Regular physical activity plays an important role in preventing or controlling many chronic illnesses. It is also viewed as a foundation for other good health behaviors — people who exercise regularly are more likely to eat nutritiously and better manage stress, while being less likely to use tobacco. Unfortunately, not even 30% of middle-age and older adults get enough physical activity. So the challenge is this: what can we do cost-efficiently to get people to exercise more and sustain their efforts over time?


The study, Ongoing Physical Activity Advice by Humans Versus Computers: The Community Health Advice by Telephone (CHAT) Trial, begins to provide some insights. Published in Health Psychology, the study evaluated, at 6 and 12 months, the effectiveness of phone interventions by health educators vs. an automated computer system in getting people to be more active. The researchers (Abby King, et al) also compared the results of each method to a control group who received no phone intervention.


At 6 and 12 months, participants in both the live health educator and automated computer groups outperformed control participants for physical activity levels. Perhaps even more remarkable was that the mean physical activity level of both groups was above the recommended 150 minutes/week of moderate to vigorous exercise.


The CHAT trial study suggests that emerging telecommunication technologies provide potentially effective methods for delivering ongoing, individually tailored physical activity advice and support to large numbers of people. The phone is viewed as one of the richest forms of media, second only to face-to-face communication. (In this study, both approaches optimized the natural elements of real-time personalized verbal communication with cognitive and behavioral processes of change.)


While both live voice and automated systems can be cost-efficient at scale, automated initiatives are the least expensive to deliver continuously.


Until now, the question has been whether automated systems are as effective as humans at changing behavior. In this study — while humans were more effective in driving physical activity at both 6 and 12 months, and the gap widened between months 6 and 12 — the difference in outcomes produced by the 2 phone approaches at month 12 was not statistically significant. This suggests that, when balancing cost of delivery against results, automated telecommunication approaches can be of high value for wellness programs.


Be mindful of several other factors when interpreting this study and considering telecommunications to encourage physical activity:


  • In the study, both the human and automated phone groups received about 15 interactions over the study year. This may help establish the optimum number of contacts needed for effectiveness, regardless of the intervention approach. Providing this many “touches” by humans is considerably more expensive.
  • This study was performed on people 55 and older and potentially may not be generalized to all ages.
  • By 12 months the automated system impact appeared to diminish relative to human advice. This raises questions as to whether the benefits of this approach are sustainable over a long period.
  • A significant potential exists to combine human and automated approaches for the highest possible value. It will take more experimentation to find the perfect blend, which likely will be unique to each individual, based on age, number of risk factors, existing chronic illnesses, preferred media, and related variables.
  • There may be other difference between the human advice and automated advice approaches that are beyond this study’s scope. Better understanding these differences may help us learn significantly more about the effectiveness of both approaches and how to combine them.

This study demonstrates that automated interventions can be a new tool for health promoters’ efforts to inspire more exercise. Automated phone approaches will likely work for other behaviors, too.


So go ahead and be a pioneer. Try a combination of telecommunication approaches in your health promotion program, and tell the rest of the field about the results. Your findings might be the next breakthrough in driving sustained behavior change.


John Harris is Chief Wellness Officer and Senior VP of Healthways.

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