Abstract
BACKGROUND: Lifestyle-related diseases can be controlled by improving individuals' lifestyles; however, improving and maintaining a healthy lifestyle is difficult. Mobile health (mHealth) applications have recently attracted attention as tools for maintaining and improving health, and their use may also increase physical activity. OBJECTIVE: This study aimed to verify the effect of registration in Asmile, an mHealth application provided by the Osaka Prefectural Government, on step counts using a Causal Impact approach based on the step count data recorded in the Asmile application. METHODS: This observational study included Osaka residents aged 20-79 years, newly registered to Asmile, between the fiscal years 2020 and 2023. Of these, 80,689 participants with step count records for 4 weeks before and after the day they registered to Asmile were included in the analysis. We used daily step counts that were automatically transferred from a standard smartphone health care app into Asmile. We used a Causal Impact model to estimate the increase in step count after registration to Asmile. RESULTS: Of the 80,689 participants analyzed, 38.5% (31,082/80,689) were men, and the mean age was 51.6 (SD 13.2) years. The mean step count before registration was 5923 (SD 4860) steps per day, with the highest proportion of new users registered in spring (38,389/80,689, 47.6%) and in fiscal year 2020 (34,491/80,689, 42.7%). The analysis revealed that the effect of Asmile registration on step counts was 360 steps (95% CI 331-389) per day and 10,041 steps (95% CI 9632-10,450) over 4 weeks. Stratified analysis showed that the impact of increased step count was more pronounced in younger groups and groups with fewer step counts before registration. Conversely, the effect of registration on step count was relatively minor in the groups registered in summer or winter. CONCLUSIONS: This study demonstrates increased physical activity among users registered with the Asmile app. These findings suggest that mHealth apps such as Asmile can effectively promote healthier lifestyles and potentially reduce the risk of lifestyle-related diseases.