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Kristine Houde


This past December, Google proclaimed 2014 the year of health and fitness apps, with over 100,000 apps available for Android and iOS, doubling the number of apps that existed just two years ago. Faced with so much choice for consumers, should health professionals be recommending health & fitness apps to our patients? And if yes, how do we pick the ones that are right for them?

The Big Idea

Shortly after I upgraded my smart phone software, an app with a heart icon appeared out of nowhere on my home screen. I was even more surprised when I opened the Health app to note that it had been stealthily tracking my movements. It was kind of cool to see how active I had been over the previous days, and I found myself opening the app throughout the day to check on my activity level.

As you might expect, the initial novelty of the app wore off, and on days where I checked the app and I wasn’t as active as I should have been, I felt guilty instead of feeling motivated to move more.

In exploring this topic, I realized that my reaction to my new app was not that uncommon. Awhite paper by Endeavor Partners, which was cited in Tech Crunch last week, stated that a third of US consumers stop using their tracking devices within six months of receiving them. The reason? The majority of fitness apps and devices on the market fail to elicit long-term user engagement.

My take on things …

A recent study of 200 top-rated physical activity apps (not open access, unfortunately) concluded that the problem lies in the design of the apps themselves: the majority fail to incorporate proven behaviour change techniques (BCTs) such as habit formation, social motivation, and goal reinforcement to help users stick with their programs. It seems to me that mobile health apps should be incorporating concepts in their designs that are more like physiotherapists’ in-person interventions with our patients!

As the consumer appetite for fitness apps grows, savvy app designers have begun including health professionals in the design process in order to address these concerns. By also incorporating BCT and user engagement principles in their core designs, these apps have the potential to elicit the desired long-term changes in users’ health behaviours. Here are a few examples of apps in development or on the market that are helping take mobile health apps to the next level:

  • The MyRecovery health app being piloted in the UK was developed by surgeons in order to help patients prepare for their operation, understand what to expect during and after their hospital stay, and guide them through rehab exercises tailored to their needs.
  • The tRAppen app, referenced by Trisha Parsons in Rep #4, is currently in development. It uses an action research paradigm with patients as co-investigators to develop a physical activity app for people living with rheumatoid arthritis.
  • UBC student, Kaila Holtz, is developing a mobile health app called My Exercise Prescriptionto help doctors assess their patient’s physical activity level. The app would generate a patient’s ‘Exercise Vital Signs’, and assist a physician in exercise prescription and referral to specialists in the community.

It’s not enough for an app to work great. It’s got to look great too! Check out some of thesedesign concepts for health tracking apps that might be popping up on your smart phone in the near future.

Prescribing Apps

Jared Reitzin. mHealthWatch

So, are health professionals ready to recommend mobile health apps to their patients? Unfortunately, I don’t think we’re quite yet there with fitness apps, but we may be getting closer. This infographic from eClinicalWorks’ online survey of 2,200 US physicians demonstrates that 89% would recommend a mobile health app to their patients to assist with health issues such as medication adherence, diabetes, or preventative care, especially if the app could link with their patient’s electronic health record (EHR).

While physiotherapists have been slower to adopt EHR in our practices, many of us currently do prescribe home exercise programs (HEPs) for our patients using software such as PhysiotecPhysioTools, or SimpleSetPro which can be synced with a patient’s e-health record, and can be conveniently accessed by a patient on any mobile device.

Smartphones have invaded our everyday life. Smartwatches and other wearable devices are soon to follow, making it that much easier for us to keep track of our health data. It is now up to the next generation of fitness apps to evolve using  key principles in their design which will encourage patients to adopt more long-term sustainable health behaviours. I, for one, can’t wait to see how these app innovations will be used to help shape the health of our patients for years to come.

Dig Deeper

If you missed it the first time, scroll back to Rep #9, Diana Hopkins-Rosseel’s 30 Reps contribution providing PTs with the tools needed to incorporate behaviour change in our approach to promote treatment adherence and improve patient outcomes. Here are some other articles on the you might find interesting:

  • Privacy and security related to mobile health app use were not addressed in this Rep, but they are factors that should be seriously considered when deciding to use any health app.  Before clicking ‘I agree’ when installing your next app, remember to read the fine print.
  • Mobile health apps like iPhone’s ResearchKit, recently used by Stanford researchers in their heart health study, will be playing a larger role in helping researchers gather objective (rather than self-reported) data on a larger sample of people in a much shorter amount of time.
  • It’s not just individuals who are being swept up in the app revolution. Workplaces are now using health apps to encourage employee health and wellness, cut employer healthcare costs, and help employees reduce their health insurance rates.


As technology plays a bigger role in our personal and professional lives, where do you see mobile health apps fitting into our lives 2, 5, or 10 years from now?

If you were asked to help design a mobile health app, what health issue would it address and what would it be able to do?

Chime in using the comments box below, on CPA’s Facebook page or on Twitter (hashtag #cpa30reps).

About Kristine Houde

Kristine Houde is Health Promotion Manager at the University of Ottawa Health Services. She has worked as a physiotherapist clinician in a variety of clinical settings, and as project manager for CPA and the CPA Private Practice Division. In addition to health and wellness, her interests include EMR adoption and use, physiotherapy clinic benchmarking, and e-Health.

You can reach her on FacebookLinkedIn and Twitter.