Evaluation of a Population-Wide Mobile Health Physical Activity Program in 696 907 Adults in Singapore

Background Evidence of scaled-up physical activity interventions is scarce. This study evaluates the uptake, engagement, and effectiveness of one such intervention program. Methods and Results The program was open to individuals aged ≥17 years in Singapore. The main intervention components comprised device-based daily physical activity recording paired with step count goals and financial rewards. According to the different reward opportunities, we divided the evaluation period (August 2017 to June 2018) into the baseline monitoring phase, the main challenge phase, and the maintenance phase. Uptake was assessed by the number of individuals registered, and engagement by the step recording duration after registration. The effectiveness was defined as changes in mean daily step count from baseline to the main challenge phase and the maintenance phase. A total of 696 907 participants registered, including more Singapore citizens (versus noncitizens), women, and younger (aged 17-39 years) individuals. The evaluation of engagement and effectiveness included 421 388 (60.5%) participants who provided plausible characteristic information and step count data. The median duration of engagement was 74 (IQR, 14-149) days. Compared with the baseline of 7509 (SD, 3467) steps, mean daily step count increased by 1579 (95% CI, 1564-1594) steps during the main challenge phase and 934 (95% CI, 916-952) steps during the maintenance phase. Greater engagement and activity increase were found in participants who are citizens, women, aged ≥40 years, non-obese, and using separate wearables (versus smartphones). Conclusions Mobile health physical activity interventions can successfully reach a large population and be effective in increasing physical activity, despite declining program engagement over time.