USING ONLINE TECHNOLOGY TO INCREASE QATAR'S COMMUNITY INVOLVEMENT IN PHYSICAL ACTIVITY DURING COVID-19 RESTRICTIONS

Abstract

In Qatar, 63.3% of the adult population (18 - 64 years) do not participate in recreational physical activities. Surveillance data show that 9.3% of people in Qatar die annually due to physical inactivity and 36.8% do not meet current global physical activity recommendations. Regular walking is an easy, accessible, and inexpensive form of physical activity which improves and maintains the general health of an individual. This study has a double fold aim: evaluates the impact of the online messaging intervention on the Qatar's population physical activity levels and the impact of mobile applications use on the Qatar's population involvement in the walking program. The study population is a representative sample of Qatar community. A total of 299 eligible adults (18-64 years), active members of different SIH communities participated in the study. Randomized control trial (RCT) study with 5 months walking program, 8 weeks online messaging intervention, awareness and educational messages about physical activity guidelines, 156 adults in the experiment group and 143 adults in the control group. Step counts measured by pedometers and mobile applications linked to a web-database. Physical activity levels categorized based on daily steps achievements. The findings confirms that walking programs in Qatar are efficient for adults with low physical activity levels and implemented during cool weather months. Online messaging during COVID-19 pandemic do not influence step-counts amongst study group. Adult population in Qatar prefers mobile applications use. Pedometer users are more active than apps users. COVID-19 restrictions in Qatar negatively impact adults' physical activity levels.

Headnote

Abstract: In Qatar, 63.3% of the adult population (18 - 64 years) do not participate in recreational physical activities. Surveillance data show that 9.3% of people in Qatar die annually due to physical inactivity and 36.8% do not meet current global physical activity recommendations. Regular walking is an easy, accessible, and inexpensive form of physical activity which improves and maintains the general health of an individual. This study has a double fold aim: evaluates the impact of the online messaging intervention on the Qatar's population physical activity levels and the impact of mobile applications use on the Qatar's population involvement in the walking program. The study population is a representative sample of Qatar community. A total of 299 eligible adults (18-64 years), active members of different SIH communities participated in the study. Randomized control trial (RCT) study with 5 months walking program, 8 weeks online messaging intervention, awareness and educational messages about physical activity guidelines, 156 adults in the experiment group and 143 adults in the control group. Step counts measured by pedometers and mobile applications linked to a web-database. Physical activity levels categorized based on daily steps achievements. The findings confirms that walking programs in Qatar are efficient for adults with low physical activity levels and implemented during cool weather months. Online messaging during COVID-19 pandemic do not influence step-counts amongst study group. Adult population in Qatar prefers mobile applications use. Pedometer users are more active than apps users. COVID-19 restrictions in Qatar negatively impact adults' physical activity levels.

Keywords: physical activity; mobile app; pedometer; walking; Qatar, step-count

I. INTRODUCTION

Scientific evidence shows that 31% of the world's population does not get enough physical activity and about 6-10% of major noncommunicable diseases worldwide are attributed to physical inactivity (cardiovascular disease, diabetes, high blood pressure, obesity, overweight, high blood cholesterol). [1] The World Health Organization (WHO) states that in the Eastern Mediterranean Region (EMR), physical inactivity varies among the 22 countries between 14.1% (in Sudan) and 82.1% (in Saudi Arabia). [2] In Qatar, the situation of adults aged 18-64 was reported in 2021 in the second edition of Qatar's National Physical Activity Guide, and the results are considered alarming: 41.4% of respondents were obese; 21.9% of respondents had high cholesterol levels; 16.7% of respondents had diabetes; 63.3% of the population between 18 and 64 years old do not participate in recreational physical activities; 86.2% of women aged 45-65 reported not participating in any form of vigorous physical activity. [3]

Recent surveillance data show that 9.3% of people in Qatar die annually due to physical inactivity [4] and 36.8% do not meet current global and national physical activity recommendations. [5] Pratt et al. (2020) proposes that effective interventions shall be implemented to combat this situation. There is a need to improve and build capacity in the field to implement physical activity programs and an adequate allocation of resources for this area. [6]

1.1. Physical activities performance status during the COVID-19 pandemic

Currently, worldwide, the spokesperson's efforts are focused on the threats of the COVID-19 pandemic. In addition to the high percentages of NCD increase, another cause for concern, globally, is the 9% premature mortality rate; the equivalent of more than 5 million people who die prematurely each year due to the physical inactivity pandemic.

Dwyer et al (2020) point out that throughout the COVID-19 pandemic the restrictions on using sports facilities and physical distancing oscillated continuously; during critical pandemic periods the sports facilities were closed, physical distancing was imposed, while at other times physical activities were allowed to be performed only in restricted percentages, thus facility restrictions have changed continuously over the past two years, the physical activity literature has consistently recommended to the population to keep performing physical activity during the COVID-19 pandemic, emphasizing on the health benefits. Throughout these timings of the pandemic, health professionals recommended customized exercises to each need according to age, health, and fitness level, performed at home or in public spaces that allow individuals to respect the physical distancing restrictions.[7]

According to Al-Kuwari et al. (2021) the use of welfare, healthcare services in Qatar was affected by the COVID-19 pandemic; the study emphasizes that there was a sharp decline in the use of healthcare services between March and May 2020. [8] González-Hernández et al (2017) appreciate that regular exercise and associated behaviors (balanced diet, regular sleep, and proper hygiene) promote strong, healthy bodies and predict a long and healthy living among the population. [9] Fitzgerald et al (2020) and Warburton et al (2006) point out that there is a linear relationship between physical activity and health; further, an increase in physical activity and fitness levels leads to further improvements in health. [10, 11].

1.2. Barriers and solutions for physical activities in Qatar

The barriers that prevent adults from engaging in physical activity in Qatar are diverse. Extremely hot weather lasts for 6 months a year situation which limits the time spent outdoors hence most people are looking to spend their time in air-conditioned indoor spaces, consequently the use of public parks and outdoor recreation zones is very limited, too. Walseth et al. (2003) cites other condition that prevents adults from Qatar from engaging in physical activity, traditions, and culture. Most Qatari citizens have their own beliefs grounded in Islam; through their strong belief in mutual respect, women and men do not exercise together, apart from people in the same family. Although Islam encourages women to participate in sports, there are barriers to the use of the veil, gender segregation, and Muslim society's view of women and their sexuality. [12]

The above-mentioned barriers for adults in Qatar to maintain an active lifestyle: high levels of obesity, lack of physical activity, the COVID-19 pandemic, tradition, and culture, are situations for which the state officials have created several documents, plans, and strategies to combat these conditions: Qatar National Vision 2030 (QNV 2030); Qatar National Health Strategy (QNHS 2018 - 2022); Qatar National Physical Activity Guidelines (QNPAG); Qatar National Sports Day (QNSD); Healthy 2022 World Cup: Creating a Legacy for Sport and Health; Step into Health (SIH).

Qatar's National Vision 2030 (QNV 2030) is based on four pillars. This study refers to an intervention adjacent to the first QNV pillar: "Human Development" - a pillar which encourages the inhabitant's development towards a prosperous society, an ambition to develop a healthy population, physically and mentally while aims for a complex health system with accessible services to the entire population, as to satisfy the needs of current and next generations, ensuring a healthy and long life to all citizens. [13]

1.3. Walking as a form of physical activity

Hanson et al (2015) consider in their scientific evidence in the field, that walking has ample benefits on human health. Walking regularly and for a long time reduces systolic blood pressure and diastolic blood pressure, resting heart rate, body fat, body mass index, total cholesterol, depression, and increases VO2max. [14] Jackson et al (2008), Sisson et al (2008) and Allender et al (2006) talk about walking as a form of easy, accessible, and inexpensive physical activity, effective in involving adults in physical engagement, and they show that walking improves and maintains the general health of an individual. [15, 16, 17]

Walking can be influenced by environmental factors, such as social considerations, related to the acceptability of walking among social groups, individual motivation to start walking regularly, and sustained commitment. Sisson et al (2008) established in the U.S. that community-based walking intervention programs help adults comply with national physical activity guidelines. [18]

Plangger et al (2019) and Grajek et al (2021) talk about group walking as an approach to significantly increase the walking time while offering rewards that will meaningfully raise activity levels. [19, 20] Ogilvie et al (2007) and Richards et al (2016) reported that the use of pedometers, mobile step counting applications, and online messaging is a motivational strategy for adults to increase self-reported gait. [21, 22] Elizabeth et al (2019), Adria et al (2016) demonstrate that the use of information and communication technologies (e.g., walking devices, mobile applications, and webbased interventions) are effective in changing behavior toward a healthier lifestyle. Factors such as managing time, motivation, and reminders are important in promoting this type of behavior for adults. [23, 24] Vetrovsky et al (2018) establishes that the use of e-mail communication during pedometerbased interventions is feasible and has the potential to enhance physical activity levels. [25]

II. RESEARCH DESIGN

The overall aim of the current paper is to study the impact of the SIH walking program during the COVID-19 pandemic on Qatar community's physical activity levels and involvement. This study has two objectives: evaluates the impact of the online messaging intervention on the Qatar's population physical activity levels and the impact of mobile applications use on the Qatar's population involvement in the walking program. Study population is encouraged to achieve the goal of 10,000 steps/day using pedometers and mobile applications as step measuring instruments.

2.1. Research questions

The questions answered in this study are:

- To what extent does online messaging motivate Qatar's adults to engage in regular physical activity?

- To what extent do the physical activity levels of adults in the Qatar community change before, during, and after the implementation of the intervention?

2.2. Hypothesis

1. Walking programs implemented amongst adults from the Qatar community can raise the awareness of health benefits through regular physical activity as support to an active lifestyle enrichment.

2. Experiment group's participation in the walking program will display higher engagement in regular physical activity compared to the control group.

3. The use of online messaging during the COVID-19 pandemic could motivate Qatar's adult population to not give up on performing physical activity during this period, to a significantly greater extent than the situation when adults are using only pedometers or mobile applications as a standalone method to encourage regular physical activity.

2.3. Research methods

This study employs the randomized pretest-posttest experimental study method with the control group. The eligible population, participants in the Step into Health (SIH) program, are randomly assigned to one of two groups: Group 1 (experimental), which receives the intervention, and Group 2 (control) without intervention.

The IBM statistical package for social sciences (SPSS version 21.0, IBM Corp., Armonk, NY, USA) was used to perform the quantitative statistical analysis of this research. Descriptive statistics (mean + SD and frequencies) were established at the group level. Subgroup analysis of the classified categories of physical activity levels was conducted making use of the following tests: the arithmetic mean (X) to estimate the central predisposition of the series; the standard deviation (SD) to form a point of view on the homogeneity of the sample; the Two-Way ANOVA for testing the hypotheses. Data collection was performed through the SIH system supported by IT implications, has been prepared using the Excel program, and imported into the SPSS program for analysis while the results were displayed through graphs and tables.

Mobile apps and pedometers for step counting

A daily number of steps was measured using two types of equipment. One method is the Omron HJ-324U pedometer (Omron Healthcare Co., Ltd., Japan) [26]. This device has a USB connection that allows participants to upload recorded information; it is electronically supported by an online self-monitoring account and connected to the SIH web database. An efficient step recording was considered in this study during the recruitment process when the participants were advised to carry the pedometers at the hip level.

The second method of measuring the steps is through the mobile application. It measures accumulated steps, monitors athletic performance, and compares it to the average healthy standard of 10,000 steps per day. The app offers several features designed to monitor fitness levels. In addition to counting steps and measuring distance, it also calculates calories and the amount of fat burned. The results obtained on the app are synchronized to the SIH program website, where overall performance and achievements can be monitored. The app is designed to have a minimum effect on the phone's battery life, allowing for long-distance exercise. Moreover, the app is in English and Arabic and can be downloaded on all iPhone IOS 5 and Android devices.

Online messaging for educational content distribution

An online method is used for educational content distribution twice per week for 2 months. The messaging intervention is launched through e-mails and SMS. The intervention started with 2 invitation messages to participation (one for the control group and the other for the experiment group). 16 emails were sent to each participant from the program address stepintohealth [email protected]. 16 messages were sent by SMS on mobile phone (SMS size limit of 160 characters when using the Latin alphabet) through the SIH program online system. The educational content was developed from Qatar National Physical Activity Guidelines, 2" edition [27] which emphasized: the importance to commit to the 10,000 steps per day; the health benefits obtained through regular walking; the walking awareness as a form of physical activity; the national physical activity recommendations for healthy and active lifestyle; the available places in Qatar for performing walking (outdoors and indoors). The intervention concluded with 2 messages which marked the end of the intervention (one for the control group and the other for the control group).

2.4. Target group

This research targets adults in the Qatar community registered SIH members which previously consented to their involvement in the program and participated on other occasions in SIH walking initiatives. Only members who currently have pedometers or the steps measurement app on their mobile phones were involved in this study. The sample population was randomly selected from all SIH registered members from the beginning of the program to the present. The cohort group underwent eligibility examination. Eligible subjects received the walking intervention and parallel educational messages through online messaging according to the type of randomized experimental research pretest-posttest with the control group (RCT). Once the intervention was completed, the number of daily steps performed by the subjects was analyzed.

Inclusion criteria for study population: SIH program's registered active members which signed the informed consent form; healthy adults of different nationalities, aged 18 to 64 years, women, and men.

Exclusion criteria for study population: Patients with chronic diseases (e.g., cardiovascular disease, diabetes, metabolic syndrome); those who refuse to sign informed consent; those who report less than 1,100 or more than 65,000 daily steps as outliers or erroneous measures.

Withdrawal criteria for study population: registered participants have the option to withdraw from the SIH web database at any time.

Following the verification of the baseline data after the launch of the intervention, the research team worked with the following sample size: 299 total participants (156 adults in the experiment group; 143 adults in the control group). The study population is a Qatar community representative sample, active members of different SIH community communities of the overall walking program: SIH in Qatar Community, SIH in Campuses, and SIH in Workplaces.

2.5. Research methodology

SIH registered members, users of pedometers, and mobile applications were invited from October 2021 to February 2022 to participate in a physical activity intervention based on walking. This study is a randomized control trial and the study population was divided into two groups, randomly selected, control and experimental, and asked to join the 8 weeks intervention, being encouraged to walk 10,000 steps and more during the day in an uncompetitive, recreational, and social manner. The goal of reaching 10,000 steps/day is known as an indicator of good health.

During this time, the experiment group received through email and SMS, twice a week, educational messages containing details of Qatar National Physical Activity Guidelines. [28] At the end of the intervention, the experiment group received a message announcing the winner of the participation prize and the physical activity category which they obtained during the intervention. The control group received emails informing them of the start and end of the intervention.

The online database was checked two months before the launch of the intervention (September - October 2021), two months during the intervention (November 2021 - January 2022), and one month after the intervention (February 2022), to identify the physical activity levels and the step measuring equipment frequency use (pedometers and steps measuring applications on the mobile phone). During this period, the research team and program coordinators provided participants with the following support: pedometers distribution, mobile phone walking application installation, or any other technical assistance as and when requested.

Participants were notified to access a registration link: www.stepintohealth.qa/Registration.aspx to download the "SIH" application. Upon registration, participants received an email with a membership number, a username, a password, and a link to download the app. Once the link is activated, participants can make language settings and preferences. The application offers several advantages and features and uses motion sensors that allow step count monitorization. Consequently, participants were recommended to carry mobile phones in their hands or pockets while using the application to ensure an accurate recording of steps numbers.

To evaluate the physical activity intervention through online messaging, the number of daily steps is classified into the following categories: less than 5,000 steps per day - sedentary lifestyle index, 5,000-7,499 steps per day - low active, 7,500- 9,999 steps per day, active, more than 10,000 steps per day - active, more than 12,500 steps per day - very active. The average of steps uploads to the system is also calculated.

2.6. Research ethics

The study complied with all current data protection policies, participants signed consent and agreed to participate in the study by creating personal accounts on the SIH website. Hence, ethical approval was granted by the Ministry of Public Health in Qatar through the Aspire Zone Foundation Institutional Review Board (AZF IRB) with the following registration and insurance numbers: MoPH Registration: IRB-AOSM-2020-007, MoPH Assurance: IRB-A-AOSM-2020-0036.

2.7. Results

Prevalence of physical activity amongst study population

The prevalence of physical activity for the study population was calculated for both groups control and experiment, while considering the pre, during, and post-intervention timings as well as the 5 different steps' categories.

In table 1, results show that the lowest physical activity prevalence is reported among the control group population in the category of more than 12,500 steps per day, considered a very active population, with the participation of 13 (9.5%) adults (figure 1). The highest reported prevalence of physical activity amongst the control group of adults specified in the post-intervention research stage, with several 34 adults (32.1%) (Figure 2) who achieved less than 5,000 steps per day - sedentary lifestyle index.

The experiment group displayed during the online messaging intervention an interesting increase in the participants' numbers, 39 (29.1%) adults positioned in the category of 5,000-7,499 steps per day - low active, compared to the pre-intervention period when only 31 (20.7%) adults were noticed, and 34 (28.3%) adults observed in the post-intervention period (figure 1).

Amongst the control group, the adults of 5,000 - 7,499 steps per day - low active category had decreasing participation in the walking program in all research stages: pre-intervention 39 adults (28.5%), during intervention 34 adults (27.4%) and after intervention 26 adults (24.5%) (figure 1).

Comparing the two groups (control and experiment), it is noticeable that, during the intervention stage of the research, the online messaging intervention had a positive impact on the adults of the experiment group with a low active lifestyle (5,000-7,499 steps per day) when they participated in a higher percentage in the walking program, although according to the national physical activity guidelines, their physical activity level is still low.

The category of active adults of the experiment group (more than 10,000 steps per day) those who meet the national recommendations, had a decreasing prevalence before intervention - 21 adults (14.0%), during - 18 adults (13.4%), and after intervention - 14 adults (11.7%) (figure 2), in contrast to the active adults from the control group which had an increasing evolution from one period of research to another (pre-intervention - 16 adults (11.7%), along the way - 17 adults (13.7%), postintervention - 19 adults (17.9%)) (figure 1). Hence, adults which have already understood the importance of regular physical activity and are already active can motivate themselves to maintain their physical activity, already being part of their lifestyle. It is important to mention here that the online messaging intervention took place under conditions and restrictions of the COVID-19 pandemic situation which impacted the participation of active adults from the experimental group to the extent of noticing a decrease in prevalence.

Daily walking becomes a regular physical activity among adults and offers significant health benefits. The literature mentions that a certain physical activity is better than its non-existence. By becoming more active during the day in simple ways, people can easily reach the recommended activity levels. When people are given opportunities to be active, they are more likely to increase their physical activity levels. [29]

The results demonstrate that both, the control group, and the experiment group had an important participation in the walking program when the population had the opportunity to become aware of the importance of regular physical activity for their health benefit. The results obtained by the research population as well as the participation in the walking program, while using steps measuring devices (mobile applications and pedometers) are ways to help the participants to understand their level of physical activity. These activities support the study population to have an effective assessment, as close as possible to reality, of their efforts to become or remain active, aiming to reach national recommendations for physical activity. [30]

Average steps per day amongst the study population

Regarding the results of the average daily steps, the control group had a lower average daily step in each research period (pre - 7644 + 425, during - 7866 + 417, post - 7639 + 398), in comparison with the experimental group (pre - 8154 + 403, during - 8128 + 395, post - 7754 + 377). Both groups fall into the category of 7,500-9,999 steps per day, somewhat active. The common denominator of the two groups is that in the post-intervention research period, both groups recorded the lowest average of steps per day (control - 7639 + 398 and experiment - 7754 + 377) (figure 3) which may be associated with the existence of wave 3 restrictions imposed by COVID-19 pandemic in Qatar.

Statistically, the results are insignificant for both groups. In terms of average steps per day, the p values don't show a significant result (Table 4, Table 5, Table 6), hence, the online messages did not influence the physical activity levels of the research population which was under COVID-19 restrictions conditions, although the participants registered an interest in participating in the walking program since they were keen to use step measuring devices during the research.

Table 3. The effect of the intervention on daily average steps of the study population from the 2 groups during the research periods (pre / during/ post-intervention)

Pairwise comparison results of Two-Way ANOVA test, differences between the groups on the average steps dependent variable

Average steps comparative analysis among pedometers and mobile applications users

Out of the total research population (299 adults), 180 used the mobile application, and 119 used pedometers throughout the research stages. Mobile app users were divided into control groups Which obtained the following average daily steps: pre-intervention 6505 + 524 steps, during intervention 6872 + 517 steps, and post-intervention 6710 + 491 steps; the experiment group attained pre-intervention 6875 + 524 steps, during intervention 6844 + 517 steps and post-intervention 6431 + 491 steps. Pedometer users were divided into control groups which obtained the following average daily steps: pre-intervention 9327 + 637 steps, during intervention 9334 + 628 steps, and postintervention 9012 + 597 steps; while the experiment group achieved pre-intervention 9622 + 562 steps, during intervention 9602 + 554 steps, and post-intervention 9272 + 526 steps (Table 7).

Mobile app users of both groups (the control group and the experiment group), positioned themselves in the low physical activity category (5,000-7,499 steps per day) throughout the research period (Figure 4).

The pedometers users of both groups (the control group and the experiment group), stood in the somewhat active physical activity category during the research period (7,500-9,999 steps per day) (Figure 5).

Compared to pedometers users (119 adults within somewhat active physical activity category of 7,500-9,999 steps per day), the mobile app users (180 adults within low physical activity category of 5,000-7,499 steps per day) are more numerous nevertheless, less active.

The experiment group of mobile app users displayed a continuous decrease in average steps attainment throughout all research periods (pre-intervention 6875 + 524 steps, during intervention 6844 + 517 steps, post-intervention 6431 + 491 steps), likewise for the experiment group of pedometer users (pre-intervention 9622 + 562 steps, during intervention 9602 + 554 steps, post-intervention 9272 + 526 steps).

Interestingly, the control group of mobile app users achieved slightly higher average steps per day during the intervention (6872 + 517 steps) compared to the experiment group of mobile users during the intervention (6844 + 517 steps) while the control group of pedometers users achieved slightly lower average steps per day during the intervention (9334 + 628 steps) compared to experiment group of pedometers users during the intervention (9602 + 554 steps), however in both cases the results did not demonstrate a significant statistical difference.

Statistically, the p-Values (Table 7) show that the results are insignificant for both, mobile phone users and pedometers users, for both, control, and experiment groups, highlighting that the online messages did not affect their physical activity levels. Overall, the study population prefers using the mobile application, while the physical activity levels are higher amongst those that are using pedometers as step measuring devices. The pedometer users are slightly influenced by online messages, yet not enough to obtain a statistically significant result.

Compared to existing scientific literature in the field, these results confirm that good weather, with cooler temperatures during the winter period in a desert climate, such as Qatar's seasons, motivates adults to keep a certain interest in performing walking as a form of physical activity. [31]

The study population, users of step measuring devices (pedometers and mobile apps) recorded a decrease in the average steps per day in the post-intervention period, which from a calendar point of view, results are associated with the restrictions implementation of 3" wave COVID-19 in Qatar. [32]

The study population's interest in participating in the walking program is meaningful since all of them were keen to use the steps measuring devices, to keep a track of their physical activity levels and report their achievements during the research period. The results obtained emphasize their motivation to sustain active lifestyle awareness. [33]

Ш. CONCLUSIONS

Qatar has many strategies and programs to promote physical activity among the population to increase awareness of regular physical activity and its benefits. Qatar's efforts in this direction are in line with global practices in the field.

The prevalence of physical activity findings amongst the study population supported hypothesis 1. SIH walking program engaged Qatar community adults (18-64 years) in regular walking as a form of physical activity. Participants stated an interest in making use of the steps measuring devices to report steps achievements during the entire research period helping them to understand their physical activity level. The online messaging intervention has a positive effect on the adults with a sedentary lifestyle index helping them to reach the low active lifestyle category (5,000-7,499 steps per day), through increased health benefits awareness. A walking program in Qatar that deploys a combination of online messaging intervention, use of steps measuring devices (mobile applications and pedometers), and implemented during cool weather in dessert climate, stimulates the population with a low physical activity level (5,000-7,499 steps per day) and provides sustenance to an active lifestyle enrichment.

The average steps per day amongst the study population reveals that the experiment group's participation in the walking program did not display statistically significant differences in regular engagement in physical activity compared to the control group hence hypothesis number 2 of this paper is not validated.

The restrictions of the COVID-19 pandemic hurt the physical activity levels of the research population hence hypothesis number 3 of this paper is not validated. During the end of intervention weeks and post-intervention research periods, both groups recorded the lowest average of steps per day (control - 7639 + 398 and experiment - 7754 + 377) (figure 3) when wave 3 restrictions of the COVID-19 pandemic were imposed. The restrictions execution on slowing the spread of COVID-19 virus in Qatar had priority amongst the study population since the online messaging intervention, statistically, did not increase physical activity levels.

Study limitations are: use of mobile applications limited the study population to continuously carry mobile phones in their hands or pockets; pedometers used in this research are devices developed in 2012 while the study took place in 2022; online messaging intervention took place in COVID-19 pandemic restrictions.

Implications and future research. The authors recommend that further studies shall be conducted to address the following: the type of step measuring devices used shall reflect the study population's preference; walking interventions shall make use of steps measuring devices at updated versions, in line with the available technology at the moment of intervention launch. Further online messaging interventions as part of walking programs shall be conducted outside COVID-19 pandemic restrictions.

Acknowledgements

The scientific work of this paper is carried out under the Doctoral School auspices of the National University of Physical Education and Sports in Bucharest.

References

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