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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.




Contents
      1 Online Exercise, Diet, and Weight Management Programs
      2 Mobile Persuasion Technology
      3 Weight Management Software
      4 Physical Activity Monitoring Gadgets
      5 Video Games
      6 Motivation and Monitoring Programs
      7 Virtual Coaching
      8 Applying Wireless Communication Technology to Fitness Devices
      9 Social Networking
      10 Sensors, Wireless Sensor Network
      11 Radio Frequency Identification
      12 Nanotechnology
      13 Discussion
      14 References



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).

                                           [[Image:]]
                               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).

                                           [[Image:]]
                                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.

                                           [[Image:]]
                                   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.‖

                                            [[Image:]]



                              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



                        Contingenc Self-    Social Proble
                  Goal                                    Cognitive Relapse Barriers
Product                 y Manage- Monitori Support, m
                  Setti                                   Restructu Preventi and
Description             ment(rewa   ng,    Network Solvin
                   ng                                       ring       on    Benefits
                           rds)   Tracking    ing    g
Exercise, Diet, and Weight Management Web Sites
                                                                            Uses
                                                                            custom
                                                                            music for
                                                                            motivatio
                                                                            n and
Podfitness                                   
                                                                            high-
                                                                            profile
                                                                            trainers;
                                                                            monthly
                                                                            fee
                                                                            Group
Peer Trainer                                                         format;
                                                                            free
                                                                            Group or
                                                                            team
Traineo                                                              format;
                                                                            monthly
                                                                            fee
Caloriescount.c                                                      Monthly
om                                                 fee;
                                                   focused
                                                   primarily
                                                   on diet
                                                   and not
                                                   physical
                                                   activity
                                                   Monthly
                                                   fee;
                                                   focused
                                                   primarily
Ediets.com                               
                                                   on diet
                                                   and not
                                                   physical
                                                   activity
                                                   Designed
                                                   for
Healthmedia.co
                                            corporati
m
                                                   ons, large
                                                   groups
                                                   Fee basis;
                                                   focused
                                                   primarily
WeightWatchers
                                            on diet
.com
                                                   and not
                                                   physical
                                                   activity.
Mobile Persuasion Technology
                                                   Cell
                                                   phone has
                                                   preloaded
                                                   software
The Fitness
                                               with
Phone
                                                   queries to
                                                   help set
                                                   up fitness
                                                   programs
                                                   Uses cell
                                                   phone to
                                                   take
                                                   pictures
myFoodPhone                     
                                                   of food
                                                   servings
                                                   and
                                                   transmit
                                     to center
                                     for
                                     analysis;
                                     fee based
Weight Management Software
                                     Number
                                     of
                                     modules,
BODYFITdb                     
                                     including
                                     vitals and
                                     nutrition
                                     Helps
                                     track all
                                     food and
Performance
                                 water
Diet
                                     intake, as
                                     well as
                                     exercise.
                                     Works on
                                     personal
                                     PDA;
                                     provides
                                     journal to
                                     record
                                     exercise
Weight-by-Date                
                                     and food;
                                     recomme
                                     nds
                                     appropria
                                     te goals;
                                     monthly
                                     fees
Activity Monitoring
                                     Simple,
                                     effective
Pedometer                   
                                     tracking
                                     device
                                     Activity
                                     tracking,
                                     calories
Forerunner (a                        burned,
                            
GPS pedometer)                       workout
                                     analysis;
                                     cons
                                     include
                                                                              learning
                                                                              curve on
                                                                              proper
                                                                              device
                                                                              use
                                                                             (continued)

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



                  Contingenc Self-     Social Proble
            Goal                                      Cognitive Relapse Barriers
Product           y Manage- Monitori Support, m
            Setti                                     Restructur Preventi     and
Description       ment(rewar   ng,    Networki Solvin
             ng                                          ing        on      Benefits
                     ds)     Tracking    ng      g
                                                                          Activity
Pam                                                                       tracking;
Personal                                                                  calories
                               
Activity                                                                  burned;
Monitor                                                                   workout
                                                                          analysis
                                                                          Monitors
                                                                          all
                                                                          physical
BioTrainer
                                                                          movement
Activity                                
                                                                          but
Monitor
                                                                          running
                                                                          and
                                                                          swimming
                                                                          Allows
                                                                          custom
                                                                          workouts
                                                                          using an
                                                                          iPod;
                                                                          aimed at
                                                                          runners
Nike + IPod                                                           and
                                                                          walkers;
                                                                          can share
                                                                          workouts
                                                                          with
                                                                          others via
                                                                          PC and
                                                                          Internet
                              Fitness
                              through
                              monitorin
Polar Heart                   g target
Rate                        heart rates;
Monitor                       software
                              and
                              programs
                              available.
                              List of
                              gadgets
                              that use
                              GPS and
Top 10                        heart rate
Walking                     monitors,
Gadgets                       and that
                              can
                              download
                              informatio
                              n.
                              Wearable
                              device
                              records
                              calories
BodyBugg               
                              burned,
                              taken in;
                              downloads
                              ; fee based
                              For real-
                              time
                              monitorin
                              g; requires
Alive Heart                   GPS and
                     
Monitor                       Bluetooth
                              phone and
                              downloads
                              data to
                              trainer
                              Inexpensiv
Shape Up
                             e, few
Advisor
                              features
                              Portable
WatchMinde                    with
                    
r                             reminders
                              all day,
                                                                             silent or
                                                                             audible
Video Games
                                                                              Requires
                                                                              treadmill
GameRunne                                                                     and
                                         
r                                                                             connection
                                                                              to
                                                                              computer
                                                                              Rewards
                                                                              user by
                                                                              allowing
                                                                              user to use
                                                                              TV or
Exer-Station                             
                                                                              entertainm
                                                                              ent
                                                                              software
                                                                              according
                                                                              to effort
                                                                              Rewards
                                                                              user; more
                                                                              effort, TV
                                                                              or video
EnterTRAIN
                                                                           games
ER
                                                                              play based
                                                                              on user
                                                                              level of
                                                                              effort.
                                                                             (continued)

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



                  Contingenc Self-     Social Proble
            Goal                                      Cognitive Relapse Barriers
Product           y Manage- Monitori Support,    m
            Setti                                     Restructur Preventi    and
Description       ment(rewar   ng,    Networki Solvin
             ng                                          ing        on     Benefits
                     ds)     Tracking    ng      g
                                                                          Higher
                                                                          scores as
Dance Dance                                                               player
                                       
Revolution                                                                advances;
                                                                          large
                                                                          player
                                            communit
                                            y with
                                            competiti
                                            ons
                                            Martial
                                            arts
                                            oriented;
                                            requires
EyeToy                                      PC,
                             
Kinetic                                     camera,
                                            and
                                            equipmen
                                            t; fee
                                            based
Tetris                                      Prototype;
Weightliftin                             not fully
g                                           developed
                                            Commerc
                                            ial
                                            product
Nintendo                                    related to
                           
Wii                                         gaming,
                                            but with
                                            sports
                                            software
                                            Easy to
                                            use, with
JumpSnap                                    limited
Virtual Jump                             settings
Rope                                        on the
                                            jump rope
                                            handle
Motivational Programs
                                            Program
                                            using
                                            prerecord
                                            ed
                                            telephone
                                            messages;
Aristotle                          
                                            based in
                                            New
                                            Zealand,
                                            so
                                            cultural
                                            references
                                          are
                                          different;
                                          fee based
                                          Designed
Health Hero                               to manage
                       
Network                                   chronic
                                          illness
                                          Uses
                                          hypnosis;
                                          user must
Neuro-
                                      visit a
VISION
                                          licensed
                                          center, fee
                                          based
                                          Provides
                                          online
                                          mapping
Map My
                                      tools to
Fitness
                                          help track
                                          exercise
                                          routes.
                                          Effective,
                                          but
                                          requires
Virtual
                                    exer-cycle
Coaching
                                          and video
                                          equipmen
                                          t
Wireless
Communicat                                Still in
ion to                                   developm
Fitness                                   ent stages
Devices
Social
Networking
                                          Requires
                                          Internet
                                          access,
                                          and user
MySpace                 
                                          must be
                                          invited to
                                          group or
                                          create one
                                          Requires
Facebook                
                                          Internet
                                                                               access,
                                                                               and user
                                                                               must be
                                                                               invited to
                                                                               group or
                                                                               create one
Sensors,                                                                       Still in
Wireless                                                                       developm
                                     
Sensor                                                                         ent for
Networks                                                                       exercise
Radio                                                                          No direct
Frequency                                                                      exercise
                                     
Identificatio                                                                  applicatio
n                                                                              ns
Nanotechnol                                                                    Speculati
                                     
ogy                                                                            ve uses
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