STEPATHLON: A Mobile-Based Exercise Program Increased Physical Activity and Promoted Weight Loss

CHICAGO, IL—A low-cost, mobile-health intervention that focuses on the getting people moving leads to significant improvements in physical activity and weight loss, a new study shows. Individuals who participated in the program—known as Stepathlon—lost approximately 1.5 kg of body weight over 100 days and reduced their sitting duration by approximately 45 minutes.

Overall, participants took more than 3,500 extra steps per day by the end of the program.  

The mass-participation program, in which individuals were grouped into teams of five people, utilized pedometers to measure daily step counts and a downloadable mobile-device app for participants to track their physical activity. Each person was sent email messages to mark individual milestones.

“The team aspect is a critical aspect,” lead investigator Anand Ganesan, MD (Flinders University of South Australia, Adelaide), said during the late-breaking clinical trial session at the American College of Cardiology 2016 Scientific Sessions. “We think that social comradery represents a critical driver of participation in these kinds of programs.”

Published concurrently in the Journal of the American College Cardiology, the intervention was conducted between 2012 and 2014, with nearly 70,000 individuals completing the Stepathlon questionnaire prior to starting the 100-day program. By three years, 36,652 people responded and completed the post-event questionnaire. Participants were recruited from 1,481 cities in 64 countries, the vast mast majority from India.

Individuals who participated in the program walked an additional 3,519 steps when compared with their baseline efforts, with similar increases in men and women. In addition, the number of exercise days per week increased by 0.89 days at study completion, with individuals who participated in the program more likely to exercise for 30 or minutes per day. Overall, individuals lost 1.45 kg over the 100-day program, with significant reductions observed in women and in men. Weight loss was observed in all ethnicities and in each socioeconomic class.

Speaking during the late-breaking clinical trials session, Ganesan said the advent of social media adds another dimension to lifestyle interventions. The Stepathlon program tried to mimic elements of social media, such as competition among participants and encouraging messages for achieving various milestones. “One of the things in the academic setting is that we tend to focus on outcomes and clinical events,” said Ganesan. “But when taking the next step, [which is] to implement things on a global scale, we need to make things attractive to consumers and sustainable to people in the real world and to make things fun.” 

Speaking during the session, David Wood, MD (Imperial College, London, England), said the results of the intervention are “descriptive” and questioned how these findings could be realistically interpreted. Given that the mobile-health intervention was not a randomized trial, and that outcomes were self-reported, Wood said the benefit of participation could have been the result of a highly motivated patient population.

Ganesan conceded the limitations of the Stepathlon intervention, but said an outcomes-driven clinical trial in this setting would be nearly impossible. “This is a primordial disease-risk population with a mean age of 36 years,” he said. “If we were to try to conduct an outcomes-based trial, using those kinds of measures, it would not be achievable on the basis of event rates and it would not be achievable in terms of the feasibility of long-term sustainability.”

The Stepathlon trial cost $50 USD per person for participants in India and $10 more per person for individuals in other countries. To TCTMD, Ganesan said it takes around 60 days for any behavior modification therapy to take hold, which is why their intervention lasted 100 days. They are planning to complete 200- and 300-day surveys to follow long-term outcomes.

Interestingly, the Stepathlon study was presented following other trials focusing on cholesterol-lowering drugs. The lifestyle intervention trial, however, failed to grab the imagination of attendees who streamed out of the Main Tent when Ganesan took the stage. Last week, a study in the Lancet projected that if current trends continue, the number of obese individuals worldwide will balloon to one in five, with profound implications for cardiometabolic disease.    

• Ganesan AN, Louise J, Horsfall M, et al. International mobile-health intervention on physical activity, sitting, and weight: the Stepathlon cardiovascular heart study. J Am Coll Cardiol. 2016;Epub ahead of print.

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