By Maurice
Wearable devices are not only a burgeoning market, they're also a growing area of scientific research.
What are the health and lifestyle benefits of wearables? On this page you'll find summaries of scientific research that answer that question, along with links to the original studies.
Enjoy!
Study Name | |
Publication | Springer Link |
Purpose | The deleterious effects of diabetes on the lower extremity are numerous, costly, and complicated to treat. |
Methods | Current healthcare practice guidelines substantially improve the long-term care of older adults; however, they are often limited to semi-regular screenings and patient-reported symptoms. |
Results | |
Conclusion | Future implementation of wearable, constant-monitoring technology has the potential to revolutionize healthcare by early detection and “pre-habilitative” therapy before the patient even needs to visit the clinic. |
Study Name | |
Publication | Springer Link |
Purpose | To estimate daily total energy expenditure (TEE) using a physical activity monitor, combined with dietary assessment of energy intake to assess the relationship between daily energy expenditure and patterns of activity with energy intake in people with dementia living in care homes. |
Methods | A physical activity monitor (Sensewear™ Armband, Body Media, Pittsburgh, PA) was employed to objectively determine total energy expenditure, sleep duration and physical activity. The armband was placed around the left upper triceps for up to 7 days. Energy intake was determined by weighing all food and drink items over 4 days (3 weekdays and 1 weekend day) including measurements of food wastage. |
Results | The mean age was 78.7 (SD ± 11.8) years, Body Mass Index (BMI) 23.0 (SD ± 4.2) kg/m2; 50% were women. Energy intake (mean 7.4; SD ± 2.6) MJ/d) was correlated with TEE (mean 7.6; SD ± 1.8 MJ/d; r=0.49, p<0.05). Duration of sleeping ranged from 0.4-12.5 (mean 6.1) hrs/d and time spent lying down was 1.3-16.0 (8.3) hrs/d. On average residents spent 17.9 (6.3-23.4) hrs/d undertaking sedentary activity. TEE was correlated with BMI (r=0.52, p<0.05) and body weight (r=0.81, p<0.001) but inversely related to sleep duration (r=-0.59, p<0.01) and time lying down (r=-0.62, p<0.01). Multiple linear regression analysis revealed that after taking BMI, sleep duration and time spent lying down into account, TEE was no longer correlated with energy intake. |
Conclusion | The results show the extent to which body mass, variable activity and sleep patterns may be contributing to daily total energy expenditure (TEE) and together with reduced energy intake, energy requirements were not satisfied. Thus wearable technology has the potential to offer realtime monitoring to provide appropriate nutrition management that is more person-centred to prevent weight loss in dementia. |
Study Name | |
Publication | ECONOMIC POLICIES IN THE AGE OF GLOBALISATION |
Purpose | New technology emerging such as wearables can potentially help to monitor the health conditions, reduce healthcare costs for the old and enable them to build a community. To take care of the elderly, watches, bandits can detect falls and send out warnings to family members, friends or emergency help center; smart spoons, glasses can monitor nutrition intake and prevent osteoporosis; GPS tracking can give real time location of the elderly and help family members deal with patients with Alzheimer’s disease and other dementia conditions. |
Methods | |
Results | To fully implement IoT solutions in healthcare industry, healthcare service providers need to work with government to build up data sharing platforms, eliminating duplicated procedures and facilitating access to medical records. Medical devices regulators shall adapt the technology standards along with technology development. Local authorities shall be given more authority to test the healthcare programs based on their own priority and get involved with the retired population which Employers may find the elderly to be more patient, careful, trained and trustworthy than imagined. In this way, healthcare quality variation can be adjusted, and optimal pathway can be promoted. When it comes to new drugs and new technology approval, population health assessment based on big data will make it possible for more policy makers to say yes or no to new drugs and treatment methodologies with much more efficiency. |
Conclusion | Wearable devices may make it possible to monitor the health conditions for the elderly and allow them to live independently as long as possible. By interacting with technology and initiating data sharing, life quality of the elderly may also improve. |
Study Name | |
Publication | NCBI |
Purpose | This pilot randomized clinical trial aimed to collect critical data on feasibility, safety, and protocol integrity necessary to design a fully powered randomized controlled trial (RCT) and evaluate the impact of combining structured exercise with an intervention designed to enhance non-exercise physical activity (EX+NEPA) compared to EX alone. |
Methods | Forty participants aged ≥60 years with moderate-to-high risk of coronary heart disease events were randomly assigned to either the EX+NEPA or EX groups and followed for 20 weeks. Both groups underwent a twice-weekly, 8-week center-based exercise intervention with aerobic and resistance exercises. EX+NEPA group also received a wearable activity tracking device along with behavioral monitoring and feedback throughout the study. Study outcomes were evaluated at 8 and 20 weeks. |
Results | Data are presented as adjusted mean change of the differences over time with 95% confidence intervals at 20 weeks. Relative to EX, the change in steps/day at 20 weeks was 1994 (−40.27, 4028) higher for EX+NEPA. For sedentary time at close-out, the EX+NEPA group was −6.8 (−45.2, 31.6) min/day relative to EX. The between-group differences for systolic and diastolic blood pressure were −9.9 (−19.6, −0.3) and −1.8 (−6.9, 3.3) mmHg, respectively. |
Conclusion | The addition of wearable technology intervention appeared to positively influence daily activity patterns and changes in blood pressure – potentially improving risk factors for CVD. A fully powered randomized trial is needed to ultimately test this hypothesis. |
Study Name | |
Publication | Science Direct |
Purpose | To assess the effects on functional outcomes and treatment adherence of wearable technology and serious games (ie, interactive computer applications with specific purposes useful in the “real world”) currently used in physical rehabilitation of patients after traumatic bone and soft tissue injuries. |
Methods | The search yielded 2704 eligible articles, which were screened by 2 independent reviewers. Studies comparing serious games to standard therapy were included.
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Results | Twelve articles were included, all of which tested “off-the-shelf” games. No studies on “wearable-controlled” games or games specifically developed for rehabilitation could be included. Medical conditions included postoperative rehabilitation and acute traumatic injuries. All studies were of low to moderate quality. Only 2 studies found beneficial effects of serious games compared to conventional therapy. One of 3 studies reporting pain scores found beneficial effects of serious games compared to physiotherapy. One of 5 trials reporting treatment adherence found a statistically significant advantage in the game group compared to conventional physiotherapy. Because of heterogeneity in study design and outcome measures, pooling of data was not possible. |
Conclusion | Serious games seem a safe alternative or addition to conventional physiotherapy after traumatic bone and soft tissue injuries. Future research should determine their validity and effectiveness in rehabilitation therapy, next to their cost-effectiveness and effect on treatment adherence. |
Study Name | |
Publication | Science Direct |
Purpose | The purpose of this article is to provide an overview of the state of the wearable technology, |
Methods | discuss advantages and challenges, and consider implications for informatics, patient care, and future research. |
Results | With digital technology, patients can be more active in their care and better understand how their behaviors can affect their health in real time. |
Conclusion | Wearables can provide data and automatic analytics that can help nurse practitioners diagnose issues more quickly and intervene sooner to prevent readmissions or negative sequelae. |
Study Name | |
Publication | Science Direct |
Purpose | The objectives of this study were to determine the usefulness and actual use of wearable devices among the elderly population. |
Methods | Our methodology was based on a systematic review and a survey questionnaire. In the systematic review, search was conducted in four databases PubMed, MDPI, Sage, and Scopus with search terms “wearable device” and “elderly”, “wearable sensor” and “elderly”. The inclusion criteria were the studies which described health-related wearable devices, its use as the outcome, conducted on a minimum of ten participants and published in the last five years. The survey was conducted on the MOOCs (Massive Open Online Course) platform. The questionnaire was related to the use of technology, intention to use, security and privacy concerns, and willingness to pay. |
Results | The review identified 4915 articles, of which, 31 studies eventually met the inclusion criteria. All studies reported positive impacts after assessing devices, despite certain drawbacks. The majority of the samples were males. The survey revealed responses from 233 individuals out of the 1100 participants of the course. The survey results were categorized into two age groups: 54.3% were elderly (>65 years) and 45.49% were non-elderly (≤65 years). Very few elderly people were currently using WD. More than 60% of elderly people were interested in the future use of wearable devices, and preferred future use to improve physical and mental activities. A majority of the respondents were female. |
Conclusion | This study suggests awareness should be created among elderly populations regarding the use of wearable devices (WDs) for the early detection and prevention of complications and emergencies. Elderly populations are more prone to benefits from using WDs. The review concluded that devices should be tested on elderly groups as well, considering sex equality, and on both healthy and sick participants for better insights. The survey determined the elderly as frequent users of technology, but lack of knowledge of WD and demonstrated female interest in the use of WD. In future research on WDs, it is suggested that clinical studies be conducted for longer durations, and standard protocols such as age and sex equality should be considered. Requirements from both users and physicians should be acknowledged for better cognizance of WDs. |
Study Name | |
Publication | designsociety.org |
Purpose | We conducted an exploratory feasibility study adapting wearable technologies to support the above-mentioned elderly user group remember to remember their daily activities such as non-routine appointments. |
Methods | Six design concepts with smartwatches, smart bands, smartphones, smart calendar boards, NFC tags, and augmented reality glasses were sketched and two low-fidelity prototypes, Memofy and Komihu, were developed and tested with three patients and their caregivers. |
Results | |
Conclusion | Technology acceptance was high both amongst patients and health personnel, encouraging further in-depth and longitudinal tests for health outcoMES. |
Study Name | |
Publication | Auburn University |
Purpose | Wearable devices have great potential values to benefit the aging population, while the gap between the product value and current usage is quite huge. This thesis aims to help designers to design an inclusive wearable device for promoting health, especially to accommodate older users’ needs |
Methods | Based on user experience design (UX) theory, a series of design guidelines are provided with different design stages to help designers create and evaluate their concepts. The design thinking behind this research is using design to influence user’s behavior. Specifically, through inclusive design, UX design, and persuasive design strategy, a designer can understand behavior, enable behavior and finally influence behavior. |
Results | |
Conclusion | An ideal inclusive wearable device should not only be accessible to older adults without stigma but should also be attractive to normal consumers because of ease of use. |
Study Name | |
Publication | SAGE |
Purpose | A goal in designing these devices is to provide seamless technological integration with people’s daily lives. These novel, unobtrusive devices are typically smaller than a smartphone yet may provide important information on a moment-by-moment basis to a user throughout the day. |
Methods | |
Results | Considering these limitations and recommendations during the design process will improve the usability of wearable technology for a growing population of adults 65 and older. Although members of this population historically have been characterized as hesitant to adopt technology, designers of wearable technology may be able to overcome this demographic trait by developing devices that are useful, comfortable, and easy for senior citizens to interact with. |
Conclusion | Broadly speaking, the older adult population is one that could potentially benefit considerably from wearable devices that offer support for some of the declines normally experienced with age. All in all, the potential synergy between older adult users and wearable technologies is one that should encourage developers to design strategically and older adult users to strongly consider adoption of these assistive devices as they emerge. |
Study Name | |
Publication | BMJ Journals |
Purpose | To identify the impact the use of wearable technology could have in patients with osteoarthritis in terms of communication with healthcare providers and patients’ empowerment to manage their condition. |
Methods | Qualitative study using focus groups with patients with osteoarthritis; data from patients’ responses were analysed using Framework Methodology. |
Results | Patients’ responses suggested a positive attitude on the impact wearable technology could have on the management of osteoarthritis. It was perceived that the use of wearable devices would benefit patients in terms of feeling in control of their condition, providing them with awareness of their progress, empowering in terms of self-management and improving communication with their clinician. |
Conclusion | This paper suggests positive patient perspectives on the perceived benefits wearable technology could have on the management of osteoarthritis. The data that could be collected with the use of wearable technology could be beneficial both to patients and clinicians. The information obtained from this study suggests that introducing wearable technology into patient-centred care could enhance patient experience in the field of osteoarthritis and beyond. |
Study Name | |
Publication | SAGE |
Purpose | This study aimed to explore: 1) perceptions about wearable physical activity trackers; 2) perceptions about using technology to share physical activity information with clinicians; 3) barriers and motivators to playing games, including AVGs for rehabilitation. |
Methods | Qualitative study based on semi-structured interviews with older adults (n = 19) with chronic obstructive pulmonary disease (COPD). |
Results | |
Conclusion | Wearable activity trackers were perceived as useful to quantify activity, facilitate goal-setting, visualize long-term improvements and provide reminders. Participants generally wished to share data with their clinicians to gain greater accountability, receive useful feedback and improve the quality of clinical care. Participants were motivated to play games (including AVGs) by seeking fun, social interaction and health benefits. Some felt that AVGs were of no benefit or were too difficult. Competition was both a motivator and a barrier. |
Study Name | |
Publication | NCBI |
Purpose | To assess the performance of wearable technology in monitoring and improving physical activity in COPD patients from published studies. |
Methods | Literature search of Medline, Cochrane, Dare, Embase and PubMed databases was made to find relevant articles that used wearable technology to monitor physical activity in COPD patients. |
Results | |
Conclusion | We identified 13 studies that used wearable technology, a pedometer or an accelerator, to monitor physical activity in COPD patients. Of these, six studies were randomized controlled trials (RCTs) which used the monitors as part of the intervention. Two studies reported the same outcomes and comparable units. They had measured the difference that the intervention makes on the number of steps taken daily by the patients. The results were highly heterogeneous with I2=92%. The random-effects model gave an effect outcome on the number of steps taken daily of 1,821.01 [−282.71; 3,924.74] in favor of the wearable technology. Four of the 13 studies have reported technical issues with the use of the wearable technology, including high signal-to-noise ratio, memory storage problems and inaccuracy of counts. While other studies did not mention any technical issues, it is not clear whether these did not experience them or chose not to report them. |
Study Name | |
Publication | American cancer society journals |
Purpose | The benefits of an active lifestyle after a breast cancer diagnosis are well recognized, but the majority of survivors are insufficiently active. The ACTIVATE Trial examined the efficacy of an intervention (use of the Garmin Vivofit 2 activity monitor coupled with a behavioral feedback and goal-setting session and 5 telephone-delivered health coaching sessions) to increase moderate to vigorous physical activity (MVPA) and reduce sedentary behavior in breast cancer survivors. |
Methods | This randomized controlled trial recruited 83 inactive, postmenopausal women diagnosed with stage I-III breast cancer who had completed primary treatment. Participants were randomly assigned to the intervention group or to the control group, and the intervention was delivered over a 12-week period. MVPA and sedentary behavior were measured with Actigraph and activPAL accelerometers at baseline (T1) and at the end of the intervention (T2). |
Results | Retention in the trial was high, with 80 (96%) of participants completing T2 data collection. At T2, there was a significant between-group difference in MVPA (69 min/wk; 95% CI = 22-116) favoring the intervention group. The trial resulted in a statistically significant decrease in both total sitting time and prolonged bouts (≥20 min) of sitting, with between-group reductions of 37 min/d (95% CI = −72 to −2) and 42 min/d (95% CI = −83 to −2), respectively, favoring the intervention group. |
Conclusion | Results from the ACTIVATE Trial suggest that the use of wearable technology presents an inexpensive and scalable opportunity to facilitate more active lifestyles for cancer survivors. Whether or not such wearable technology-based interventions can create sustainable behavioral change should be the subject of future research. |
Study Name | |
Publication | Springer Link |
Purpose | Physical activity interventions can improve sleep quality in breast cancer survivors. This paper examines the effects of the ACTIVATE Trial, a wearable-based physical activity intervention (Garmin Vivofit2® coupled with behavioral feedback, goal setting, and health coaching) on sleep outcomes. |
Methods | Post-primary treatment, inactive, postmenopausal breast cancer survivors were recruited and randomized to primary intervention or waitlist. Wrist-worn actigraphy (sleep onset latency, SOL; total sleep time, TST; sleep efficiency, SE; wake after sleep onset, WASO; and number of awakenings, NWAKE) and questionnaire-derived sleep measures (Pittsburgh Sleep Quality Index) were assessed at baseline (T1), 12 weeks (end of primary intervention and start of waitlist intervention, T2), and at 24 weeks (T3). |
Results | Eighty-three women (mean age = 62 years) were randomized; trial retention was 94% at T2 and 87% at T3. At T2, primary intervention participants had greater improvements in WASO (− 5.7 min, 95% CI − 11.7 to − 0.2) and NWAKE compared with the waitlist arm (− 2.0, 95% CI − 3.6 to − 0.4). At T3, within-group improvements were observed for SE (both groups), WASO (both groups), NWAKE (primary intervention group only), total PSQI score (primary intervention group), and sleep efficacy (primary intervention group). |
Conclusion | The intervention reduced actigraphy-measured sleep disturbances. Within-group analyses suggest that improvements in sleep quality are sustained over a longer duration, and there may be similar benefits from an abridged intervention (wearable device only). Actigraphy-measured effects appeared stronger in participants who were poor sleepers at study entry. |
Study Name | |
Publication | NCBI |
Purpose | The field of gastroenterology has recently seen a surge in wearable technology to monitor physical activity, sleep quality, pain, and even gut activity. The past decade has seen the emergence of wearable devices including Fitbit, Apple Watch, AbStats, and ingestible sensors. In this review, we discuss current and future devices designed to measure sweat biomarkers, steps taken, sleep efficiency, gastric electrical activity, stomach pH, and intestinal contents. We also summarize several clinical studies to better understand wearable devices so that we may assess their potential benefit in improving healthcare while also weighing the challenges that must be addressed. |
Methods | IBD represents a chronic disease where the application of wearable technology may be able to improve management and predict or even prevent inflammatory disease flare. In a first study, Jagannath et al[11] used EnLiSense’s Sweatsenser for noninvasive continuous monitoring of interleukin-1 (IL-1β) and C-reactive protein (CRP), two key biomarkers associated with IBD, in human eccrine sweat. The sensor device demonstrated capability to detect and real-time monitor IL-1β and CRP in sweat. This study signifies a promising non-invasive wearable microsensor device that has the potential to empower patients to actively engage in monitoring and managing their IBD. This device may also give patients the chance to intervene earlier and help gastroenterologists understand whether treatment is effective. |
Results | Wearable technology could represent a vital method for gastroenterologists to diagnose, manage, and monitor patients with numerous GI conditions and may even prevent disease. Because of the many available technologies such as remote sensor wearables, smartphones and mobile apps, telemedicine, and electronic health records, remote patient monitoring is very promising in the near future. Wearable devices have the ability to connect wirelessly to other devices, allowing the transfer and exchange of information and placing these devices in a category of technology known as the Internet-of-Things[58]. The Internet-of-Things is one framework that will make such a future possible by providing the framework for exchange and communication of data between sensors and health care providers[58]. This will benefit physicians and patients as wearable sensor systems can help reduce the costs associated with high-quality and continuous health care monitoring by reducing unnecessary hospital admission and length of stay[59], facilitate health behavior in the long run by monitoring and sending alerts to patients to give cues to modify behavior[60], and improve health in vulnerable populations[61]. Technological developments need to be carefully addressed to ensure that patients feel comfortable sharing a significant amount of data regarding their daily lives with health care providers, insurance companies, and data analytic companies[62]. Regulations will also need to evolve continuously to ensure the best interest of the general population. Nonetheless, wearable technology continues to expand and make great impacts in patients’ lives from fitness to health and wellness monitoring to possible future diagnostic and management tools. |
Conclusion | In general, remote patient monitoring in the field of gastroenterology are showing great promise for detection of GI conditions and managing and monitoring patients during their routine daily lives. They also show potential of reducing health care costs by encouraging better self-management and intervention approaches while allowing for a stronger physician patient collaboration and more personalized medicine. With rapidly advancing technological advancements, wearable technology has the potential to revolutionize how physicians provide high quality, reliable, and affordable health care to all. |
Study Name | |
Publication | Science Direct |
Purpose | Wearable devices have potential benefits for seniors healthcare. However, the rate of adoption of these devices is very low for seniors compared to other age groups. This study aims at examining the factors that influence seniors’ use of wearable devices and the effect of these devices on seniors’ behavior. |
Methods | This study uses qualitative methods to address the research questions. We conducted 26 interviews of seniors who have never used wearable devices before. We interviewed seniors before and after using activity tracking wearable devices. Furthermore, we collected wearable device quantitative data to support interview results. |
Results | |
Conclusion | Seniors adoption of wearable devices involve several factors that can be categorized as technology related factors such as the complexity and customizability of wearable devices and individual related factors such as social influence, self-efficacy. Furthermore, the effects of using wearable devices vary among seniors depending on their activity patterns and exercise schedule. |
Study Name | |
Publication | Ingenta Connect |
Purpose | Postmenopausal women cite lack of time as their primary barrier to exercise and related weight control behaviors. The purpose of this study was to address this barrier via testing the feasibility and initial outcomes of a short-duration/high-intensity interval training (HIIT)-based weight loss program among obese postmenopausal women, with descriptive comparison to an endurance-focused exercise program |
Methods | A 16-week behavioral program incorporated (1) HIIT to limit time necessary to produce health benefits of exercise, and (2) wearable activity sensors to facilitate self-monitoring exercise. Participants (n = 11; M Age = 59 ± 5.33; M BMI = 32.0 ± 2.53 kg/m2) were randomly assigned to HIIT or endurance exercise. Both groups followed a calorie-restricted diet, attended monthly in-person meetings, weekly weigh-ins and electronic check-ins to review behavioral skills, and monitored their exercise with a Fitbit ChargeHR. Adherence to exercise programs, assessed with the Fitbit sensor, was used to determine feasibility. |
Results | Participants in the HIIT group (6/6) adhered to their program, whereas 3 of 5 adhered to the Endurance program. Participants in the HIIT group lost twice as much weight as those in the Endurance group (8.7% vs 4.3% of initial body weight), and lost an additional 6 in. of body mass. In addition, only the HIIT group significantly changed fat mass, body mass index, and fat-free mass (Ps < 0.04). |
Conclusion | These findings support the feasibility and potential effectiveness of HIIT for weight loss and body composition changes in obese postmenopausal women, and indicate that additional investigation of this approach is warranted to reduce postmenopausal chronic disease risk. |
Study Name | |
Publication | Translational Journal of the ACSM |
Purpose | Wearable fitness devices are becoming increasingly common with goals of tracking and improving health-related behaviors. These devices have been primarily used to increase physical activity; less is known about their potential for reducing sedentary behaviors. The objective of this study is to pilot the efficacy of using wearable technology to reduce sedentary time in daily life. The secondary purpose was to examine changes in mood and physical activity across the intervention |
Methods | This was a single-blind study. Participants and study personnel delivering instructions were aware of the group assignment. However, data entry and quality checking of accelerometer data at the single-subject level were conducted by study personnel who were blind to the group assignment. Data were collected in two cohorts: one during the fall semester (n = 16) and one during the spring semester (n = 14). For both cohorts, participants were enrolled within the first 3 wk of the semester and finished at least 2 wk before finals. The protocol involved three laboratory visits (baseline, week 2, and week 10) and was divided into three phases: a 1-wk baseline, a 5-wk intervention, and a 4-wk follow-up (see Fig. 1 for an overview of the study). The institutional review board approved all procedures, and all participants read and signed an informed consent document before participation. To characterize the sample resting HR, blood pressure, height (m), and weight (kg) were assessed at baseline. Participants then completed additional baseline assessments including questionnaires (detailed below) and received a set of monitors to objectively measure sedentary (activPAL3™ VT (AP)) and physical activity behaviors (ActiGraph GT3X+ (AG)) over the subsequent 7 d under free-living conditions. |
Results | Thirty college-aged men and women from 22 different majors enrolled in the study. All were full-time students during the intervention and follow-up periods. One participant in the MEC group did not complete the study because of scheduling difficulties, and one participant (also in MEC) had AP malfunctions during baseline testing; both of these individuals were in the fall cohort. Analyses were limited to those with complete data only; therefore, data are presented from 28 participants (SF = 15; MEC = 13; for participant characteristics and baseline mood, see Table 1). Moreover, the improvements in prolonged sedentary behavior in the SF group were maintained 4 wk postintervention in the absence of feedback, suggesting that feedback from a wearable device was useful in creating healthier habits in our sample. Evidence for the development of habits is particularly noteworthy because research has demonstrated that once formed, habits are likely to persist even when conscious motivation decreases (26). |
Conclusion | This study demonstrates that increasing awareness of sedentary behaviors using wearable technology may be a viable approach to address growing health concerns surrounding accumulation of large amounts of prolonged sedentary time. Furthermore, the improvement in mood indicates that reducing prolonged sedentary time might be an area of high public health importance because of the prevalence of clinical and subclinical mental health issues in the general population. Due to the market for commercially available wearable devices growing, this technology may be beneficial to the improvement in behaviors like sedentary time that have previously been challenging to monitor and change because of their pervasiveness in daily life. Future research employing commercially available devices with sedentary alert functions in larger samples of varying ages and health statuses will be an important step toward determining the broader use and translatability of this type of intervention for promotion of health and well-being. |
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