Digital health nudging to increase physical activity and quality of life in pediatric patients with congenital heart disease: a randomized controlled trial

Abstract

Background: Digital health nudging has been shown to be a compelling, age‐appropriate, and modern e‐health intervention to increase physical activity (PA) in healthy adolescents. However, such studies are lacking in adolescents with congenital heart disease (CHD), although activity promotion is particularly important in this vulnerable population. Purpose: This randomized‐controlled trail examines if digital health nudging via daily smartphone messages increases PA and health‐related quality of life (HrQoL) in adolescents with CHD. Methods: From May 2021 to April 2022, 97 patients (15.1 ± 2.0 years, 50% girls) with moderate or severe CHD were randomly allocated 1:1 to an intervention group (IG) or control group (CG). Daily PA was objectively assessed in minutes of moderate‐to‐vigorous PA (MVPA) by the wrist worn wearable “Garmin Vivofit jr.” over the entire study period. HrQoL was assessed with the KINDL‐questionnaire at baseline and after the intervention. The IG received daily, short and informative smartphone messages based on Bandura's social cognitive theory on the subject of MVPA, thus nudging them to be more active in their everyday lives over a period of three month. Intention‐to‐treat analysis was performed based on multiple imputed data. To analyze the change of MVPA, the first two weeks of the intervention were compared to the last two weeks of the intervention with Mann‐Whitney‐U test. Results are expressed as median [25 quartile; 75 quartile]. Results: MVPA decreased from 78.1 [62.5; 86.5] to 71.4 [56.6; 75.2] min/day in the IC and from 80.2 [64.7; 102.9] to 76.0 [68.0; 94.0] min/day in the CG over the study period of three month. There was no significant change in MVPA when comparing the IG with the CG group (IG: Δ ‐6.4 [‐18.6; 3.0] min/day vs. CG: ‐2.5 [‐12.8; 8.5] min/day, p=0.199). Physical well‐being significantly increased over the study period (IG: Δ1.60 [‐0.24; 6.25] vs. CG: Δ0.00 [‐12.5; 6.35], p=0.043), but not the total HrQoL score (p=0.518). Conclusion: Three month of digital health nudging did not increase PA, but improved feelings of physical well‐being in adolescents with CHD. Our results might indicate that although wearables and digital health nudging initially have a positive influence on physical activity, activity declines over time in both groups and digital health nudging apparently does not have the potential to stop or slow down this phenomenon.