a webcam, that allows users to control their PlayStation 2 game console. The device plugs into the game console, is set on top of the TV, and is used to take real-time pictures of a player that are then translated into motion on the screen. As the user moves in front of the camera, his or her movements are used to control characters on the screen. No additional external controllers are used; it simply translates body movement into game movement. While the EyeToy was not designed for the purpose of physical activity, it nonetheless accomplishes it by requiring users to move in front of the camera in order to control the game—so, like users of the Dance Dance Revolution game, users achieve exercise while playing games (Sony Computer Entertainment Europe, 2006).

Tetris Weightlifting

Developed by two graduate students at the Indiana University Human-Computer Interaction design consortium, Tetris Weightlifting is a prototype entertainment fitness system that allows players to control a modified version of Tetris by lifting weights. To play the classic game Tetris, users hold in each hand a controller with sensors that allow them to make play movements in the game. The user can attach standard dumbbell weights to the controllers to allow weightlifting exercise during the game. A Web site set up by the developers provides instructions for consumers wishing to build their own controllers, as well as instructions for setting up an interface with a standard PC. The developers also provide drivers for the controllers and step-by-step instructions for setting up and running the system in a variety of settings. Currently there are no commercially available models of this device or any planned for production: the developers consider it a demonstration model rather than a product. They nonetheless note its value in encouraging physical activity in those who wish to play computer games (Tucker, 2006).

Nintendo Wii

The Wii is the most recent game console system to be developed by game manufacturer Nintendo. Although not offering the same high-end graphics as other game systems, the Wii does offer an innovative wireless controller that allows for freedom of movement for gamers playing a wide variety of games. The user simply moves the controller in ways that mimic the motion involved in playing the real game that is being simulated: the controller includes several accelerometer sensors so that users’ movements can be translated into control of characters in the game.

Nintendo currently offers a package called Wii Sports, which provides many different activities, all of which can be performed with the same controller. Games included in this bundle are bowling, boxing, and tennis, among others. Users can achieve some level of physical activity while playing these games, because they require that the users stand, walk, run, and move around the room in front of the controller as if they were playing the actual sports game. Again, this is an example of a game’s providing exercise while allowing consumers rewarding, entertaining play (Nintendo, 2007).

JumpSnap Virtual Jump Roping

The JumpSnap is described as a ropeless jump rope. By removing the need for a swinging rope, the device allows users to avoid the problems of tripping and of finding sufficient space for jumping. The device consists of two controller handles with accelerometer sensors attached on small tethers. The user performs the movement of jumping rope by swinging the handles and jumping as if he or she were actually using a normal jump rope. The device senses the motion and translates it into counts of the behavior that are recorded in the built-in memory. The device can provide a summary of the workout, complete with the number of jumps, calories burned, and progress toward goals; the included software helps users design a workout based on their age, height, weight, and current level of fitness. The device also provides an audible count for the user as he or she jumps, and it has a voice mode that delivers a spoken summary of the workout (Under Sail Marketing, 2007).

= Motivation and Monitoring Programs = Aristotle

Many people find it hard to stay with their plans to achieve goals. Aristotle, based in New Zealand, is a service that combines Internet-based goal-setting tools with telephone-based motivational messages. Consumers are asked to set up their account with several short-term and long-term goals. Then they are asked to set their preferences for feedback and encouragement from the system. One of the many different types of goals offered by the system is fitness and physical activity. Users are guided through the process of setting up goals and then reminded, in accordance with a chosen schedule, to adhere to their plan. Each day, the Aristotle system offers support by telephoning members at a specified phone number, checking their progress, reminding them of their goals, offering coaching tips, and encouraging them with inspirational messages from a variety of celebrities (Aristotle, 2007).

Health Hero Network

Health Hero Network offers users health monitoring and health behavior intervention systems designed to help improve health habits and manage personal health. Using a device called the Health Buddy, the service offers tailored programs that address the specific health needs of users. The device interacts with the user by asking questions, taking readings of vital signs, and prompting the user to behave in ways consistent with his or her current health goals or condition. The Health Buddy also connects via various protocols (wireless, wired network, removable media, etc.) to a central database and control system that stores user health information and provides feedback in real time. Reports are sent to each consumer’s health care provider to give them progress reports on their patients and to warn them of potential problems. Goals for change are set cooperatively between health care providers and patients at regular intervals.

The device was originally designed as an intervention tool for medical outpatients with chronic health conditions; however, it has recently expanded into weight loss and physical activity. To address these issues, the system allows additional user input regarding methods of effecting weight loss and exercise. Throughout the day, as with other conditions, the Health Buddy will prompt users to eat well; exercise; and input measurements like time of exercise, duration of exercise, intensity of exercise, heart rate, mood, and the like. By providing encouragement, instruction, tracking, and review functions on the device, the Health Hero Network allows users to better manage their health and achieve their goals (Health Hero Network, 2006)

Neuro-VISION

Neuro-VISION is a program that uses hypnosis as a tool to modify behavior. The program consists of a series of lessons contained in a computer-based training program or audio CD that attempt to change the way people think and act with regard to physical activity. Using multiple training and “hypnotic” sessions, the program aims to motivate people to exercise by increasing their desire to be active. The Neuro-VISION program can be licensed to existing, related businesses, such as a diet control or exercise center, and are available for consumers’ direct purchase from the company (NEURO-Vision, 2005).

Map My Fitness

Map My Fitness offers a series of “Map My. . .” functions (e.g., Map My Walk, Map My Run) that enable users to trace their physical activity route on a satellite map. The service may be helpful to many people who like to participate in outdoor activities such as running, walking, bike riding, or others. The system enables the user to map his or her route, using a mash-up of Google maps and the Map My Fitness Web site, and then calculates the distance for each route (Figure 3). Users can store their favorite routes, share their routes with others, and find routes recommended by other users. Additional features include a calendar feature to track daily and accumulated physical activity, weight change, and calories burned.



'''Figure 3. Map My Fitness'''

= Virtual Coaching = Interesting experiments are currently being conducted that explore how technology may be able to enhance physical fitness. For example, having a virtual coach may help propel those that are otherwise unwilling to exercise. For instance, in an article appearing in the Massachusetts Institute of Technology journal Presence, researchers report on media technology factors that might help exercise equipment users stay motivated to complete regular workouts. Their experiment had people use a stationary home exercise bike with a virtual racetrack featuring two levels of immersion (high and low) and two levels of virtual coaching (with and without).

The study found that the virtual coach significantly lowered the perceived control and pressure/tension dimensions of intrinsic motivation, but it did not affect the enjoyment dimension. The presence of the virtual coach also reduced negative effects associated with virtual environments, such as dizziness or nausea. Overall, the results showed that having a virtual coach was helpful in motivating significantly more participants to exercise—and enjoy the experience—as compared with not receiving a virtual coach. Approaches like this one may encourage those who do not exercise much to do so more frequently (Ijsselsteijn, de Kort, Westerink, de Jager, & Bonants, 2006).

= Applying Wireless Communication Technology to Fitness Devices = In an effort to provide more comfort and convenience, modern urban environments have by design frequently reduced user requirements for movement and energy expenditure. Consequently, the opportunities for physical activity have often been reduced to such a degree that most people do not regularly exercise. In a white paper titled, “Applying Wireless Communication Technology to Fitness Devices,” a group of researchers from the Lappeenranta University of Technology in Finland argue for a new approach to using commonly available technologies to support and encourage physical activity. They argue that a new set of common standards should be developed that will allow exercise equipment to interact with common personal devices, such as cell phones or PDAs.

In particular, the authors argue for the widespread adoption of the Bluetooth communication protocol so that all exercise information may be stored on a consumer’s own trusted device (e.g., cell phone, PDA). Then, leveraging software on the device to help users set, track, and motivate themselves to meet their goals, the device could be used as a fitness management tool. The authors cite the many benefits of this approach for both consumers and device manufacturers. For manufacturers, they believe that the change would result in cost savings and more revenue because products could see greater use. For consumers, they believe that the change would help those living and working in modern urban environments be more physically active and healthy. Currently, cell phone makers such as Nokia are exploring the possible use of this approach, but there are no products or announced plans to make this idea a reality (Keski-Jaskari, Jäppinen, & Porras, 2003).

= Social Networking = According to Wikipedia, there are over 200 social networking Web sites that use various technologies to help consumers connect with each other over the Internet. Consumers enjoy an opportunity to interact with others in a virtual environment, sharing photos, opinions, and other information. Some social networking sites are organized around specific themes or topics, while others are simply an open service where anyone can participate (Social Network, 2007).

For consumers interested in physical fitness, numerous free and pay-premium services are available. Message boards dedicated to physical fitness can be found on many large free services, such as Yahoo, AOL, Facebook, and MySpace. Consumers can also sign up for pay services on diet and exercise sites such as Weight Watchers, Caloriescount, Ediets, and Healthmedia. Also growing in popularity are blog sites where consumers can post their own opinions and interact with others via discussion boards focused on specific topic areas, such as fitness, weight loss, and specific sports (e.g., running, walking, cycling). Most of these sites offer some free services initially but require monthly or yearly fees after a trial period (Foster & Sundstrom, 2007).

MySpace

Currently, the most popular general-topic social networking site on the Internet is MySpace. Particularly popular with adolescents and young adults, the site is designed to “create a private community” where users can “share photos, journals and interests with [their] growing network of mutual friends.” The site allows users to set a profile that can include pictures, contact information, interests, and other personal information; users are allowed to post in a blog format their opinions, stories, pictures, or comments on anything they wish. Users can also join communities of interest that will allow them to receive updated messages from these groups, post private members-only messages, and broadcast to these groups.

A search of the MySpace group directory shows that there are currently more than 27,000 groups with specified interests in health, wellness, and physical fitness. For instance, there are groups for women’s fitness, bodybuilding, martial arts, running, walking, and other fitness pursuits. There are also related groups on such topics as vegetarianism, popular diet programs (e.g., Atkins, South Beach), and other wellness issues. In particular, social networking resources like MySpace may be effective in positively influencing young people to engage in exercise more regularly (MySpace.com, 2007).

Facebook

Another very popular social networking site, Facebook, is designed to help consumers connect. Instead of being focused only on communities of interest, as MySpace is, Facebook organizes users around institutions, such as schools or companies, and by regions of the country. As with most social networking sites, users fill out a profile with a photo, their interests, work, educational history, and other information. Users are allowed to upload to their page as many photo albums as they want, including photos and notes from mobile phones. Users can attach tags to people in photos so that they are both searchable and available to those people if they are current members of Facebook.

Once users have set up a profile and starting using Facebook, the system will allow them to keep track of their friends by creating live news feeds. These news feeds include all new pictures, profiles, and other information that has changed since the user last logged in to the site. For consumers who have exercise or fitness goals, Facebook could be an effective way to update and encourage their friends to stay on track with their exercise; for instance, users could upload information on their current exercise program, information on recent accomplishments, and pictures showing the difference that exercise has made. Also, users could receive encouragement from others who upload their information: they could compare fitness routines and their progress toward meeting goals (Facebook, 2007).

= Sensors, Wireless Sensor Network = Scientists are currently developing wearable health monitoring systems for patients to improve medical diagnoses and overall health care. Figure 4 presents a conceptual model developed by researchers at the School of Engineering and Applied Sciences at Harvard University (2006) to describe how wearable sensors might be used in health care. Researchers at Harvard (and many other schools across the country) are “exploring applications of wireless sensor network technology to a range of medical applications, including pre-hospital and in-hospital emergency care, disaster response, and stroke patient rehabilitation.”



'''Figure 4. Wireless Sensor Network'''

Wireless networks consisting of small, battery-powered sensors called “motes” with limited computation and radio communication capabilities could be worn by the consumer. By networking a number of these motes and feeding their data to a central database, one could capture, store, and use the information to monitor health, identify emerging problems, and detect medical emergencies. The data can be transmitted and stored on any number of devices, including PDAs, laptop computers, and ambulance-based terminals. For example, motes could be placed on disaster or accident victims, and the information they report could aid in treatment and notify workers if vital signs are failing. The current project is supported by grants from the National Science Foundation, the National Institutes of Health, and the U.S. Army, and by gifts from Sun Microsystems, Microsoft Corporation, Intel Corporation, and Siemens AG (School of Engineering and Applied Sciences, Harvard University, 2006).

One can imagine the use of motes in the realm of fitness to monitor vital signs and other data. For example, in the 2006 Tour de France, Ubilabs, a German health technology company, selected cyclists to wear heart rate monitors together with wireless GPS units throughout the race. The data were transmitted to a database in real time, using a cellular wireless transmitter mounted on the rider. The database, using the information on each rider, created a match with Google maps to show live on a Web site the current position of each rider, together with the rider’s current heart rate. Cycling fans were able to see real-time changes in the heart rates of world-class racers as they pushed themselves on spinning stretches, on hill climbs, and in sprints.

Motes or other sensors can allow for better real-time monitoring of the impact of physical activity on users’ heart rates and other physical measures of the body’s response to exercise. Similar to the Bodybugg and Body Gem, the device can provide immediate feedback to consumers, coaches, and health care professionals working with the consumer; the data from these devices also provide a fuller picture than any single measurement of physical response to activity. The data can then be used to modify activities to better match the needs of users (Ubilabs, 2006).

= Radio Frequency Identification = Radio frequency identification, or RFID, is a generic term referring to technologies that use radio waves to automatically identify people or objects. The most common RFID method is to store a serial number or other information that identifies a person or object on a microchip with a small antenna (called an RFID transponder, or an RFID tag). The transponder sends out identification information to a reader, which converts radio waves sent back from the RFID transponder into digital information for computers to use (RFID FAQS, 2007).

A variety of applications of this technology exist for supporting health. For example, Stankovic et al. (2007) describe a near future in which “those suffering from diseases of the elderly will increase.” They explain, “In-home pervasive networks may assist residents by providing memory enhancement, control of home appliances, medical data lookup, and emergency communication. Unobtrusive, wearable sensors will allow vast amounts of data to be collected and mined for next-generation clinical trials” (Stankovic et al., 2007, p. 1). The data can be collected with less strain on the patient, fewer resources, and less cost.

Intel Corporation also describes RFID technology uses, which range from sensor-network pilot applications for smart home systems that “improve the quality of life for the elderly, to sensors that measure the structural health of the Golden Gate Bridge” (Intel Corporation, 2004b). For the home, Intel describes an experimental smart home it is developing with a network that could monitor the vital signs of an Alzheimer’s patient while reminding him or her to carry out daily tasks.

Intel describes other networks and equipment it is developing to help the estimated 76 million Baby Boomers who are approaching retirement. Intel focuses on changing the dynamic of health care for the aging to “include three components: an emphasis on prevention rather than treatment; a shift in the focus of care from expensive clinical settings to the home; and a shift of some responsibility for care from formal providers to individuals and their family and friends.” They believe that this “solution can be enabled by a range of proactive computing technologies in the digital home” (Intel Corporation, 2004a, pp. 1–2). Intel is seeking to place motes and RFID tags in locations and on objects around the home so that activities can be monitored. For example, tags on toothbrushes can help determine if the consumer is actually brushing, while other tags can help determine if the person has taken his or her medications.

One major concern about this technology is privacy. Privacy advocates fear that chips embedded in clothing, identity cards, currency, and personal documentation might be used to spy on individuals by tracking their whereabouts and activities: RFID tags found in clothes and other items consumers might carry transmit signals that could be exploited for surveillance if governments or others had a key to the RFID tag. Industry groups indicate that consumers would be able to remove RFID tags, however, or easily block the transmissions between tag and the intended receiver.

RFID tags also offer some possible advantages for consumers in terms of physical activity. For instance, if consumers wore an RFID-tagged identification device, their activities could be tracked throughout the day and stored in a central location. The device could identify them to exercise equipment that could both recognize them and adjust settings or goals to meet their needs. The device could track their movement over a defined space, much as a GPS does, if a distributed network of sensors were placed in the areas where they typically go during a given day; the sensors could register their movement and translate this input into miles walked or run and other data about daily activities. Then the consumer, with his or her health care provider or exercise professional, could review the data and make decisions on new plans for physical activity.

= Nanotechnology = Researchers at various technology companies and universities envision a future world in which microscopic, cancer-eating machines, cloned human organs, designer foods, and computers are everywhere, perhaps “even embedded in your clothes and under your skin” (Battelle Corporation, 2005). This micro technology is referred to as nanotechnology. According to Wikipedia, nanotechnology is the science of manipulating matter smaller than 1 micrometer, normally between 1 and 100 nanometers, as well as making devices on this same length scale, which is about the size of a single cell in the human body—or smaller.

In the literature of science fiction and speculation, future nanotechnology is used to repair human bodies from the ravages of disease and even aging, offering humans near immortality. Nanotechnology is also often the villain: uncontrolled nanotechnology creates new plagues that threaten the existence of humanity. However, if the technology grows and reaches its promise, it would surpass the mote technology and allow the ability to detect and repair problems in real time and on a very large scale with miniature, wireless, mobile, computing networks.

As products are developed, nanotechnology may offer benefits to consumers in terms of physical activity. Nanotechnology is already being used to construct lighter materials for use by high-end athletes. The first applications for consumers are likely to be small sensor networks much like the motes already described. These devices could be used to monitor physical activity and feed this information back to other devices that would inform the consumer about his or her current physical activity, progress toward goals, potential for injury, and future exercise needs. Nanotechnology may also develop sufficiently to be used to influence or encourage consumers to exercise: by methods still to be discovered, nanotechnology might enhance mood, provide physical stimulus, or in some other way remind users to exercise and reward them for doing so.

= Discussion = The purpose of this technology scan has been to briefly review the technologies (and associated services) available to consumers to support physical activity. The identified technologies focused on planning, tracking, monitoring, and performing the activity. Appendix Table A-1 consolidates all this information, summarizing each of the technologies and the ways it may benefit consumers’ physical activity. The table provides details on whether the technology involves a number of known mediators of behavior change, including


 * goal setting
 * contingency management (setting and providing rewards)
 * self-monitoring and tracking
 * social support and networking
 * problem solving
 * cognitive restructuring
 * relapse prevention

Importantly, the table lists for each technology or service any known pros or cons making it a good or poor solution for particular categories of people.

Using Technology to Support Behavior Change

Project ActivHealth seeks to motivate sedentary adults to become active and maintain a healthy lifestyle; however, it remains to be seen whether most of the available software and devices to help people make fitness plans, motivate themselves, and adhere to exercise plans will be effective with a sedentary audience. Many of the applications or products must be sought out by individuals who have developed an interest in pursuing weight management and fitness. In addition, many of these products record downloadable information but seem to require custom software or Internet applications to record, analyze, and share the data. This extra effort and cost may impede this population’s adoption of new technologies and services.

Furthermore, most of the advertising associated with these products displays images of young, fit, and attractive persons. For example, the Nike + iPod Web site opens with a young woman engaged in what appears to be a very fast run. She appears quite fit, with an apparently low body fat percentage, and has a determined look on her face as she is running. Although the Nike + iPod kit can be used for walking, none of the examples on the site shows other people walking or exercising more moderately. Another example is the EyeToy Kinetic Web site, which uses avatars, or cartoon-like representations of people. All of the avatars used have been modeled on young, fit persons, who are recorded doing the exercises and who demonstrate the intense fitness activities. These examples may be a “turnoff” to many sedentary adults, making their participation in physical activity even more difficult.

Several currently available products might be useful in motivating a primarily sedentary audience to engage in fitness activities. The simplest example is the WatchMinder, the product developed for therapeutic use with children and adults with attention-deficit/hyperactivity disorder. Because exercise can occur throughout the day, the WatchMinder’s ability to deliver many different alarms might involve sedentary people in fitness activities. Moreover, the watch offers an unobtrusive way to remind users to exercise without embarrassing them by disclosing their exercise requirements to others.

Weight Loss Tools and Sedentary Adults

Many technology-based physical activity functions are components embedded in more comprehensive weight management programs. Such weight loss Web sites share similar attributes. They provide methods to encourage goal setting and mechanisms to monitor behavior and track progress; they offer the ability to set rewards for successes; they also strongly encourage journaling of food intake and active participation in the program to be successful. Additionally, almost all offer a social support network consisting of diet coaches or of other people enrolled in the program. Most offer help in problem solving, changing habits, and preventing relapses, offering a variety of articles and tips by fitness experts, by nutritionists, and by people who have successfully met weight loss and other goals. The main positive benefit of the identified Web sites and services is the quantity of potentially beneficial products and services they offer. On the other hand, the negatives of many of the Web sites include monthly fees, requirement for consistent use (or users are removed from the site), and requirement of a fairly significant amount of work in journaling and recording of food intake.

For those who may not want a full array of services, a few of the technology devices (e.g., Shape Up Advisor) or software packages (BODYFITdb or Performance Diet) may be more helpful; however, people often seek out social support, which is not offered by the devices or software.

Although not the focus of ActivHealth, weight loss is a major goal of many sedentary adults who wish to engage in exercise. These weight management tools can be used in conjunction with ActivHealth to help sedentary adults identify appropriate goals, motivate themselves to exercise, monitor their behavior, and track their progress to have maximal impact. As much of the literature is beginning to show, a combination of exercise and healthy diet is best for supporting healthy weight loss that is sustainable over time.

Motivating Sedentary Adults

Although physical activity is important to most people, it is often hard to make the transition from desire to action and to adopt exercise as a regular part of everyday life. Various technologies have been identified that may help motivate sedentary adults to be more active. For instance, mobile persuasion technology offers many of the same features that the software and Web sites do but offers greater flexibility for the user: they do not have to access a Web site or use a fixed device but can be motivated to be active in many locations. The unfortunate downside of mobile technologies is that they depend on a complex piece of equipment—a cell phone—and on having and keeping current a subscription to the cell phone and other services.

Video games are widespread in American culture. While many people enjoy them, few gamers exercise as much as they should, because of the sedentary nature of these games. However, a number of companies cited in this report are working to join technology with fitness to make games that are motivating and a benefit to the user’s health. These efforts are interesting and show some promise, but they require user time and money to be successful. Most of the games mentioned in this report require a substantial initial investment of money to subscribe to or purchase the necessary games and exercise equipment. Moreover, several require access to and knowledge of how to use a standard PC. Several of the platforms are designed for entertainment but have a fitness and exercise portion on the side. For example, Dance Dance Revolution requires the participant to duplicate dance moves of increasing complexity and speed; the Nintendo Wii offers simulations of golf, bowling, fishing, and other activities. Despite the great current investment in video game and exercise equipment hybrids, their effectiveness in helping users improve fitness or health remains to be seen.

Other motivational programs covered here, including the Aristotle program, the Health Hero Network, and Neuro-VISION focus on providing positive motivational messages to consumers. The idea is that, by encouraging users to continue to work toward their goals, the programs will make users more successful in meeting those goals. These programs all cite success stories in which they have helped many people achieve their fitness and diet goals; however, each exacts significant costs and time for setup and use. People may see either the cost or the time involved in setting up the tools as barriers to using them to effect change.

The future of technology in fitness applications also appears interesting and promising. Many of the applications currently being developed might be tailored effectively to help motivate people to exercise, to keep track of their progress, and improve fitness. For example, wireless sensor networks and radio frequency identification might be used in homes or in a person’s clothing to record activity during the day, send the information to a database, and have reminders sent to the person (e.g., telephone, cell phone, e-mail, personal assistant devices, and other means) to encourage exercise. Although these applications show great promise, most of these tools are years away from possible use for most consumers.

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Appendix A: Product Matrix

Table A-1.Product Matrix for Hardware, Software, and Future Technologies Facilitating Physical Activity and Health

(continued)

Table A-1.Product Matrix for Hardware, Software, and Future Technologies Facilitating Physical Activity and Health (continued)

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Table A-1.Product Matrix for Hardware, Software, and Future Technologies Facilitating Physical Activity and Health (continued)