https://mhealth.jmir.org/issue/feed 2024-01-05T10:15:04-05:00 JMIR Publications editor@jmir.org Open Journal Systems Unless stated otherwise, all articles are open-access distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work ("first published in JMIR mHealth and uHealth...") is properly cited with original URL and bibliographic citation information. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included. JMIR mhealth and uhealth is a new journal focussing on mobile and ubiquitous health technologies, including smartphones, augmented reality (Google Glasses), intelligent domestic devices, implantable devices, and other technologies designed to maintain health and improve life. https://mhealth.jmir.org/2026/1/e71340 2026-05-14T17:45:18-04:00 Ruihua Feng Jiu Cheng Yueying Cui Xi Wang Yinghao Lv Weipeng Jiang Chenjun Zhou Yuanlin Song Hui Liu

Background: The management of chronic obstructive pulmonary disease (COPD) places a significant burden on health care systems worldwide. Home noninvasive positive pressure ventilation (NPPV) is an established treatment option associated with significant benefits for patients with COPD and hypercapnic chronic respiratory failure. Internet of Things (IoT)–based management may improve communication between patients and physicians and strengthen the integration and comprehensiveness of home NPPV telemonitoring. However, the economic value of such systems remains insufficiently understood. Objective: This study aimed to assess the cost-effectiveness of IoT-based management versus standard management of home NPPV in patients with COPD and hypercapnic chronic respiratory failure. Methods: A Markov decision analytic model was developed to simulate real-world COPD progression and predict health outcomes and costs associated with IoT-based and standard management of home NPPV. COPD progression consisted of 4 health states: stable period, nonserious exacerbation period, serious exacerbation period, and death. Efficacy and cost inputs were primarily sourced from a published multicenter, prospective, randomized controlled trial and supplemented by official Chinese databases where necessary. Quality-adjusted life years (QALYs) were used as effect indicators for this model, which were derived from COPD Assessment Test scores. The discounted lifetime cost per QALY gained was calculated from the Chinese health care payer perspective, and sensitivity analyses were conducted to test the robustness of model results across different assumptions. Results: Compared with standard NPPV, IoT-based NPPV increased costs by ¥3607.26 and improved QALYs by 0.24 per person across the lifetime horizon, resulting in an incremental cost-effectiveness ratio of ¥15,030.25 per QALY, with a 93.6% probability of being cost-effective at the given willingness-to-pay threshold (currency conversion to US dollars was based on the average exchange rate in 2019 [US $1=¥6.9]). Base case results were also robust to multiple one-way sensitivity analyses, with the main drivers being hospitalization costs for the standard and IoT-based NPPV groups during the serious exacerbation period. Conclusions: IoT-based NPPV was cost-effective compared with standard NPPV for patients with COPD and hypercapnic chronic respiratory failure.

2026-05-14T17:45:18-04:00 https://mhealth.jmir.org/2026/1/e77778 2026-05-14T17:15:16-04:00 Manali Desai Shreela Sharma Joel Fokom-Domgue Robert Yu Wenyaw Chan Onyema G Chido-Amajuoyi Charles Darkoh Sanjay Shete

Background: Digital tools are known to promote public health interventions such as vaccine delivery. The recommendation that health care professionals (HCPs) use vaccination-related mobile apps or web-based applications has contributed to improving vaccine awareness and acceptance in the United States. The state of Texas, which has one of the lowest human papillomavirus (HPV) vaccination rates, has seen a significant increase in HPV vaccine hesitancy, particularly during the COVID-19 pandemic. Objective: This study aimed to examine the association between changes in HPV vaccine hesitancy observed by HCPs among patients in Texas and promotion of vaccination-related applications at the health care facilities where they practiced during the COVID-19 pandemic. Methods: A population-based cross-sectional survey was administered in 2021 by the MD Anderson Cancer Center to HCPs working in Texas using email addresses obtained from the LexisNexis Master Provider Referential Database. HCPs were asked if they assessed HPV vaccination status during every patient encounter. Those who responded “Often/Always” or “Sometimes” were subsequently asked whether they observed any change (“Decreased,” “No change,” “Increased,” or “Not sure”) in HPV vaccine hesitancy during the COVID-19 pandemic. Additionally, HCPs were asked whether their practice offers HPV vaccination. Those who responded “Yes” to this question were further asked whether vaccination-related applications are promoted at the facility where they practice, with response options being “Yes,” “No,” or “I don’t know.” Logistic regression analysis was performed to examine the association between changes in HPV vaccine hesitancy observed by HCPs and promotion of vaccination-related applications at the facility where they practice. Results: A total of 1283 HCPs completed the survey. Of the 730 HCPs who observed changes in HPV vaccine hesitancy, 51 (7%) reported a decrease in their patients’ HPV vaccine hesitancy. Of these 730 HCPs, 578 (79.2%) responded to the questions regarding vaccination-related applications, of whom 104 (18%) reported that vaccination-related applications were promoted at their facilities. Compared to HCPs who reported not promoting vaccination-related applications, those who reported doing so at their facilities had significantly higher odds of observing a decrease in HPV vaccine hesitancy among patients (adjusted odds ratio [aOR] 2.48, 95% CI 1.10-5.55; =.03). HCPs working at federally qualified health centers or city, county, or public health care facilities (aOR 4.02, 95% CI 1.33-12.14; =.01) and HCPs who administered the HPV vaccine under standing orders at their facilities (aOR 2.91, 95% CI 1.11-7.63; =.03) had significantly higher odds of observing a decrease in HPV vaccine hesitancy at their practices. Conclusions: Our findings suggest that promoting vaccination-related applications at health care facilities in areas with high HPV vaccine hesitancy such as Texas could further decrease HPV vaccine hesitancy in the population. This may be potentially applicable across diverse health care settings, particularly in the context of pandemic preparedness.

2026-05-14T17:15:16-04:00 https://mhealth.jmir.org/2026/1/e58908 2026-05-14T14:00:04-04:00 Siddharth Seth Sumedha Kushwaha Reshma Prashad Michael Chaiton

<strong>Background:</strong> Over the past 2 decades, global rates of cannabis use have risen significantly, especially among young adults. This has corresponded to an increase in cannabis-related problems and hospitalizations. Thus, there has been significant interest in developing new interventions that can help facilitate cannabis cessation and reduce hospitalization rates. Specifically, mobile apps have emerged as scalable and accessible stand-alone or adjunct interventions that can help individuals with cannabis use disorders. <strong>Objective:</strong> This study aimed to evaluate the quality of free cannabis cessation apps available on both the Apple App Store and Google Play Store, focusing on the analysis of their features, content, and adherence to evidence-based practices. <strong>Methods:</strong> A systematic search was conducted in April 2023 using a variety of keywords. The apps were deemed eligible if they were free, available in English, accessible on both the Apple App Store and the Google Play Store, and related to cannabis cessation. Eligible apps were used for at least 1 month and were rated on the Mobile App Rating Scale by 2 reviewers. Interrater reliability was excellent, with a weighted Cohen κ of 0.893 (95% CI 0.835-0.943). <strong>Results:</strong> Four apps were included in the analysis, namely, “Grounded–Quit Weed,” “Quit Weed,” “Marijuana Addiction Calendar,” and “Marijuana Anonymous.” The mean overall quality score of the apps was 3.4 out of 5, indicating poor to acceptable quality. The apps scored the highest on the “functionality” section and the lowest on the “information” section. Of the 4 apps, 3 focused on tracking cannabis use and duration of abstinence, whereas 1 focused on peer support. A limited number of cannabis cessation apps were identified, and those that were available were of low quality due to a lack of evidence-based information. <strong>Conclusions:</strong> This study is the first to evaluate the current availability and quality of mobile apps designed for cannabis cessation. Unlike previous research that broadly assessed cannabis-related mobile apps, this study focuses on the limited number of free cannabis cessation tools, reflecting what is most available to the general population. The findings highlight a significant gap between the growing demand for virtual cessation tools and the quality of existing options. With the rising global prevalence of cannabis use disorders, there is an increasing need for robust, accessible, and evidence-based therapeutic options. While mobile health apps may be a viable option to support cannabis cessation, the current landscape is limited by poor quality apps and a lack of evidence-based information. From a real-world perspective, this study highlights the need for users to exercise caution when relying on current cannabis cessation apps and underscores the urgent need for the development and evaluation of new evidence-based digital interventions.

2026-05-14T14:00:04-04:00 https://mhealth.jmir.org/2026/1/e82276 2026-05-12T14:15:03-04:00 Maria F Vasiloglou Zoë van der Heijden Eric Antoine Scuccimarra Alberto Conde Freniche Desiree A Lucassen Nienke de Vlieger Frédéric Ronga Elske Brouwer-Brolsma Tamara Bucher

<strong>Background:</strong> Nutrition apps offer scalable opportunities to support dietary behavior change and prevent chronic diseases. Their success depends on sustained user engagement, which is essential yet challenging to achieve and, consequently impacts the long-term effectiveness of these digital tools. Engagement strategies have been widely explored in digital health, but a comprehensive synthesis focusing on nutrition apps for adults is lacking. <strong>Objective:</strong> This scoping review aimed to map the current engagement approaches and metrics implemented in nutrition apps targeting adults and to identify how user engagement is defined across studies. <strong>Methods:</strong> We conducted a search of the PubMed, Scopus, Cochrane, and Web of Science databases for relevant studies published from January 1, 2013, to June 30, 2024. The inclusion criteria included original adult interventional or observational studies that evaluated nutrition apps and reported user‑engagement strategies or metrics. Two reviewers independently screened records in Covidence, with discrepancies resolved by a third reviewer. Data were charted across study characteristics, engagement strategies, and engagement metrics and then synthesized narratively. <strong>Results:</strong> A total of 59 studies that used apps to improve dietary behaviors were included in our analysis, including randomized controlled trials, observational trials, and mixed methods studies. Most of these apps were designed for adults who were overweight and obese. The studies were primarily conducted in North America and Europe and were randomized controlled trials or nonrandomized intervention studies, with varying durations and sample sizes. Engagement strategies varied widely, and engagement was typically measured by frequency of specific function use and frequency of app use, followed by retention rate. The most common engagement strategies reported in studies were push notifications (n=29, 49%), behavioral theory integration (n=24, 41%), personalization and customization (n=19, 32%), and goal‑setting features (n=18, 31%). Only 31% (n=18) of studies provided an explicit definition of “user engagement,” and definitions were highly heterogeneous. Engagement measurement was dominated by quantitative system‑recorded metrics, including time and frequency of using specific functions (n=38, 64%), app use frequency (n=34, 58%), and retention (n=17, 29%). Few studies assessed qualitative or long‑term engagement dimensions, and long‑duration studies rarely integrated adaptive or contextualized engagement mechanisms. Research apps more frequently used theory‑driven strategies compared with commercial apps, which tended to emphasize streamlined user experience. <strong>Conclusions:</strong> Although several engagement strategies are commonly used, their implementation is inconsistent and often lacks grounding in conceptual frameworks. Research in the future needs to prioritize the use of common definitions for user engagement and measurement criteria while implementing user-centered design methods and using multiple research approaches to study the complex patterns of user engagement. The evidence base for engagement strategies needs strengthening because it will support the development of sustainable nutrition mobile health interventions.

2026-05-12T14:15:03-04:00 https://mhealth.jmir.org/2026/1/e81397 2026-05-11T16:30:13-04:00 Rou Zhong Nanxi Li Le Xiao Lei Feng Yuan Feng Gang Wang Xuequan Zhu

Background: Continuous follow-up for patients with major depressive disorder (MDD) is essential for treatment decisions and a better prognosis. There remains limited evidence regarding the critical issue of depression variation trajectory prediction using mobile health (mHealth) measures. Moreover, the temporal dynamics of mHealth measures have not been fully modeled in previous studies, and the poor patient adherence to mHealth records poses great challenges to the dynamic feature modeling. Objective: This study aimed to examine the contribution of mHealth measures in predicting depression variation trajectory for patients with MDD, with full consideration of the temporal dynamics of mHealth measures. Methods: A total of 229 patients with MDD from a multiple-center, prospective cohort were included. A 12-week follow-up was conducted involving the collection of the Hamilton Depression Rating Scale (HAMD-17), along with patient-reported outcomes (Immediate Mood Scaler and Altman Self-Rating Mania Scale) via mobile devices and sleep duration through wearable wristbands. We used functional data analysis to extract dynamic features from the sparse mHealth records, rather than aggregating the data to a single scalar summary measure through collapsing over time. Subsequently, 3 machine learning models were applied to predict the depression variation trajectory classes based on the baseline characteristics and these extracted dynamic features. Results: Based on the variation of HAMD-17 scores within 12 weeks, the participants were labeled into 4 classes through the -means algorithm. The classes included stable decline (n=93), fluctuate decline (n=44), fast decline (n=60), and delayed and fluctuate (n=32), in light of the shape of depression trajectories. With both baseline features and dynamic features of the mHealth measures, accuracy rates for the overall data were 54.35%, 60.87%, and 56.52%, for the stable decline patients were 78.95%, 84.21%, and 73.68%, for the nonstable decline patients were 59.26%, 62.96%, and 70.37% based on the 3 machine learning models, respectively. The results were significantly superior to the prediction obtained without mHealth measures (with an overall accuracy below 50%) and only showed a marginal reduction in accuracy relative to the ideal prediction with assessment obtained from clinical visits. Moreover, in the construction of the most accurate prediction model, dynamic features of the Immediate Mood Scaler, the Altman Self-Rating Mania Scale, and sleep duration emerged as the most influential predictors, ranking first, third, and fourth, respectively, in terms of their relative importance. Conclusions: Longitudinal mHealth measures show potential in depression variation trajectory monitoring for patients with MDD even under poor patient adherence. Our work provides practical help in alleviating the follow-up burden for patients with MDD and validates the effectiveness of mHealth measures in clinical applications.

2026-05-11T16:30:13-04:00 https://mhealth.jmir.org/2026/1/e72242 2026-05-08T14:45:13-04:00 Kazuki Aoyama Yuya Nakajima Shu Meguro Yasunori Sato Rei Goto Mariko Hida Takeshi Arimitsu Yoshifumi Kasuga Mamoru Tanaka Hiroshi Itoh Kaori Hayashi

Background: In the management of gestational diabetes mellitus (GDM), the usual medical treatment requires frequent visits for glucose monitoring and insulin dose adjustment, and this imposes significant physical, psychological, and economic burdens on pregnant women. As mobile health platforms become increasingly integrated into diabetes care, telemedicine may help alleviate these burdens; however, evidence evaluating its effectiveness as a replacement for routine in-person GDM care remains limited. Objective: This study aims to evaluate the impact of telemedicine on the quality of life and costs for patients with GDM requiring insulin therapy. Methods: This single-center, 2-arm, randomized, open-label, parallel-group study included patients with GDM who started insulin injection therapy. Participants were randomized to either the telemedicine or standard face-to-face care groups for 10 (SD 2) weeks. The telemedicine intervention used a smartphone-linked platform that enabled the automatic transfer of glucose data from connected glucose meters and facilitated real-time video consultations. Primary end points included costs and patient satisfaction. Costs were assessed using claims data, transportation calculations, and wage-based productivity losses, while patient satisfaction was evaluated through changes in the Problem Areas in Diabetes Survey and Diabetes Therapy-Related Quality of Life questionnaire scores. Secondary outcomes included glycemic control and perinatal outcomes. Results: In total, 38 participants were included, with 18 assigned to the telemedicine group and 20 to the standard care group. Total costs (32,712, 95% CI 15,412‐50,013 vs 59,202, 95% CI 42,603‐75,800 Japanese yen; $284, 95% CI 134‐435 vs $515, 95% CI 370‐659, purchasing power parity [PPP]–adjusted; =.01), direct non–health care costs (922, 95% CI −240 to 2084 vs 2561, 95% CI 1447‐3676 yen; $8, 95% CI −2 to 18 vs $22, 95% CI 13 to 32 PPP-adjusted; =.02), and indirect costs (8981, 95% CI −7119 to 25,082 vs 32,832, 95% CI 17,384‐48,279 yen; $78, 95% CI −62 to 218 vs $285, 95% CI 151‐420 PPP-adjusted; =.01) reduced significantly in the telemedicine group compared with the standard care group. The improvements in the Problem Areas in Diabetes Survey (−7.6, 95% CI −13.7 to −1.4; =.02) and Diabetes Therapy–Related Quality of Life domain 1 (10.5, 95% CI 0.9-20.1; =.03) scores from the baseline were significantly greater in the telemedicine group than that in the standard care group. Nonetheless, glycemic control and frequency of perinatal complications were comparable between the 2 groups. Consultation time was similar across groups, suggesting no added workload for clinicians. Conclusions: In this randomized trial, mobile health–enabled telemedicine safely replaced routine in-person visits for patients with GDM requiring insulin therapy. Telemedicine significantly reduced psychological and economic burdens without compromising glycemic or perinatal outcomes, demonstrating its value as a patient-centered and cost-efficient model of care. These findings support the broader implementation of mobile-based telemedicine approaches in GDM management. Trial Registration: UMIN-CTR UMIN000047009; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000053519

2026-05-08T14:45:13-04:00 https://mhealth.jmir.org/2026/1/e91332 2026-05-08T09:00:24-04:00 Qing Zhang Yanjun Wang Meiling Wang Haiyan Hu Quan Wang Yuchen Guo Jianan Sun Xuan Sun

Background: Low anterior resection syndrome (LARS) is a common postoperative complication in patients with low rectal cancer, presenting with a spectrum of bowel dysfunction symptoms, including urgency, incontinence, evacuation disorders, and changes in stool frequency. Pelvic floor muscle training (PFMT) can alleviate LARS, but its effectiveness may be limited by poor accuracy of technique and low adherence during home-based training due to a lack of real-time feedback and monitoring devices. Objective: This study aimed to evaluate the effects of a novel integrated balloon biofeedback device for home-based PFMT on accuracy of technique, adherence, quality of life, and LARS reduction in patients after sphincter-preserving surgery for low rectal cancer. Methods: A nonrandomized controlled trial was conducted among 164 patients with low rectal cancer who underwent temporary ileostomy without neoadjuvant therapy. Participants were assigned by surgical date to an intervention group (n=82) using an adjustable-pressure balloon device with real-time waveform feedback via a mobile app or a control group (n=82) performing PFMT without equipment. PFMT was initiated within 72 hours after temporary ileostomy and continued throughout the stoma period until 1 month after ileostomy reversal. Outcomes including PFMT accuracy of technique, adherence, LARS score and incidence, and quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) were assessed 1 month after stoma reversal. Results: At baseline, major LARS was present in 47.6% (39/82) of patients in the intervention group and 62.2% (51/82) of patients in the control group. Compared with the control group, the intervention group showed significantly higher PFMT training accuracy and adherence (<.001 in both cases). LARS scores were significantly lower in the intervention group (median 16.00, IQR 11.00-29.00 vs 32.00, IQR 13.75-36.00), with a markedly reduced proportion of major LARS (17/82, 20.7% vs 45/82, 54.9%; <.001). Global health/quality of life scores were significantly higher in the intervention group (<.001). Conclusions: The integrated balloon biofeedback device improved the accuracy of technique and adherence to home-based PFMT, reduced the incidence and severity of LARS, and enhanced quality of life in patients after low rectal cancer surgery. These findings support further development and clinical implementation of the device. However, the nonrandomized, time-sequenced study design and baseline differences between groups may limit causal interpretation of the results, and randomized controlled trials with longer follow-ups are needed to confirm long-term efficacy.

2026-05-08T09:00:24-04:00 https://mhealth.jmir.org/2026/1/e78689 2026-05-06T12:45:14-04:00 Ruting Gu Yueshuai Pan Jing Han Min Wang Xiaomin Liu Xia Liu Qianqian Li Jingyuan Wang Shanshan Ji Changfang Shi Haiqing Zhou Lili Wei

Background: Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use are critical for improving survival after out-of-hospital cardiac arrest. Although conventional training methods are initially effective, they are often hampered by rapid skill decay over time. Game-based mobile apps have emerged as a promising and scalable alternative for CPR and AED education; however, evidence of their long-term efficacy remains scarce. Objective: This study aimed to evaluate the integration of a game-based mobile app into traditional CPR and AED training. We assessed its impact on university students’ theoretical knowledge, practical skills, and theoretical knowledge retention, as well as their willingness to perform CPR and their awareness of disseminating these skills. Methods: A nonrandomized controlled trial was conducted among university students in China from March 21 to September 21, 2024. Participants were assigned to either an experimental group, which received game-based mobile app training supplemented with traditional training, or a control group, which received traditional training only. The game-based app featured a simulated scenario that required users to execute the correct sequence of resuscitation procedures and operate a virtual AED under time constraints. The intervention period lasted for 6 months. Participants’ theoretical knowledge and practical skills were assessed immediately after training (baseline) and at the 7-day follow-up. Long-term retention of knowledge, willingness to perform CPR, and dissemination awareness were evaluated at the 6-month follow-up. Data were analyzed using SPSS software (IBM Corp), employing the chi-square test, Mann-Whitney test, and Wilcoxon signed-rank test. Results: A total of 481 participants completed the entire survey (n=241 in the experimental group and n=240 in the control group). In the short-term (7-d) assessment, the experimental group demonstrated significantly higher scores in both theoretical knowledge (=.02) and practical skills (<.001) compared to the control group. This advantage was maintained in the long term, with the experimental group showing superior knowledge retention at the 6-month follow-up (median score: 9/10 vs 8/10; <.001). Furthermore, a majority of all participants expressed willingness to perform CPR on strangers (70.9%, 341/481) and to disseminate first-aid knowledge (92.1%, 443/481). However, no significant intergroup differences were observed for these latter 2 outcomes (=.85 and =.97, respectively). Conclusions: Despite the methodological limitations inherent in this nonrandomized study, our findings indicate that supplementing traditional training with the game-based mobile app significantly enhanced short-term acquisition of theoretical knowledge and practical skills and promoted sustained knowledge retention. This supports the app’s potential as an effective and promising complement to conventional CPR and AED training programs. Trial Registration: Chinese Clinical Trial Registry ChiCTR2500102813; https://www.chictr.org.cn/hvshowproject.html?id=277054&v=1.0

2026-05-06T12:45:14-04:00 https://mhealth.jmir.org/2026/1/e85353 2026-05-04T15:15:15-04:00 Mohamed Yaakoubi Ahmed Ghorbel Hiba Abdelkafi Liwa Masmoudi Omar Trabelsi Safaa M Elkholi Fatma H Yagin Georgian Badicu Adnene Gharbi

Background: Problematic smartphone use among adolescents is a growing public health concern closely associated with psychological distress and loneliness. Effective, culturally grounded, school-based interventions are needed. Objective: The aim of this study was to assess the effects of a 12-week program combining traditional social sports games and mental exercises on smartphone addiction, nomophobia, psychological distress, and loneliness in adolescents. Methods: In this randomized controlled trial, 69 school-recruited Tunisian adolescents (aged 14-16 years) with clinically elevated smartphone addiction scores were assigned to an experimental group (n=36, 52.2%) or a control group (n=33, 47.8%). The experimental group received a 12-week intervention comprising 4 weekly sessions integrating traditional social sports games with mental exercises, whereas the control group continued standard physical education. Outcomes (smartphone addiction, nomophobia, psychological distress, and loneliness) were assessed at baseline and after the intervention using scales validated in Arabic. Results: Linear mixed-effects models adjusted for age, sex, and BMI revealed significant group × time interactions of moderate magnitude across all outcomes (<.05 in all cases) favoring the experimental group. Adjusted postintervention comparisons confirmed significantly lower scores in the experimental group for smartphone addiction, nomophobia, psychological distress, and loneliness (<.05 in all cases; partial η=0.08‐0.12). Mediation analysis indicated that reductions in loneliness accounted for 34.4% of the intervention’s effect on smartphone addiction, consistent with partial mediation. Conclusions: A culturally adapted, school-based intervention combining traditional social sports games and mental exercises significantly reduced problematic smartphone use and improved psychological well-being. The partial mediation through reduced loneliness highlights the critical role of social connectedness in adolescent digital health interventions. Trial Registration: Pan African Clinical Trials Registry PACTR202601838702413; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=39795

2026-05-04T15:15:15-04:00 https://mhealth.jmir.org/2026/1/e80339 2026-05-04T15:15:15-04:00 Kenshiro Taguchi Asuka Oyama Jun'ichi Kotoku Hiroshi Toki Ryohei Yamamoto

Background: Being overweight and obese are major health concerns worldwide, contributing to lifestyle-related diseases such as hypertension, dyslipidemia, type 2 diabetes, and cardiovascular disease. Increasing physical activity is an effective strategy for weight management. However, earlier step count studies have remained limited to small populations, short-term measurements of 1‐2 weeks, and mainly cross-sectional comparisons of average step counts. The effects of long-term step count changes on weight loss remain unclear. Objective: This study was conducted to assess the effects of long-term patterns of step counts on weight loss using data from the “Asmile” mobile health app in Japan. We hypothesized that participants with continuously increasing step counts over time would have a higher likelihood of significant weight reduction than participants who show steady or fluctuating patterns, even if their average step counts were similar. Methods: We analyzed data of 2778 Asmile users aged 40‐74 years with BMI ≥25 kg/m² who underwent a specific health checkup during fiscal years 2019‐2023 and who had valid step count records for 10‐14 months. Step count trajectories, reflecting long-term trends in physical activity, were classified using a latent class mixed model into four patterns: (increasing), (steady), (decreasing), and (increasing then decreasing). Logistic regression was applied to estimate odds ratios for achieving ≥3% weight loss, with step trajectory as the explanatory variable and weight loss as the outcome. Results: Among participants, 1601 (57.6%) were men and 1177 (42.4%) were women, with respective mean ages of 65.8 (SD 7.9) and 64 (SD 8.2) years. Step count trajectories were distributed as 28.5% , 36.2% , 20.1% , and 15.2% . Compared with the group, participants in the group had a significantly higher likelihood of achieving ≥3% weight loss (adjusted odds ratio 2.45, 95% CI 1.78‐3.38). Conclusions: Long-term tracking of step counts using the Asmile app revealed distinct activity patterns. Continuous increases in step counts were associated with the greatest likelihood of weight loss, emphasizing the importance of sustained physical activity. These findings support the use of long-term step monitoring to guide interventions for obesity and lifestyle-related disease prevention.

2026-05-04T15:15:15-04:00