The Utility and Limitations of Remotely Delivered Feedback Messages Regarding Physical Activity in a 12-Month Weight Loss Intervention: Insights From the SMARTER Trial Focus Groups

Kariuki J.K. Burke L.E. Zickmund S. Beatrice B. Kimball E.R. Galyean P. Cheng J. Sereika S.M. Bizhanova Z. Cedillo M. Wells J. Conroy M.B.
December 2025 Lippincott Williams and Wilkins

Journal of Cardiovascular Nursing
2025 #40 Issue 6 E313 - E319 pp.

Background – The increasing prevalence of obesity necessitates innovative interventions to address this grave public health concern. Standard behavioral therapy has been the mainstay for promoting weight loss, but its access and uptake are limited. The SMARTER randomized controlled trial aimed to explore the effects of self-monitoring with real-time, remotely delivered tailored feedback to recorded physical activity (PA) on weight loss. Objective – This qualitative study examined the perceived utility and limitations of key intervention components in promoting PA and weight loss in the SMARTER trial. Methods – Twenty-three participants who received feedback engaged in Zoom-based focus groups, providing insights into their interactions with the SMARTER app, Fitbit Charge 2 tracker, Aria II scale, and daily weighing. Participants perspectives on feedback messages, personalized app experiences, and the impact of daily weighing on mental health emerged, providing nuanced insights into the multifaceted nature of success. Results – Themes from the focus group emphasized the importance of tailoring feedback to individual preferences related to message timing, content, and engagement. The challenges that made the participants stop using the program as instructed included disappointment with not losing weight after several weeks of engagement, inability to open feedback messages within the 60-minute window, and environmental situations that prevented them from acting on the feedback received. Conclusion – These findings contribute to ongoing efforts geared toward refining interventions targeting PA and weight loss among individuals with obesity and provide important insights for future studies seeking to optimize the design and delivery of remotely delivered feedback messages. Copyright

cardiovascular system , exercise , mHealth , physical activity

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Associate Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
Professor Emerita, School of Nursing, University of Pittsburgh, PA, United States
Professor, Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, United States
Instructor, School of Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, United States
Research Analyst, Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, United States
Program Manager, Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, United States
Postdoctoral Fellow, Harvard T.H. Chan School of Public Health, Massachusetts General Hospital, Boston, United States
Professor, School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
Senior Teaching Faculty, School of Medicine and Healthcare, Al-Farabi Kazakh National University, Almaty, Kazakhstan
Senior Research Program Manager, Division of General Internal Medicine, University of Utah, Salt Lake City, United States
Associate Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
Professor, Department of Internal Medicine, Division of General Internal Medicine, University of Utah, Salt Lake City, United States

Associate Professor
Professor Emerita
Professor
Instructor
Research Analyst
Program Manager
Postdoctoral Fellow
Professor
Senior Teaching Faculty
Senior Research Program Manager
Associate Professor
Professor

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