ONWARDS - E-health interventions to promote physical activity among underserved populations: a Hybrid Type I effectiveness-implementation RCT


The project addresses physical inactivity as a global health issue. Physical inactivity is the fourth leading risk factor for global mortality. Moreover, inactive adults have a higher risk to develop non-communicable diseases. Underserved populations, including geographically isolated persons, ethnic minorities, and individuals with low socioeconomic status, are less likely to engage in sufficient physical activity and are thus at increased risk of morbidity and mortality. Research in physical activity promotion among these vulnerable populations is scarce. Nevertheless, there is preliminary evidence of the efficacy in the use of strategies including e-health and fitness technologies.

A Hybrid Type I effectiveness-implementation randomised controlled trial (RCT) will investigate the effects of 1) fitness trackers 2) home-based online training and 3) tailored motivational support on physical activity promotion among underserved populations. The design will allow testing the study outcomes while gathering information on implementation in a real-world situation.

The project will increase access to physical activity, promote long-term adherence to health-enhancing behaviours, and result in better primary prevention of non-communicable diseases. The study will also provide evidence for the use of fitness technologies in the participants’ homes. The study will be conducted in the Finnmark County in Northern Norway, which is highly underserved. However, the results will be applicable to other regions and countries. The interventions could be also applicable to selected patient groups, particularly those with mobility impairment.


The primary objective is to test which combination of implemented e-health strategies (fitness trackers, home-based online training, tailored motivational support) is more effective in increasing physical activity levels among physically inactive adults in underserved areas and sustaining long-term exercise adherence.

Secondary objectives include: proportion of participants reaching physical activity recommendations; exercise adherence; physical fitness; cardiovascular risk; quality of life; self-efficacy; well-being; social support, usability and enjoyment; subjective impression of change; participants? perspectives.

We hypothesise that use of activity trackers can promote physical activity and improve health outcomes. Furthermore, we hypothesise that the additional use of home-based online training with simple exercise equipment is more effective in engaging in regular physical activity. Finally, we hypothesise that participants receiving tailored motivational support will have better long-term adhererence to physical activity.


A Hybrid Type I effectiveness-implementation RCT will be conducted aiming at an inactive, vulnerable and presumably high-risk population living in the underserved areas of the Finnmark County in Northern Norway. One hundred and eighty participants will be assigned to 3 groups in a 1:1:1 ratio and participate for 18 months. Participants in group A will use the fitness tracker Mio Slice with the computational algorithm Personal Activity Intelligence (PAI). Participants in group B will be provided with both the PAI and access to Les Mills On Demand with the necessary equipment to perform training classes from home. Participants in group C will be offered the PAI, Les Mills On Demand and additional tailored motivational support.