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 lifestyle diseases. To date, there is preliminary evidence of the efficacy in the use of certain strategies including fitness technologies and digital interventions for physical activity (PA) promotion. Intervention studies are needed to test the effectiveness of PA promotion strategies.

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) peer support via social media among inactive adults. The design will allow testing the study outcomes while gathering information on implementation in a real-world situation.


The primary objective is to test which combination of implemented e-health strategies (activity trackers, home-based online training, peer support via social media) is more effective in increasing PA levels among physically inactive adults and sustaining long-term exercise adherence.

The secondary objective is to determine the effects of implemented e-health strategies on health outcomes, including: proportion of participants reaching PA recommendations; exercise adherence; physical fitness; cardiovascular risk; quality of life; perceived competence for exercise; self-efficacy; social support; usability; participants’ perspectives.

This project will test the study objectives with three implementation strategies. We hypothesise that the use of activity trackers with the computational algorithm PAI can promote PA and improve health outcomes. Furthermore, we hypothesise that the additional use of home-based online training is more effective in engaging in regular PA. Finally, we hypothesise that participation in peer support group via social media will result in better long-term adherence to PA.


A Hybrid Type I effectiveness-implementation RCT will be conducted aiming at an inactive, vulnerable and presumably high-risk population living in the Troms and Finnmark county. One hundred and eighty participants will be assigned to 3 groups in a 1:1:1 ratio and participate for 18 months. The effectiveness-implementation hybrid design allows testing the outcomes of the interventions while gathering information on delivery and potential for implementation in a real- world situation.

Participants in the group A will be provided the fitness tracker Mi Smart Band 5 with the computational algorithm PAI. Participants in group B will be provided with both the fitness tracker Mi Smart Band 5 with the computational algorithm PAI and access to Les Mills On Demand to perform training classes from home. Participants in group C will be provided the fitness tracker Mi Smart Band 5 with the computational algorithm PAI, Les Mills On Demand and additional peer support via social media. The presence of three interventional groups will allow testing which combination of implementation strategies is more effective in increasing levels of PA. As all study participants will be wearing an activity tracker, levels of PA will be objectively measured and monitored along the whole duration of the study.


This project will contribute to reduce disparities in PA levels among inactive adults by increasing access to PA and promoting long-term adherence. Increased PA will result in better prevention of lifestyle diseases. The study will be conducted in the Troms and Finnmark county. 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 characterised by a low levels of PA. Effective e-health interventions for PA could be prescribed by general practitioners or specialists as “medicine” to both healthy and impaired individuals.