New technologies for promoting a healthy diet andactive living

Sergio Guillén, Alberto Sanna, Joy Ngo, Teresa Meneu, Eva del Hoyo, and Michel Demeester

Information and communication technologies (ICT) offer innovative formats forpromoting healthy lifestyles and reinforcing public health initiatives. They can beapplied to large population segments without losing the functionality of beingtailored to individual fluctuating needs. Advantages of ICT include real-timeprovision and adaptation of nutrition and health recommendations based on anindividual's particular situation, the potential to combine assessment procedureswith healthy lifestyle support and the ability to unify psychosocial and culturaldimensions to enhance adherence. Two pilot programs are presented that show thepotential for applying ICT to the promotion of healthy eating and physical activityhabits.© 2009 International Life Sciences Institute

INTRODUCTION

Information and communication technologies (ICT)provide a unique channel for the promotion of healthylifestyles and the enhancement of public health initia-tives, simultaneously reaching a wide audience whilemaintaining, and even increasing, the capacity for person-alization and adaptation to an individual’s dynamicneeds. The positive aspects of ICT include real-timeadaptation of recommendations to an individual’s spe-cific situation, the possible combination of profilingactions with nutritional and physical activity support, andthe ability to combine multicultural dimensions in theoverall picture.

However, the following key factors must be takeninto account in order to assure that the empowerment ofthe individual is sound and that personalization is accu-rate: 1) understanding the cultural and social dimensionbehind individual lifestyles, as most aspects are not only amatter of health but form part of the society’s matrix; 2)modelling the individual’s needs and reality, includingthe issues underlying the characteristics of modern lifeand the need to comprehensively manage the family unit;

3) the need for more dynamic generation of healthy life-style content, improving both its quality and its potentialto be communicated effectively to the individual (i.e., viamultimedia tools); and 4) the need to overcome possiblefears the user may have about using the technology aswell as protecting their privacy and the reliability of theinformation.

APPLYING INFORMATION AND COMMUNICATIONTECHNOLOGIES TO PUBLIC HEALTH

The potential of ICT for improving the efficacy of healthpromotion and risk prevention initiatives is primarilyfocused on the following three functions: personalization,mobility, and adaptation.

For people to effectively modify their lifestyle, a highdegree of psychological action is necessary. The enact-ment of any change that is expected to be permanentneeds to start from the internal conviction of the person,and a high level of continuous support is required toassure compliance and motivation. However, most peopledo not live in isolation; rather, they are surrounded by

Affiliations: S Guillén, T Meneu, and M Demeester are with Instituto de Aplicaciones de las Tecnologías de Información y las ComunicacionesAvanzadas (ITACA), Universidad Politécnica de Valencia, Spain. A Sanna is with the Fondazione Centro San Raffaele del Monte Tabor (HSR),Milan, Italy. J Ngo is with the Community Nutrition Research Centre, Barcelona Science Park, University of Barcelona, Spain. E del Hoyo iswith the Universidad Politécnica de Madrid (UPM), Spain.

Correspondence: S Guillén, ITACA, Edificio 8G, Universidad Politécnica de Valencia, Camino de Vera, s/n, 46022 Valencia, Spain. E-mail:sguillen@itaca.upv.es.

Key words: information and communication technology, nutrition, public health

doi:10.1111/j.1753-4887.2009.00171.xNutrition Reviews® Vol. 67(Suppl. 1):S107–S110 S107

myriad circumstances that greatly influence their atti-tudes towards their own lifestyle, and these may vary overtime. In this complex context, ICT systems supported byenhanced profiling tools facilitate a shift from the moregeneric messages of public health campaigns, which arefocused on a specific population group and based onshort, concrete, and generic messages, to a more detailedand complete set of recommendations that can be applieddirectly to each individual and that address the mostimportant and particular issues for each individual withina group. This personalized support is able to provide eachperson with tailored recommendations that will assistthem in practical aspects of enacting change and reducethe potential negative impact on their daily life, whileassuring an acceptable level of compliance.

This is accomplished by the enhanced capacity ofcomputers to analyze, store, and match data, combiningpublic health knowledge with the complete and compre-hensive user profile (lifestyle, preferences, etc.) in order togenerate the best possible outcome and guide associatedpractical action. ICT presents this information to indi-viduals in the most appropriate way for their psychologi-cal needs and level of motivation.

ICT also makes support available anywhere andanytime, and it can adapt content to the concrete contextof the user in that particular instant. Again, the computa-tion potential of ICT, together with the use of wirelesstechnologies, distinguishes them from traditional publichealth campaigns. It is expected that the continuoussupport and adaptability that ICT provides will allowindividuals to reduce the degree of noncompliance withrecommendations, even if full compliance is notpossible.1

However, even if the possibilities of ICT in this fieldseem very attractive, only a few, and in most cases verysimple, solutions are available, apart from the broadcast-

ing of multimedia content on the internet with a certaindegree of simple personalization. Within this context, anexample of best practices can be found in the work devel-oped by the European PIPS (Personalized InformationPlatform for Life & Health Services) Project and MyHeart.

Pilot experiences: Activity Coach

Activity Coach (AC) is one of the four product conceptsdeveloped within the MyHeart project.2 The AC productconcept is a personal-health system that aims to motivateand guide the users in an immersive experience designedto help them reach and maintain their optimal personalfitness goals. Activity Coach aims to engage the users intheir progressive process of cardiovascular fitnessenhancement and maintenance, enabling a healthy life-style and a long-term relationship with the system(Figure 1). To achieve these objectives, two fundamentalprocesses have been designed: the training program man-agement algorithms and the coaching and motivationinteraction process.

The algorithm designed to implement the AC tech-nology aims to improve cardiovascular health by increas-ing exercise load and duration in progressive increments.To do so, a multivariate algorithm has been designed,taking into consideration relevant literature in the perti-nent area.3 The following parameters are used as inputsfor the algorithm: age, sex, body mass index (BMI), pres-ence or absence of cardiovascular diseases, smoking ornon-smoking habits, level of physical activity and timespent on exercise, results of a test specifically designed toassess cardiovascular function during recovery fromexercise, adherence to exercise program and the timeelapsed from the start. Moreover, the algorithm separatelycalculates the level of intensity – provided as target heart

Figure 1 Activity coach concept components.

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rate (tHR) – and duration of exercise. By assigning differ-ent values for intensity and duration to input parameters,the aim is to better meet the individual’s needs for train-ing prescription.

The motivation-and-coaching algorithm aims toprovide continuous real-time guidance to optimize theworkout session and to achieve the given training objec-tives set by the training program. During the exercisesession, heart rate (HR) and respiration are monitored bysensors built into the user’s garment. This information iscompared with the session’s targets: i.e., HR max, HRmin, tHR, rpm target, resistance target, motivation marks,etc. In this way, the system generates on-demand multi-media content to guide users in reaching their goals.

Support pilot experiences: “Move It, Lose It, and Win”

“Move it, Lose it, and Win” is one of the four pilots in thePIPS Project.4 It is based on the successful internationalprogram for smoking cessation, “Quit and Win”.5

However, the focus is on achieving healthy weight loss byproviding users with a motivation-based platform andtools for learning, putting healthier eating habits intopractice, and being more physically active. The overallstrategy consists of a contest in which overweight partici-pants (BMI between 26 and 30) who are between 18 and60 years of age without comorbidities and who loseweight following the recommended personalized guide-lines, qualify for a lottery to receive special prizes. Eligibleparticipants are initially screened to determine theirreadiness to make changes in their eating and physicalactivity habits. This screening is based on a protocolelaborated from the adaptation of an integrative model(Fishbein) that considers the transtheoretical model,health belief model, social cognitive theory, and the tech-nology acceptance model.6 With the aim of personalizinginformation/advice provided in the intervention, a set oftargeted rapid assessment questionnaires on food habits(reduced food frequency questionnaire and a 24-h recall)and physical activity are completed. Participants are thenclassified into distinct intervention profiles and provideda pedometer and access to the program’s Internet portal.

More specifically, the platform provides the follow-ing features: 1) Interactive profiling of the participant’shabits, using interactive multimedia tutorials for com-pleting rapid assessment questionnaires. 2) Personalizeddesign of the steps to be taken towards achieving ahealthier diet, taking into account the participant’s pre-ferences, and incorporating goal-setting strategies. 3)Support for healthy cooking and healthy shopping prac-tices. 4) Mobile support (body weight and steps walkedare sent by text message). 5) Motivation and remindermessages by cell phone. 6) Visual control of the partici-pant’s evolution. 7) Automatic adaptation of the pro-

posed diet to improvements in the participant’s habits;this is based on goal achievement in the areas of eatingand exercise habits. 8) Web-based information and rec-ommendations on nutritional matters.

Within this context, the “Move it, Lose it, and Win”intervention aims to transform “standard” informationthat individuals usually receive into a personalized,motivation-based format with the goal of improving selfefficacy, eating habits, and physical activity levels.

CONCLUSION

The active use of ICT technologies for the improvementof public health campaigns offers a wide range of advan-tages and possibilities for new strategies, either indepen-dently or in combination with traditional means, whichshould be explored and developed. However, in light ofthe low number of rigorous studies available to date, aneed exists for a more complete and comprehensiveanalysis of both the opportunities these technologies offerand the impact they may have on populations and onindividuals.

In all cases, these opportunities must be subject toseveral considerations in order to reduce the risk offailure or of reduced effectiveness due to the design of thesolution itself. First, it should be remembered that ICTscurrently require a minimum cost, level of coverage, andlevel of literacy that could prevent its applicability incertain contexts and for certain population groups.However, the digital divide is expected to be reduced overtime by the natural pressures of key ICT stakeholders(mainly the economic and political actors), the increasingpenetration of ICT into the daily lives of individuals, andthe increasing variety of multimedia interfaces thatsimplify and adapt the interaction with ICT solutions.Second, any intervention in this domain must have astrong focus on the motivational and social aspects of thetarget population, with these features being incorporatedas much as possible into the personalization of strategiesfor each particular user.

Acknowledgments

The MyHeart and PIPS projects are partially funded bythe European Commission. Special acknowledgment isextended to the Spanish Society of Community Nutrition(SENC) for their support of the nutritional aspects of thePIPS project.

Declaration of interest. The authors have no relevantinterests to declare.

REFERENCES

1. World Health Organization. The World Health Report: 2002.Reducing Risks, Promoting Healthy Life. Geneva: WHO; 2002.

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2. My Heart Consortium. MyHeart Project – Fighting Cardiovas-cular Diseases by Preventive Lifestyle and Early Diagnosis.Available at: http://www.hitech-projects.com/euprojects/myheart/home.html. Accessed 3 September 2007.

3. Taylor AW, ed. Training: Scientific Basis and Application. Spring-field, IL: Charles C Thomas; 1972.

4. PIPS Consortium. PIPS – Personalized Information Platformfor Life & Health Services. Available at: http://www.pips.eu.org. Accessed 3 September 2007.

5. European Network on Young People and Tobacco. Interna-tional Quit and Win. Available at: http://www.quitandwin.net/. Accessed 23 June 2007.

6. Hoyo-Barbolla Eva del. E-health reference framework for per-sonalised information provision to promote sound lifestyles.Doctoral Thesis – Tecnología Fotónica/E.T.S.I. Telecomuni-cación (UPM); April, 2007.

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