International Mobile-Health Intervention on Physical Activity, Sitting, and Weight: The Stepathlon Cardiovascular Health Study

Anand N. Ganesan, Jennie Louise, Matthew Horsfall, Shane A. Bilsborough, Jeroen Hendriks, Andrew D. McGavigan, Joseph B. Selvanayagam, Derek P. Chew

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65 Citations (Scopus)


Background Although proof-of-concept for mobile health (mHealth) life-style programs targeting physical inactivity and overweight/obesity has been established in randomized trials, the feasibility and effect of a globally distributed, large-scale, mass-participation mHealth implementation has not been investigated. Objectives The purpose of this study was to determine the effect of Stepathlon, an international, low-cost, mass-participation mHealth intervention, on physical activity, sitting, and weight. Methods We prospectively collected cohort data from participants completing Stepathlon, an annual 100-day global event in 2012, 2013, and 2014. Participants were organized in worksite-based teams, issued pedometers, and encouraged to increase daily steps and physical activity as part of the team-based race. The program was conducted via an interactive multiplatform application available on mobile devices and the Internet. Analysis was performed according to a pre-specified plan. Results A total of 69,219 subjects participated (481 employers, 1,481 cities, 64 countries, all populated continents, age 36 ± 9 years, 23.9% female, 8.0% high-income countries, and 92.0% lower-middle income countries). After Stepathlon completion, participants recorded improved step count (+3,519 steps/day; 95% confidence interval [CI]: 3,484 to 3,553 steps/day; p < 0.0001), exercise days (+0.89 days; 95% CI: 0.87 to 0.92 days; p < 0.0001), sitting duration (-0.74 h; 95% CI: -0.78 to -0.71 h; p < 0.0001) and weight (-1.45 kg; 95% CI: -1.53 to -1.38 kg; p < 0.0001). Improvements occurred in women and men, in all geographic regions, and in both high and lower-middle income countries, and the results were reproduced in 2012, 2013, and 2014 cohorts. Predictors of weight loss included step increase, sitting duration decrease, and increase in exercise days (all p < 0.0001). Conclusions Distributed mHealth implementation of a low-cost life-style intervention is associated with short-term, reproducible, large-scale improvements in physical activity, sitting, and weight.

Original languageEnglish
Pages (from-to)2453-2463
Number of pages11
JournalJournal of the American College of Cardiology
Issue number21
Publication statusPublished or Issued - 31 May 2016


  • mobile health
  • physical activity
  • prevention
  • sitting
  • weight loss

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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