The increase in activity levels is known to have numerous benefits to our health. Exercise, even at moderate intensity, plays an important role in the prevention of many diseases, including heart disease and diabetes.
Carron and Lewis Manning are two chartered physiotherapists with a huge amount of experience in the NHS, private practice and also elite sport. They developed iPrescribe Exercise, a free, evidence-based app which analyses the user's health and then produces a personalized 12-week physical activity program with a goal to help app users increase their activity levels, thus improving their health.
Can you tell us the story behind your mobile app? Where did the idea for your app come from? What served as your inspiration for the app?
As physiotherapists, we have got a huge amount of experience in prescribing physical activity for the prevention and management of non-communicable diseases whilst working with the patients we see every day. It was the realization that although people need an evidence-based graduated plan based on their individual circumstances and health conditions, this can be automated if we collect some of their current health data and we follow the current medical guidelines. We found that people became more engaged with a physical activity program if they were given the appropriate guiding information, but were able to make their own decisions about how and when they complete their program. We also recognized that much of the information about physical activity for health was being misinterpreted, exercise intensity does not always need to be high to get the most health benefit.
How did you build the content that's contained in the app? Does the information in your app come from evidence-based resources, such as scientific literature, peer-reviewed articles and case studies?
Before we started any app development, we spent a year researching the scientific and medical literature on physical activity for health. There is a huge volume of good quality evidence to support the use of physical activity as an intervention for chronic disease - sometimes with better effects than drugs. Peer-reviewed articles, RCT's and review papers really highlight the need to include prescribed exercise in the management of chronic health conditions. We also followed the current guidelines from the American College of Sports Medicine in their excellent publication 'Guidelines for Exercise Testing and Prescription', which is updated on a regular basis.
What impact has your app had on clinical practice so far? We'd appreciate if you could share some stats on how frequently your app is used worldwide.
Our app is being used around the world, and currently, 70% of our users are in the USA. Back at home, we have just been accepted onto the UK NHS Apps Library after an extensive application process.
What are the tools and technologies used to build your mobile app (both cloud- and client-side)? Was it native or cross-platform development? Did you consider other technologies?
We decided to develop for iOS in the first instance. As we were self-funding the app, we had to choose one platform to build a viable prototype on, be able to test the app both clinically and from a usability point of view, and most importantly show the product to the medical community to get their feedback. Our next priority is to develop an Android version of iPrescribe Exercise.
What were the main challenges you had to overcome when developing your app? Could you please single out the biggest technical challenges, product challenges, marketing challenges, and support challenges?
Our biggest challenge was having a non-technical background. We knew exactly what we wanted to achieve clinically, but we then had to translate that digitally. It has been a huge learning experience! It has also been challenging speaking with people in the corporate world - their digital priorities are quite different. There is often a focus on monetization rather than real-world impact. On the contrary, we absolutely love to speak with healthcare professionals about what we have done as we are confident about the way we have developed the app - it is 100% evidence-based.
Could you single out the 3 biggest mistakes you made when developing the 'iPrescribe Exercise' app?
1. We should have added more user feedback options (e.g. graphs to show the effect on health/fitness data).
2. We should have considered a hybrid development for Android.
3. We should have recruited a technical co-founder at the start of the process.
When it comes to medical apps, sooner or later the issue of data protection and security always comes up. How do you make sure that user data is secure?
On iPrescribe Exercise, data is only stored on the user's device - we do not have access to the user's data at all. If the user wishes, they can extract all of their health and fitness data as a form and email it to their healthcare professional directly from the app.
What's next for your app? Are there any new features, functionalities, or upgrades planned for future updates?
We hope to develop an Android version very shortly - it is something we get asked for on almost a daily basis. We are also planning to create a platform for healthcare professionals to securely view their patient's data.
We will be adding greater functionality, more exercise options and generally making the app more user-friendly.
From an evidence point of view, we check for new updates to the physical activity medical literature on a daily basis - if the evidence changes, we have the capacity to change our app as and when required.
We are excited about the technologies and what they might hold for the healthcare and the future of medicine. What do you think this technology-driven, human-centered future holds for mobile health and how do your app plan to contribute?
Medicine and exercise lend itself well to use a combination of human skill, experience, personal empathy and creative thinking with the raw power of technology.
Automated systems are having increasing success at reducing the errors made in medicine. They can immediately analyze the full spectrum of research available along with the person’s full medical and family history and suggest potential diagnoses, which are then tested by the clinician.
Could you share some word of advice with other mobile app developers? What steps they should follow in order to make a successful app?
As clinicians, we feel that healthcare professionals should be involved in every step of the process when developing medical apps. The app should always fulfill a clinical need, we shouldn't develop things just for the sake of it! We understand the challenges that many healthcare practitioners face - there is a huge amount of work to be done and often not enough time - technology should exist to improve the patient experience and clinical outcome, and its adoption in healthcare will be improved if this becomes a seamless experience.
We are lucky enough to know this area well, we have been prescribing exercise for many years and we are passionate about using physical activity to improve health.