Trained as a sport scientist in Germany my research primarily focuses on e- & mHealth physical activity and sedentary behavior interventions. During my PhD I developed, implemented and evaluated an mHealth exercise intervention targeting older adults in multi-ethnic Malaysia. As a postdoctoral research fellow at the University of Southampton, UK, I increased my skills in digital-health intervention development and gained expertise in qualitative research. With this, I have a strong background and interest in technology-driven behavioural health research in diverse populations (older adults and culturally diverse people). Due to my strong collaborative ties with colleagues from various regions I am fortunate to be able to support the development of respective research initiatives in upper- and lower-middle income countries. Currently, I am a research fellow at the Saw Swee Hock School of Public Health, National University of Singapore. Here, I investigate the determinants of physical activity and sedentary behaviour in Asian populations to inform the development of (e- & mHealth) interventions. As a committee member of the e- & mHealth Special Interest Group affiliated to the International Society of Behavioural Nutrition and Physical Activity (ISBNPA) I also contribute meaningfully to various efforts to progress the field.
Low physical activity and high sedentary behavior in older adults can be addressed with intervent... more Low physical activity and high sedentary behavior in older adults can be addressed with interventions that are delivered through modern technology. Just-In-Time Adaptive Interventions (JITAIs) are an emerging technology-driven behavior-change intervention type and capitalize on data that is collected via mobile sensing technology (e.g., smartphones) to trigger appropriate support in real-life. In this paper we integrated behavior change and aging theory and research as well as knowledge around older adult's technology use to conceptualize a JITAI targeting the reduction of sedentary behavior in older adults. The JITAIs ultimate goal is to encourage older adults to take regular activity breaks from prolonged sitting. As a proximal outcome, we suggest the number of daily activity breaks from sitting. Support provided to interrupt sitting time can be based on tailoring variables: (I) the current accumulated sitting time; (II) the location of the individual; (III) the time of the day; (IV) the frequency of daily support prompts; and (V) the response to previous support prompts. Data on these variables can be collected using sensors that are commonly inbuilt into smartphones (e.g., accelerometer, GPS). Support prompts might be best delivered via traditional text messages as older adults are usually familiar and comfortable with this function. The content of the prompts should encourage breaks from prolonged sitting by highlighting immediate benefits of sitting time interruptions. Additionally, light physical activities that could be done during the breaks should also be presented (e.g., walking into the kitchen to prepare a cup of tea). Although the conceptualized JITAI can be developed and implemented to test its efficacy, more work is required to identify ways to collect, aggregate, organize and immediately use dense data on the proposed and other potentially important tailoring variables. Machine learning and other computational modelling techniques commonly used by computer scientists and engineers appear promising. With this, to develop powerful JITAIs and to actualize the full potential of modern sensing technologies transdisciplinary approaches are required
Multiethnic Malaysia provides a unique case study of divergence in population aging of different ... more Multiethnic Malaysia provides a unique case study of divergence in population aging of different sociocultural subgroups within a country. Malaysia represents 3 major ethnicities in Asia—the Malay, Chinese, and Indian. The 3 ethnic groups are at different stages of population aging, as they have undergone demographic transition at different pace amidst rapid social and economic changes. Between 1991 and 2010, the Malaysian population aged 60 and over has more than doubled from about 1 million to 2.2 million, and this is projected to rise to about 7 million or 17.6% of the projected population of 40 million by 2040. In 2010, the aging index ranged from 22.8% among the Bumiputera (Malays and other indigenous groups), to 31.4% among the Indians and 55.0% among the Chinese. Population aging provides great challenges for Malaysia’s social and economic development. The increasing prevalence of noncommunicable diseases in older adults, coupled with the erosion of the traditional family support system has increased demands on health care services with an overwhelming need for multidisciplinary and specialized geriatric care. Following the adoption of the National Policy for the Elderly in 1995, issues of population aging have gained increasing attention, especially among researchers. There is an urgent need to increase public awareness, develop infrastructure, as well as support action oriented research that will directly translate to comprehensive and cohesive social strategies, policies, and legislation to protect not just the current older Malaysians but the future of all Malaysians.
Overweight and obese populations in Asia are high and increasing rapidly. Physical ac... more Overweight and obese populations in Asia are high and increasing rapidly. Physical activity prevalence studies have found low physical activity rates among Asian school-age children and adolescents. The purpose of this review is to establish a baseline for physical activity rates in Asian school-age children and adolescents and serve as a platform for additional research. Thirty articles published between 2000 and 2011 on physical activity prevalence of school-age children and adolescents were included in the review. Fourteen studies were conducted in East Asia, 10 in Southeast Asia, 2 in South Asia, and 2 in West Asia. Studies used subjective methods (questionnaires or diaries) and objective methods (accelerometers or heart rate monitors). Although nearly all studies found low physical activity levels, it was not possible to provide an accurate picture due to an absence of standardized, reliable, and economically viable measurement tools.
Physical activity and aging research has burgeoned in the past few decades. However, despite the ... more Physical activity and aging research has burgeoned in the past few decades. However, despite the increase in scholarly publications, no attempts have been made to summarize the publication landscape and identify work that has had great impact on physical activity and aging research. We conducted a bibliometric analysis and collected publication data from 1980 to February 6, 2015, in the Web of Science Core Collection. Of 9.935 publications, most were published after 2007 and almost 60% were in the category of geriatrics and gerontology or sport sciences. Highly cited publications (.n = 45) were mostly authored by researchers from US institutions and were quantitative in nature. Publications that reported on the associations between physical activity and health, or effects of physical activity on health, in older adults made up 60% of the highly cited publications. We expect more scholars from various backgrounds and geographical regions to join the conversation on physical activity and aging.
Physical activity promotes health in children and adolescents, but activity levels are low. The
I... more Physical activity promotes health in children and adolescents, but activity levels are low. The Internet offers opportunities for physical activity interventions because children and adolescents are widely exposed to the web and enjoy being online. This review investigated the success of Internet-based interventions designed to increase physical activity in children and adolescents. Of the 13 studies we included, five reported that Internet-based interventions had significant effects on most physical activities. Conclusion: Internet-based physical activity interventions in children and adolescents are potentially successful, but interdisciplinary, child-centred collaboration is needed to design interventions that align with their Internet experiences and preferences.
Because physical inactivity and unhealthy diets are highly prevalent, there is a need for cost-ef... more Because physical inactivity and unhealthy diets are highly prevalent, there is a need for cost-effective interventions that can reach large populations. Electronic health (eHealth) and mobile health (mHealth) solutions have shown promising outcomes and have expanded rapidly in the past decade. The purpose of this report is to provide an overview of the state of the evidence for the use of eHealth and mHealth in improving physical activity and nutrition behaviors in general and special populations. The role of theory in eHealth and mHealth interventions is addressed, as are methodological issues. Key recommendations for future research in the field of eHealth and mHealth are provided.
Non-communicable diseases (NCDs) such as
diabetes and cardio-vascular diseases are a serious
glob... more Non-communicable diseases (NCDs) such as diabetes and cardio-vascular diseases are a serious global health problem of modern times. The burden is especially high in developing countries which account for more than 80% of NCD-related deaths (Lozano et al., 2012). With this NCDs are slowly but surely outgrowing infectious diseases in terms of its impacts on morbidity and mortality in developing countries. These are grim facts, but fortunately the answer to the question of how to deal with the NCD epidemic is already well established in the research literature and beyond: Live a healthy life – which most commonly translates to get active and eat healthily (Sallis et al., 2016; World Health Organization, 2014). And this is where the problem lies. Rapid urbanisation and development made many forms of work- and travel-related physical activity unnecessary for many people living in developing countries (Lachat et al., 2013). Additionally, healthy local foods are increasingly replaced by processed foods high in salt, sugar and fat (Baker & Friel, 2014). In light of the struggles of fragmented and under resourced health-care systems that cannot cope with the increasing burden of NCDs, interventions that promote healthy lifestyles are urgently needed.
Physical activity is effective in preventing chronic diseases, increasing quality of life and pro... more Physical activity is effective in preventing chronic diseases, increasing quality of life and promoting general health in older adults, but most older adults are not sufficiently active to gain those benefits. A novel and economically viable way to promote physical activity in older adults is through non-face-to-face interventions. These are conducted with reduced or no in-person interaction between intervention provider and program participants. The aim of this review was to summarize the scientific literature on non-face-to-face physical activity interventions targeting healthy, community dwelling older adults (≥ 50 years). A systematic search in six databases was conducted by combining multiple key words of the three main search categories " physical activity " , " media " and " older adults ". The search was restricted to English language articles published between 1 st January 2000 and 31 st May 2013. Reference lists of relevant articles were screened for additional publications. Seventeen articles describing sixteen non-face-to-face physical activity interventions were included in the review. All studies were conducted in developed countries, and eleven were randomized controlled trials. Sample size ranged from 31 to 2503 participants, and 13 studies included 60% or more women. Interventions were most frequently delivered via print materials and phone (n = 11), compared to internet (n = 3) and other media (n = 2). Every intervention was theoretically framed with the Social Cognitive Theory (n = 10) and the Transtheoretical Model of Behavior Change (n = 6) applied mostly. Individual tailoring was reported in 15 studies. Physical activity levels were self-assessed in all studies. Fourteen studies reported significant increase in physical activity. Eight out of nine studies conducted post-intervention follow-up analysis found that physical activity was maintained over a longer time. In the six studies where intervention dose was assessed the results varied considerably. One study reported that 98% of the sample read the respective intervention newsletters, whereas another study found that only 4% of its participants visited the intervention website more than once. From this review, non-face-to-face physical activity interventions effectively promote physical activity in older adults. Future research should target diverse older adult populations in multiple regions while also exploring the potential of emerging technologies.
Background: Mobile technology to promote exercise is effective; however, most evidence is from st... more Background: Mobile technology to promote exercise is effective; however, most evidence is from studies of younger groups in high-income countries. Investigating if short message service (SMS) texting can affect exercise participation in older adults from an upper-middle-income country is important considering the proliferation of mobile phones in developing regions and the increased interest of older adults in using mobile phones.
Background: Promoting physical activity and healthy eating is important to combat the unprecedent... more Background: Promoting physical activity and healthy eating is important to combat the unprecedented rise in NCDs in many developing countries. Using modern information-and communication technologies to deliver physical activity and diet interventions is particularly promising considering the increased proliferation of such technologies in many developing countries. The objective of this systematic review is to investigate the effectiveness of e-& mHealth interventions to promote physical activity and healthy diets in developing countries. Methods: Major databases and grey literature sources were searched to retrieve studies that quantitatively examined the effectiveness of e-& mHealth interventions on physical activity and diet outcomes in developing countries. Additional studies were retrieved through citation alerts and scientific social media allowing study inclusion until August 2016. The CONSORT checklist was used to assess the risk of bias of the included studies.
Low physical activity and high sedentary behavior in older adults can be addressed with intervent... more Low physical activity and high sedentary behavior in older adults can be addressed with interventions that are delivered through modern technology. Just-In-Time Adaptive Interventions (JITAIs) are an emerging technology-driven behavior-change intervention type and capitalize on data that is collected via mobile sensing technology (e.g., smartphones) to trigger appropriate support in real-life. In this paper we integrated behavior change and aging theory and research as well as knowledge around older adult's technology use to conceptualize a JITAI targeting the reduction of sedentary behavior in older adults. The JITAIs ultimate goal is to encourage older adults to take regular activity breaks from prolonged sitting. As a proximal outcome, we suggest the number of daily activity breaks from sitting. Support provided to interrupt sitting time can be based on tailoring variables: (I) the current accumulated sitting time; (II) the location of the individual; (III) the time of the day; (IV) the frequency of daily support prompts; and (V) the response to previous support prompts. Data on these variables can be collected using sensors that are commonly inbuilt into smartphones (e.g., accelerometer, GPS). Support prompts might be best delivered via traditional text messages as older adults are usually familiar and comfortable with this function. The content of the prompts should encourage breaks from prolonged sitting by highlighting immediate benefits of sitting time interruptions. Additionally, light physical activities that could be done during the breaks should also be presented (e.g., walking into the kitchen to prepare a cup of tea). Although the conceptualized JITAI can be developed and implemented to test its efficacy, more work is required to identify ways to collect, aggregate, organize and immediately use dense data on the proposed and other potentially important tailoring variables. Machine learning and other computational modelling techniques commonly used by computer scientists and engineers appear promising. With this, to develop powerful JITAIs and to actualize the full potential of modern sensing technologies transdisciplinary approaches are required
Multiethnic Malaysia provides a unique case study of divergence in population aging of different ... more Multiethnic Malaysia provides a unique case study of divergence in population aging of different sociocultural subgroups within a country. Malaysia represents 3 major ethnicities in Asia—the Malay, Chinese, and Indian. The 3 ethnic groups are at different stages of population aging, as they have undergone demographic transition at different pace amidst rapid social and economic changes. Between 1991 and 2010, the Malaysian population aged 60 and over has more than doubled from about 1 million to 2.2 million, and this is projected to rise to about 7 million or 17.6% of the projected population of 40 million by 2040. In 2010, the aging index ranged from 22.8% among the Bumiputera (Malays and other indigenous groups), to 31.4% among the Indians and 55.0% among the Chinese. Population aging provides great challenges for Malaysia’s social and economic development. The increasing prevalence of noncommunicable diseases in older adults, coupled with the erosion of the traditional family support system has increased demands on health care services with an overwhelming need for multidisciplinary and specialized geriatric care. Following the adoption of the National Policy for the Elderly in 1995, issues of population aging have gained increasing attention, especially among researchers. There is an urgent need to increase public awareness, develop infrastructure, as well as support action oriented research that will directly translate to comprehensive and cohesive social strategies, policies, and legislation to protect not just the current older Malaysians but the future of all Malaysians.
Overweight and obese populations in Asia are high and increasing rapidly. Physical ac... more Overweight and obese populations in Asia are high and increasing rapidly. Physical activity prevalence studies have found low physical activity rates among Asian school-age children and adolescents. The purpose of this review is to establish a baseline for physical activity rates in Asian school-age children and adolescents and serve as a platform for additional research. Thirty articles published between 2000 and 2011 on physical activity prevalence of school-age children and adolescents were included in the review. Fourteen studies were conducted in East Asia, 10 in Southeast Asia, 2 in South Asia, and 2 in West Asia. Studies used subjective methods (questionnaires or diaries) and objective methods (accelerometers or heart rate monitors). Although nearly all studies found low physical activity levels, it was not possible to provide an accurate picture due to an absence of standardized, reliable, and economically viable measurement tools.
Physical activity and aging research has burgeoned in the past few decades. However, despite the ... more Physical activity and aging research has burgeoned in the past few decades. However, despite the increase in scholarly publications, no attempts have been made to summarize the publication landscape and identify work that has had great impact on physical activity and aging research. We conducted a bibliometric analysis and collected publication data from 1980 to February 6, 2015, in the Web of Science Core Collection. Of 9.935 publications, most were published after 2007 and almost 60% were in the category of geriatrics and gerontology or sport sciences. Highly cited publications (.n = 45) were mostly authored by researchers from US institutions and were quantitative in nature. Publications that reported on the associations between physical activity and health, or effects of physical activity on health, in older adults made up 60% of the highly cited publications. We expect more scholars from various backgrounds and geographical regions to join the conversation on physical activity and aging.
Physical activity promotes health in children and adolescents, but activity levels are low. The
I... more Physical activity promotes health in children and adolescents, but activity levels are low. The Internet offers opportunities for physical activity interventions because children and adolescents are widely exposed to the web and enjoy being online. This review investigated the success of Internet-based interventions designed to increase physical activity in children and adolescents. Of the 13 studies we included, five reported that Internet-based interventions had significant effects on most physical activities. Conclusion: Internet-based physical activity interventions in children and adolescents are potentially successful, but interdisciplinary, child-centred collaboration is needed to design interventions that align with their Internet experiences and preferences.
Because physical inactivity and unhealthy diets are highly prevalent, there is a need for cost-ef... more Because physical inactivity and unhealthy diets are highly prevalent, there is a need for cost-effective interventions that can reach large populations. Electronic health (eHealth) and mobile health (mHealth) solutions have shown promising outcomes and have expanded rapidly in the past decade. The purpose of this report is to provide an overview of the state of the evidence for the use of eHealth and mHealth in improving physical activity and nutrition behaviors in general and special populations. The role of theory in eHealth and mHealth interventions is addressed, as are methodological issues. Key recommendations for future research in the field of eHealth and mHealth are provided.
Non-communicable diseases (NCDs) such as
diabetes and cardio-vascular diseases are a serious
glob... more Non-communicable diseases (NCDs) such as diabetes and cardio-vascular diseases are a serious global health problem of modern times. The burden is especially high in developing countries which account for more than 80% of NCD-related deaths (Lozano et al., 2012). With this NCDs are slowly but surely outgrowing infectious diseases in terms of its impacts on morbidity and mortality in developing countries. These are grim facts, but fortunately the answer to the question of how to deal with the NCD epidemic is already well established in the research literature and beyond: Live a healthy life – which most commonly translates to get active and eat healthily (Sallis et al., 2016; World Health Organization, 2014). And this is where the problem lies. Rapid urbanisation and development made many forms of work- and travel-related physical activity unnecessary for many people living in developing countries (Lachat et al., 2013). Additionally, healthy local foods are increasingly replaced by processed foods high in salt, sugar and fat (Baker & Friel, 2014). In light of the struggles of fragmented and under resourced health-care systems that cannot cope with the increasing burden of NCDs, interventions that promote healthy lifestyles are urgently needed.
Physical activity is effective in preventing chronic diseases, increasing quality of life and pro... more Physical activity is effective in preventing chronic diseases, increasing quality of life and promoting general health in older adults, but most older adults are not sufficiently active to gain those benefits. A novel and economically viable way to promote physical activity in older adults is through non-face-to-face interventions. These are conducted with reduced or no in-person interaction between intervention provider and program participants. The aim of this review was to summarize the scientific literature on non-face-to-face physical activity interventions targeting healthy, community dwelling older adults (≥ 50 years). A systematic search in six databases was conducted by combining multiple key words of the three main search categories " physical activity " , " media " and " older adults ". The search was restricted to English language articles published between 1 st January 2000 and 31 st May 2013. Reference lists of relevant articles were screened for additional publications. Seventeen articles describing sixteen non-face-to-face physical activity interventions were included in the review. All studies were conducted in developed countries, and eleven were randomized controlled trials. Sample size ranged from 31 to 2503 participants, and 13 studies included 60% or more women. Interventions were most frequently delivered via print materials and phone (n = 11), compared to internet (n = 3) and other media (n = 2). Every intervention was theoretically framed with the Social Cognitive Theory (n = 10) and the Transtheoretical Model of Behavior Change (n = 6) applied mostly. Individual tailoring was reported in 15 studies. Physical activity levels were self-assessed in all studies. Fourteen studies reported significant increase in physical activity. Eight out of nine studies conducted post-intervention follow-up analysis found that physical activity was maintained over a longer time. In the six studies where intervention dose was assessed the results varied considerably. One study reported that 98% of the sample read the respective intervention newsletters, whereas another study found that only 4% of its participants visited the intervention website more than once. From this review, non-face-to-face physical activity interventions effectively promote physical activity in older adults. Future research should target diverse older adult populations in multiple regions while also exploring the potential of emerging technologies.
Background: Mobile technology to promote exercise is effective; however, most evidence is from st... more Background: Mobile technology to promote exercise is effective; however, most evidence is from studies of younger groups in high-income countries. Investigating if short message service (SMS) texting can affect exercise participation in older adults from an upper-middle-income country is important considering the proliferation of mobile phones in developing regions and the increased interest of older adults in using mobile phones.
Background: Promoting physical activity and healthy eating is important to combat the unprecedent... more Background: Promoting physical activity and healthy eating is important to combat the unprecedented rise in NCDs in many developing countries. Using modern information-and communication technologies to deliver physical activity and diet interventions is particularly promising considering the increased proliferation of such technologies in many developing countries. The objective of this systematic review is to investigate the effectiveness of e-& mHealth interventions to promote physical activity and healthy diets in developing countries. Methods: Major databases and grey literature sources were searched to retrieve studies that quantitatively examined the effectiveness of e-& mHealth interventions on physical activity and diet outcomes in developing countries. Additional studies were retrieved through citation alerts and scientific social media allowing study inclusion until August 2016. The CONSORT checklist was used to assess the risk of bias of the included studies.
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Papers by Andre M Müller
prevalence studies have found low physical activity rates among Asian school-age children and
adolescents. The purpose of this review is to establish a baseline for physical activity rates
in Asian school-age children and adolescents and serve as a platform for additional research.
Thirty articles published between 2000 and 2011 on physical activity prevalence of school-age
children and adolescents were included in the review. Fourteen studies were conducted in
East Asia, 10 in Southeast Asia, 2 in South Asia, and 2 in West Asia. Studies used subjective
methods (questionnaires or diaries) and objective methods (accelerometers or heart rate
monitors). Although nearly all studies found low physical activity levels, it was not possible to
provide an accurate picture due to an absence of standardized, reliable, and economically viable
measurement tools.
have been made to summarize the publication landscape and identify work that has had great impact on physical activity and aging research.
We conducted a bibliometric analysis and collected publication data from 1980 to February 6, 2015, in the Web of Science Core Collection.
Of 9.935 publications, most were published after 2007 and almost 60% were in the category of geriatrics and gerontology or sport sciences.
Highly cited publications (.n = 45) were mostly authored by researchers from US institutions and were quantitative in nature. Publications that
reported on the associations between physical activity and health, or effects of physical activity on health, in older adults made up 60% of the
highly cited publications. We expect more scholars from various backgrounds and geographical regions to join the conversation on physical
activity and aging.
Internet offers opportunities for physical activity interventions because children and
adolescents are widely exposed to the web and enjoy being online. This review
investigated the success of Internet-based interventions designed to increase physical
activity in children and adolescents. Of the 13 studies we included, five reported that
Internet-based interventions had significant effects on most physical activities.
Conclusion: Internet-based physical activity interventions in children and adolescents are
potentially successful, but interdisciplinary, child-centred collaboration is needed to design
interventions that align with their Internet experiences and preferences.
diabetes and cardio-vascular diseases are a serious
global health problem of modern times. The burden
is especially high in developing countries which
account for more than 80% of NCD-related deaths
(Lozano et al., 2012). With this NCDs are slowly but
surely outgrowing infectious diseases in terms of
its impacts on morbidity and mortality in
developing countries. These are grim facts, but
fortunately the answer to the question of how to
deal with the NCD epidemic is already well
established in the research literature and beyond:
Live a healthy life – which most commonly
translates to get active and eat healthily (Sallis et
al., 2016; World Health Organization, 2014). And
this is where the problem lies. Rapid urbanisation
and development made many forms of work- and
travel-related physical activity unnecessary for
many people living in developing countries (Lachat
et al., 2013). Additionally, healthy local foods are
increasingly replaced by processed foods high in
salt, sugar and fat (Baker & Friel, 2014). In light of
the struggles of fragmented and under resourced
health-care systems that cannot cope with the
increasing burden of NCDs, interventions that
promote healthy lifestyles are urgently needed.
prevalence studies have found low physical activity rates among Asian school-age children and
adolescents. The purpose of this review is to establish a baseline for physical activity rates
in Asian school-age children and adolescents and serve as a platform for additional research.
Thirty articles published between 2000 and 2011 on physical activity prevalence of school-age
children and adolescents were included in the review. Fourteen studies were conducted in
East Asia, 10 in Southeast Asia, 2 in South Asia, and 2 in West Asia. Studies used subjective
methods (questionnaires or diaries) and objective methods (accelerometers or heart rate
monitors). Although nearly all studies found low physical activity levels, it was not possible to
provide an accurate picture due to an absence of standardized, reliable, and economically viable
measurement tools.
have been made to summarize the publication landscape and identify work that has had great impact on physical activity and aging research.
We conducted a bibliometric analysis and collected publication data from 1980 to February 6, 2015, in the Web of Science Core Collection.
Of 9.935 publications, most were published after 2007 and almost 60% were in the category of geriatrics and gerontology or sport sciences.
Highly cited publications (.n = 45) were mostly authored by researchers from US institutions and were quantitative in nature. Publications that
reported on the associations between physical activity and health, or effects of physical activity on health, in older adults made up 60% of the
highly cited publications. We expect more scholars from various backgrounds and geographical regions to join the conversation on physical
activity and aging.
Internet offers opportunities for physical activity interventions because children and
adolescents are widely exposed to the web and enjoy being online. This review
investigated the success of Internet-based interventions designed to increase physical
activity in children and adolescents. Of the 13 studies we included, five reported that
Internet-based interventions had significant effects on most physical activities.
Conclusion: Internet-based physical activity interventions in children and adolescents are
potentially successful, but interdisciplinary, child-centred collaboration is needed to design
interventions that align with their Internet experiences and preferences.
diabetes and cardio-vascular diseases are a serious
global health problem of modern times. The burden
is especially high in developing countries which
account for more than 80% of NCD-related deaths
(Lozano et al., 2012). With this NCDs are slowly but
surely outgrowing infectious diseases in terms of
its impacts on morbidity and mortality in
developing countries. These are grim facts, but
fortunately the answer to the question of how to
deal with the NCD epidemic is already well
established in the research literature and beyond:
Live a healthy life – which most commonly
translates to get active and eat healthily (Sallis et
al., 2016; World Health Organization, 2014). And
this is where the problem lies. Rapid urbanisation
and development made many forms of work- and
travel-related physical activity unnecessary for
many people living in developing countries (Lachat
et al., 2013). Additionally, healthy local foods are
increasingly replaced by processed foods high in
salt, sugar and fat (Baker & Friel, 2014). In light of
the struggles of fragmented and under resourced
health-care systems that cannot cope with the
increasing burden of NCDs, interventions that
promote healthy lifestyles are urgently needed.