1. The Total Health Application Team Zebra: Jordan Gumm, Evan Byrne, Aaron Sieloff

2. Rationale for the Key Features of the Total Health Application While the Total Health Application mainly addresses the broader health issues of inadequate aerobic exercise and inadequate intake of fruits and vegetables among adults in the United States, it also aims to improve water intake and hours of sleep among its users. Thus, users will be able to track their daily aerobic activity, servings of fruit consumed, servings of vegetables consumed, glasses of water consumed, and hours of sleep, as well as determine if they have met the daily or weekly recommendation for each activity. The application has been developed for the following platforms: iPhone (iOS) and Blackberry. It was developed on more than one platform to potentially increase its range of usage and impact among individuals who use mobile phone applications. According to the 2008 National Health Interview Survey, only 43% of Americans engage in at least 150 minutes of moderate aerobic activity or at least 75 minutes vigorous aerobic activity per week (National Center for Health Statistics, 2011). Recently, empirical studies have explored mobile phone applications, text messaging, and websites as a potential medium for weight loss programs. Although daily text messaging reminders have been linked to the achievement of weight loss goals and dietary improvements in two studies (Haapala et al., 2009; Gerber et al., 2009), few studies have adequately addressed the use of a mobile phone application as a tool to track diet and exercise, which is the focus here. In a two-part study conducted by Mattila and colleagues (2008), twelve out of twenty-seven participants using a mobile phone diary reported statistically significant weight loss (p < 0.01). Thus, the Total Health Application was developed primarily with aerobic activity and dietary journal capabilities.

3. Rationale In addition to its aerobic activity journal capabilities that addresses inadequate aerobic activity among U.S. adults, the Total Health Application was designed to address the inadequate intake of particular food groups, especially fruits and vegetables. Between 1999 and 2002, only 11% of Americans met the U.S.D.A. guidelines for both fruit and vegetable intake (Casangrande et al., 2007). Evidence also suggested that many adults in the United States neither drink at least eight 8 ounce glasses of water per day (Mayo Clinic, 2010), nor get at least seven to nine hours of sleep per night (Centers for Disease Control and Prevention, 2010; Smith & Segal, 2010). These health problems are becoming more prevalent every year in both America, our university and the surrounding community. Users will be able to track each of the five previously mentioned activities: aerobic exercise, fruit intake, vegetable intake, water intake, and hours of sleep. Total Health was designed to graphically represent user progress towards meeting the health recommendations. A recent pilot study conducted at the University of Michigan found that the walking animation Mibo helped users visually see their walking history, fitness progress, walking speed, among other factors (Gupta et al., 2010). It is the goal of this app to duplicate that study by allowing our users to inspect their habits visually. This will provide a framework that will allow people adapt their daily habits to and form better and healthier lives.

4. Features: User Profiles Total Health Application users can create single or multiple user profiles to track their aerobic exercise, fruit intake, vegetable intake, water intake, and hours of sleep. The application asks users to enter information such as: nickname, gender, and age, in such a way that this information does not have to be re- entered every time that the user accesses the program.

5. Features: Aerobic Activity Journal Total Health Application users can select the number of minutes of aerobic activity completed during a single aerobic workout. Aerobic activity is selectable in intervals of fifteen minutes. If a user has entered more than one aerobic activity during a single day, the number of minutes of aerobic activity are added together. This number is used to generate a graph of their progress towards the daily recommendation of thirty minutes of aerobic exercise (see Features: Graphical Representation of User Progress on next slide) as well as determine their standing among the proportion of adults in their age group who achieve at least the minimum weekly aerobic exercise recommendation (National Center for Health Statistics, 2011). Please see Features: Graph of Progress Towards Weekly Aerobic Recommendation.

6. Features: Graphical Representation of Daily Progress A user can track his or her daily progress towards each of the five daily recommendations (see Table 2) for these activities: aerobic activity, fruit intake, vegetable intake, and hours of sleep. Thus, a user can generate up to five graphs, each representing progress towards one of the five activities. Each day is represented by its own alternatively white or blue colored progress bar, sorted by month. The graph below represents the dates April 16 – April 24. The progress towards achieving the daily recommendation is expressed as a percent of the total recommendation on the y-axis (1-4) and by its respective daily progress bar. Please note that if a user meets or exceeds the daily recommendation for a specific activity, the graph will output 4 on the progress bar. If a user consumed two cups of fruit on day 16 and also two cups of fruit on day 17, the user would see two progress bars: (day 16, 100%) and (day 17, 100%), where 100% represents achieving at least four servings of fruit per day.

7. Features: Graph of Progress Towards Weekly Aerobic Recommendation Users entering in daily aerobic activity information can view a graph of their standing among adults in their age group who have achieved at least 150 minutes of aerobic activity. The number of each week of the year is represented on the x-axis (range = 1 - 52). Each week, defined as Sunday 12:00 am -- Saturday 11:59 pm, is represented by its own alternatively white or blue colored progress bar. The yellow trend line represents the percent of adults in their age group who have achieved at least the minimum amount of aerobic activity per week (National Center for Health Statistics, 2011). For example, if a user is 18 – 24 years old the yellow line (trend line) would represent 52.44% of adults (see Table 1). If the user has met or exceeded the weekly recommendation of at least 150 minutes of aerobic activity, the users progress bar would appear at 100%, just like week 18 does in the picture below. If the user has not met the recommendation, the users progress bar would be less than 100% (as you might have guessed).

8. Features: Fruit, Vegetable, Water, and Sleep Journal Total Health Application users can select the number of servings of fruit consumed, the number of servings of vegetables consumed, the number of glasses of water consumed, and the number of hours of sleep from the previous night (or any naps taken during the day). The Total Health Application offers a streamlined approach, where each of these variables are represented in its own row and selectable numerical value. Users simply select the corresponding numerical value for each variable. If users have entered more than one activity in a single day, the numerical values for that activity are added together. This new number is used to graph representative progress towards the respective daily recommendation.

9. Integration of Health Data TOTAL 43.49% By age range: 18-44 18-24 25-44 45-64 45-54 55-64 65 and over 65-74 75-84 85 and above 48.78% 52.44% 47.61% 41.58% 43.28% 39.34% 30.39% 34.22% 30.03% 14.55% By race/ethnicity: White only Not Hispanic or Latino Black or African American only Native Hawaiian or Pacific Islander only Asian only American Indian or Alaska Native only 2 or more races: Hispanic or Latino Non-Hispanic (White only) Non-Hispanic (Black only) 45.04% 45.28% 34.25% DSU 42.45% 32.88% 42.48% 33.38% 47.60% 34.08% By disability status: People with disabilities People without disabilities 27.28% 46.90% By education level: < High school High school Some college Associates degree 4-year college degree Advanced degree 23.28% 34.00% 42.06% 46.36% 56.07% 61.35% 1. Health indicator: Adult aerobic > 150 min./week moderate or >75 minutes/week vigorous physical activity (Percent). Table 1. This is a summary of the Health Indicator data from the 2008 National Health Interview Survey, which was provided by the National Center for Health Statistics (2011). Provides the proportion of adults (percent) who met or exceeded the weekly recommendation of at least 150 minutes moderate or 75 minutes of vigorous aerobic activity. indicators.gov/Indicators/Adult-aerobic-150-minweek-moderate-or-75-minutesweek-vigorous-physical- activity_1319/National_0/Profile/Data indicators.gov/Indicators/Adult-aerobic-150-minweek-moderate-or-75-minutesweek-vigorous-physical- activity_1319/National_0/Profile/Data

10. Integration of Health Data Minimum Recommendation Cut-off Value Authority >30 minutes of aerobic activity per day > 75 total minutes of vigorous aerobic activity per week (recommendation is at least 75 minutes or vigorous or 150 minutes moderate, or some combination of these) >2 cups of fruit per day (recommendation actually differs by age and sex) >2 cups of vegetables per day (recommendation actually differs by age and sex) > 8 eight ounce glasses of water per day > 8 hours of sleep per day (recommendation is 7-9 hours according to the C.D.C.) U.S. Department of Health and Human Services U.S. Department of Agriculture Mayo Clinic Center for Disease Control and Prevention 2. Other recommendations used in the Total Health Application Table 2. Provides the daily or weekly recommendation for adults for the following factors: daily aerobic exercise, weekly aerobic exercise, daily fruit intake, daily vegetable intake, and daily hours of sleep. These values are used as cut-off values in the Total Health Application to determine if users have met or exceeded the recommendation.

11. References Casagrande, S., Wang, Y., Anderson, C., & Gary, T. (2007). Have Americans Increased Their Fruit and Vegetable Intake? The Trends Between 1988 and 2002. American Journal of Preventative Medicine, 32(4). doi:10.1016/j.amepre.2006.12.002 Centers for Disease Control and Prevention. (2010). Sleep and Sleep Disorders. In CDC. Retrieved April 20, 2011, from http://www.cdc.gov/features/sleep/ Gerber, B., Stolley, M., Thompson, A., Sharp, L., & Fitzgibbon, M. (2009). Mobile phone text messaging to promote healthy behaviors and weight loss maintenance: a feasibility study. Health Informatics Journal, 15(1), 17-25. doi:10.1177/1460458208099865 Gupta, M., McCurdy, K., Potvan, H., Song, E., & Zhang, X. (2010). Mibo: A Mobile Application to Encourage Walking. In Personal.umich.edu. Retrieved April 17, 2011, from http://www.xwnzhang.com/_resource/Mibo_paper.pdf Haapala, I., Barengo, N., Briggs, S., Surakka, L., & Manninen, P. (2009). Weight loss by mobile phone: a 1-year effectiveness study. Public Health Nutrition, 12(12), 2382-2391. doi:10.1017/S1368980009005230 Mayo Clinic. (2010). Water, Nutrition, and Healthy Eating. In Mayo Clinic. Retrieved April 17, 2011, from http://www.mayoclinic.com/health/water/NU00283# Mattila, E., Parkka, J., Hermersdorf, M., Kaasinen, J., Vainio, J., Samposalo, K., & Merilahti, J. (2008). Mobile Diary for Wellness ManagementResults on Usage and Usability in Two User Studies. IEEE Transactions on Information Technology in Biomedicine, 12(4). Retrieved April 17, 2011

12. References National Center for Health Statistics. (2011). Adult aerobic >150 min/week moderate or >75 minutes/week vigorous physical activity (Percent). In Health Indicators Warehouse. Retrieved April 17, 2011, from http://www.healthindicators.gov/Indicators/Adult- aerobic-150-minweek-moderate-or-75-minutesweek-vigorous-physical-activity_1319/National_0/Profile/Dat Smith, M., & Segal, R. (2010). How Much Sleep Do You Need?. In Help Guide. Retrieved April 17, 2011, from http://www.helpguide.org/life/sleeping.htm United States Department of Agriculture. (2011). Food Groups. In My Pyramid. Retrieved April 17, 2011, from http://www.mypyramid.gov/pyramid/vegetables_amount_table.html United States Department of Health and Human Services. (2010). Guide to Physical Activity. In National Heart, Lung, and Blood Institute. Retrieved April 17, 2011, from http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/phy_act.htm U.S. Department of Health and Human Services. (2008). Ch. 4 Active Adults. In Physicial Activity Guidelines for Americans. Retrieved April 17, 2011, from http://www.health.gov/PAGuidelines/guidelines/chapter4.aspx ://