Content uploaded by Alessandro Gabbiadini
Author content
All content in this area was uploaded by Alessandro Gabbiadini on Jun 28, 2018
Content may be subject to copyright.
The Journal of Sports Medicine and Physical Fitness
EDIZIONI MINERVA MEDICA
ARTICLE ONLINE FIRST
This provisional PDF corresponds to the article as it appeared upon acceptance.
A copyedited and fully formatted version will be made available soon.
The final version may contain major or minor changes.
Subscription: Information about subscribing to Minerva Medica journals is online at:
http://www.minervamedica.it/en/how-to-order-journals.php
Reprints and permissions: For information about reprints and permissions send an email to:
journals.dept@minervamedica.it - journals2.dept@minervamedica.it - journals6.dept@minervamedica.it
EDIZIONI MINERVA MEDICA
Fitness mobile apps positively affect attitudes, perceived
behavioral control and physical activities
Alessandro GABBIADINI, Tobias GREITEMEYER
The Journal of Sports Medicine and Physical Fitness 2018 Apr 04
DOI: 10.23736/S0022-4707.18.08260-9
Article type: Original Article
© 2018 EDIZIONI MINERVA MEDICA
Article first published online: April 04, 2018
Manuscript accepted: March 9, 2018
Manuscript revised: February 13, 2018
Manuscript received: October 10, 2017
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
1
Fitness mobile apps positively affect attitudes, perceived behavioral control and physical
activities
Alessandro Gabbiadini1*, Tobias Greitemeyer2
1Department of Psychology, University of Milano Bicocca, Milano, Italy; 2Department of
Psychology, University of Innsbruck, Innsbruck, Austria.
Corresponding Author
Alessandro Gabbiadini,
Department of Psychology,
University of Milano-Bicocca,
Piazza Ateneo Nuovo, 1, 20126 – Milano, Italy.
E-mail: ale.gabbiadini@gmail.com
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
2
ABSTRACT
BACKGROUND. Recent studies suggest that about 6 out of 10 users have installed a fitness
tracking application on their smartphone. Nevertheless, more than 59% of adults do not engage in
sufficient daily physical activity and much remains unknown with regard to the effectiveness of
mobile applications. By adopting the Theory of Planned Behavior, we tested whether the use of
fitness apps for daily steps tracking could positively influence people’s health behavior.
METHODS. Participants (N = 78) were randomly assigned to one of two experimental conditions;
in one condition, they were asked to adopt a fitness app for two weeks. No information regarding
mobile apps was given for participants in the control condition. In order to test the effects of using a
fitness app, a series of two-way mixed ANOVAs were conducted.
RESULTS. Participants in the experimental condition reported more favorable attitudes in the post-
test compared to the pre-test, t(43)=4.09, p < .001, d = 0.50. By contrast, in the control condition,
the difference on attitudes between pre-test and post-test was not significant (p = 1.00). They also
reported higher perceived behavioral control (PBC) scores, t(43) = 4.97, p < .001, d = 0.76,
whereas the difference on PBC for the control condition was not significant (p = .27). Participants
who used a fitness app reported to have walked more in the post-test compared to the pre-test, t(43)
= 2.41, p = .02, d = 0.87, whereas self-reported behavior did not change for participants in the
control condition (p = .46).
CONCLUSIONS. The present study provides encouraging evidence for the positive effects of
using a fitness-tracking app in promoting health behavior.
Key words: Fitness mobile apps, attitudes toward physical activities, Theory of Planned behavior
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
3
Introduction
Mobile devices have revolutionized the way people communicate. In recent years, we have seen a
steady growth in mobile device development and wearable connected devices. During the last three
years, the number of mobile apps for health monitoring has reached more than 100.000 units
available in the virtual stores 1. One recent study 2 reported that 58% of all smartphone users have
downloaded a health-related app and Google’s data indicate that the global healthcare-fitness
mobile app market will be worth about $26 billion by 2017.
These applications represent an expression of the so-called “Quantified Self”, that is, the
ability to self-monitor aspects of a person's daily life, also known as lifelogging 3. However, despite
their high popularity, there is little research about their effectiveness 2 4 5. A study on the effect of
mobile technology for promoting healthy behaviors was conducted by Fjeldsoe and colleagues 6
who developed an SMS-based intervention to increase physical activity in post-natal mothers. In
another recent study 7 Kirwan and colleagues measured the effectiveness of a smartphone
application (i.e., iStepLog) to improve health behaviors in existing members of an online physical
activity program (i.e., 10.000 Steps online program). The authors addressed the effect of a mobile
logging app on self-monitoring and examined the relationship between the perceived usefulness and
usability of the application and its actual use. However, both studies investigated mobile
technologies that are far distant from the features offered by modern fitness apps. Indeed, modern
smartphones make use of sensors to detect body movements and this peculiarity has allowed the
development of mobile apps targeting health improvement whose goal is to promote physical well-
being.
In the present research, we address the effectiveness of modern mobile fitness apps in
actually changing people’s attitudes toward physical activities to pursue health improvement.
Attitudes are woven into the fabric of daily life and they are defined as “a psychological tendency
that is expressed by evaluating a particular entity with some degree of favor or disfavor” 8. People
register an immediate and automatic reaction towards everything they encounter but attitudes can be
changed by imparting new information 8. In this regard, media messages are built on the premise
that behavior follows attitude, and attitude can be influenced with the right message delivered in the
right way 9.
Many theoretical models attempt to explain the relationship between attitudes and specific
behaviors. Perhaps the most important is the Theory of Planned Behavior (TPB) 10, which has been
shown to predict health-related behavioral intention 11 in various health-related fields 12. According
to this theoretical model, intentions are the proximal determinant of behavior, with intentions being
influenced by three factors: attitudes, subjective norm, and perceived behavioral control. The
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
4
attitude component refers to the individual’s attitude toward the behavior—whether the person
thinks that performing the behavior is good or bad. Subjective norm refers to people’s beliefs about
how other people who are important to them view the relevant behavior. People’s intention is also
influenced by whether they feel they can perform the behavior. This is captured by the concept of
perceived behavioral control (PBC). Finally, PBC is proposed to also have a direct impact on
behavior. Following the TPB theoretical framework, individuals will be successful in performing a
specific behavior if they have sufficient control over internal and external factors that influence the
behavioral goal success 13. Recently, Zhao and colleagues 14 conducted a comprehensive meta-
analysis of 23 studies on health behavior change using mobile phone apps published between 2010
and 2015 and the TPB has been found to be the most adopted theory.
Adopting a fitness app for fitness (i.e., a mobile app for monitoring the number of daily
steps) could provide individuals with more information about their goals, fostering a more positive
attitude toward physical activity. Previous research has shown that making people self-aware
promotes consistency between attitudes and behavior 15 16. Indeed, having a positive attitude toward
exercise represents one relevant predictor of the adoption of an active lifestyle 17 18.
Attitudes have been already found to predict the use of mobile apps in several domains (e.g.,
e-business research) 19. However, most of these studies focus on attitudes as a predictor of the
adoption of a mobile technology, whereas the effects of using mobile apps on attitude change are
still unexplored.
Our study represents an attempt to investigate the effects of mobile apps in the specific
domain of healthy behaviors. We assumed that making people self-conscious by adopting a
smartphone app for tracking physical activities could enhance their positive attitude toward physical
activities and their life-style. Under the assumptions of the TPB, in a single-blind experiment, we
tested whether the daily use of fitness mobile applications for daily steps tracking could positively
affect attitudes toward physical activities as well as subjective norm, PBC, intention, and behavior.
In our study, participants were randomly assigned to be asked to use a fitness app (experimental
condition) or were not asked to do so (control condition). Because of this random assignment, the
impact of confounding variables should be eliminated because one can be relatively certain that
participants in the experimental condition were no different from participants in the control
condition. Nevertheless, to ensure that the two experimental conditions were indeed comparable
before the experimental manipulation, we employed a pre-test-post-test design. Whereas no
differences across experimental conditions were expected at the pre-test, participants in the
experimental condition should differ from the participants in the control condition at the post-test.
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
5
Materials and methods
Procedure
Students from the University of Milan were contacted during class and took part as volunteers in
our study. Data collection was carried out during one semester, with the aim of running as many
participants as possible. In the first wave (T1), data collection was carried out through a written
questionnaire. At the beginning of the questionnaire, after providing written informed consent,
participants were asked to report the number of steps that they considered as a goal to achieve for
their physical well-being. We then measured demographics as well as the antecedents of the actual
behavioral goal postulated in the TPB: attitudes, subjective norm, PBC, and intentions toward
healthy activities. Participants were then randomly assigned to two experimental conditions; in one
condition, they were asked to install a fitness app on their own smartphone and to use it for the
following two weeks. As a cover story, they were told that we were interested in the evaluation of
the user interface usability of some mobile apps. We used four different apps (Pedometer or Google
Fit for Android users and Stepz or Pacer for iOS users) to increase the generalizability of findings
20. We carefully selected apps with similar functionalities. All the adopted apps count daily steps,
burned calories, and active time, alerting users with notifications about daily achievements directly
on the smartphone. Moreover, at the time of data collection, the selected apps were free without any
restrictions on monitoring features.
No information regarding mobile apps was given for participants in the control condition. Two
weeks after the first wave, partcipants who had voluntarily left a valid e-mail address at the end of
the T1 questionnaire were provided with a link to a web survey. In the follow-up phase (T2), we
reassessed measures for attitudes, subjective norm, PBC, and intentions toward healthy activities.
Finally, at the end of the survey all participants were fully debriefed by disclosing the purpose of
the study.
Sample characteristics.
The study has been carried out in accordance with the code of ethics of the world medical
association (Declaration of Helsinki) for experiments involving humans. A total of 78 participants
completed both the first and the second part of the survey; 9 were male (11.5%) and 69 were female
(88.5%). Their mean age was 19.94 years (SD = 1.36).
Measures.
All measures were adapted to the behavioral domain of healthy activities (e.g., adopting
healthy behaviors, such as having a walk). Descriptive statistics, intercorrelations, and scale
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
6
reliabilities of all measures are shown in Table 1. It is worth noticing that some scale reliabilities
were relatively poor, which is a typical psychometric cost of using short measures (Gosling,
Rentfrow, & Swann, 2003).
Attitudes toward healthy and fitness activities were evaluated using an adapted version of
the Attitude Regarding Physical Activities for Health and Fitness scale21 (6 items). Sample items
were “To promote better health conditions, people may take part in healthy activities, such as
having a walk every day” and “Physical activities, healthy activities, such as having a walk every
day, are one of the source for fitness” (on a scale from 1 = totally disagree to 7 = totally agree).
Subjective norm, PBC, and intentions were measured by adapting the original items proposed by
Perugini and Bagozzi 22. Subjective norm was assessed employing the following two items: “Most
people who are important in my life think that I should not (1) / I should (7) adopt healthy
behaviors, such as having a walk of more than the number of steps I have declared as my personal
goal” and “Most people who are important to me would disapprove (1) / approve (7) of me
adopting healthy behaviors, such as having a walk of more of more than the number of steps I have
declared as my personal goal”. The two items for PBC were “How much control do you think you
have over adopting healthy behaviors, such as having a walk of more than the number of steps you
have declared as your personal goal?” (1= no control, to 7 = total control, midpoint 4 = moderate
control) and “How easy or difficult do you think it is for you to adopt healthy behaviors, such as
having a walk of more than the number of steps you have declared as your personal goal?” (1 = very
difficult, 7 = very easy). Intentions were measured with these two items: “I intend to adopt healthy
behaviors, such as having a walk of more than the number of steps I have declared as my personal
goal in the near future” and “My intention is to adopt healthy behaviors, such as having a walk of
more than the number of steps I have declared as my personal goal in the near future” (on a scale
from 1 = totally disagree to 7 = totally agree).
One single item was employed to estimate participants’ behavior. The item was: “How
many times you think you had a walk of more than the number of steps you have declared as your
personal goal, during the last two weeks?” (anchored with 1 = less than once in two weeks, 2 = once
in two weeks, 3 = twice in two weeks, 4 = twice a week , 5 = every day).
We also assessed participant’s previous sport habits by asking them to name three preferred
physical activities and to rate how frequently they practice them (“Now please write the name of
your favorite physical activity and how often do you practice it” anchored with 1 = never, 2 = once
per week, 3 = twice per week, 4 = more than twice per week, 5 = daily). The three items were then
combined ( = .56). Participants were also asked to report the frequency of their sport behavior
during the two weeks of the study (“How frequently in the past two weeks have you engaged in
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
7
physical and sport activities?” anchored with 1 = never, 2 = once per week, 3 = twice per week, 4 =
more than twice per week, 5 = daily).
Furthermore, participants’ previous use of apps for tracking physical activities was assessed
by asking how frequently they use several famous app for tracking physical activity (i.e., “Please
now indicate how often do you use the following applications: Runtastic, Seven, MapMyWalk,
MapMyRun, Google Fit, Pedometer, Apple Health, Runkeeper, Runtrainer, Nike tracking app. If
you do not use this mobile app, please choose never” on a scale from 1 = never to 7 = very often”).
Participants were also asked to name their favorite fitness app and to rate how frequently they use it
(“Now please write the name of your favorite application for training / fitness monitoring and
indicate how often you use it. If you do not use any mobile app for training / fitness tracking, please
choose never” on a scale from 1 = never to 7 = very often). The scores reported for each application
were then combined to obtain a measure of previous use of mobile applications for tracking
physical activities ( = .90).
Finally, to check if participants in the experimental condition actually used the suggested
apps, we asked them to report how frequently they accessed Pacer / Pedometer / Google Fit / Stepz
during the two weeks of data collection. The scale was anchored with 1 = never, 2 = rarely, 3 =
occasionally, 4 = sometimes, 5 = frequently, 6= often, 7 = very often. Furthermore, in the final part
of the questionnaire we asked them to report the number of steps recorded by the adopted app on
their smartphone for each day of the two-weeks study period note 1.
Results
All statistical analyses were performed using SPSS v.24.0. We first checked whether
participants in the experimental condition actually used one of the suggested app. All the
participants reported the number of steps walked on each day of the two weeks of data collection.
The most frequently used app was Google Fit (M = 3.61, SD = 2.78), followed by Pacer (M = 2.50,
SD = 2.40), Stepz (M = 2.16, SD = 2.340, and Pedometer (M = 1.55, SD = 1.74).
In order to test the effects of using a fitness app on the dependent variables, a series of two-
way mixed ANOVAs were conducted. App usage (using vs. non-using a fitness app) was
considered as a between-groups variable and time of test (pre-test vs. post-test) as a within-
participants variable. Participant’s previous sport habits and previous use of fitness apps were
entered as covariates in all analyses. Analyses revealed no significant main effect, neither for
experimental condition, F(1, 73) = 1.81, p = .18,
2= .02, nor for time of test, F(1, 73) = 0.09, p =
.77,
2=.00, on attitudes towards fitness activities. However, the hypothesized interaction was
significant, F(1, 73) = 5.54, p = .02,
2 = .07 (Figure 1). No significant differences in attitudes
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
8
towards physical activity were found between the app condition (M = 6.19, SD = 0.54) and the
control condition (M = 6.17, SD = 0.59) in the pre-test, t(76) = 0.13, p = .89, d = 0.03. In contrast,
in the post-test, participants who used a fitness app reported more favorable attitudes in the post-test
(M = 6.45, SD = 0.37) than did participants in the control condition (M = 6.17, SD = 0.64), t(76) =
2.23, p = .028, d = 0.51. None of the considered covariates was significant (all ps > .17). To put it
differently, participants who used a fitness app reported more favorable attitudes in the post-test
compared to the pre-test, t(43) = 4.09, p < .001, d = 0.50 even when controlling for participant’s
previous sport habits, previous use of fitness apps and the frequency of sport behavior during the
two weeks of the study. By contrast, in the control condition, the difference on attitudes towards
fitness activities between pre-test and post-test was not significant, t(33) = 0.00, p = 1.00, d = 0.00.
Taken together, these results suggest that mobile fitness apps promote a more positive attitude
toward healthy activities, such as having a daily walk.
-- Insert figure 1 here –
A similar pattern of results was found for PBC. No significant main effects, neither for
experimental condition, F(1, 73) = 3.84, p = .06,
2 = .05, nor for time of test, F(1, 73) = 0.09, p =
.75,
2= .00, were found. Most important, the interaction between app usage and time of test was
significant, F(1, 73) = 4.56, p = .036,
2= .06 (Figure 2). No significant differences were found
between the app condition (M = 4.48, SD = 0.96) and the control condition (M = 4.27, SD = 1.36)
in the pre-test, t(76) = 0.79, p = .42, d = 0.18. In contrast, in the post-test, participants who used a
fitness app reported higher PBC scores (M = 5.25, SD = 1.07) than did participants in the control
condition (M = 4.48, SD = 0.71), t(76) = 3.62, p = .001, d = 0.83. To put it differently, participants
who used a fitness app reported higher PBC scores in the post-test compared to the pre-test, t(43) =
4.97, p < .001, d = 0.76. By contrast, in the control condition, the difference on PBC between the
pre-test and the post-test, was not significant, t(33) = 1.11, p = .27, d = 0.16.
-- Insert figure 2 here --
Significant differences for self-reported behavior were also found. There was a significant
main effect of experimental condition, F(1, 73) = 5.14, p = .02,
2 = .06, whereas the effect for time
of test was not significant F(1, 73) = 0.19, p = .66,
2= .00. However, the significant main effect
was qualified by a significant interaction between app usage and time of test, F(1, 73) = 6.91,
p=.002,
2= .12 (Figure 3). No significant differences were found between the app condition (M =
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
9
3.73, SD = 0.94) and the control condition (M = 3.56, SD = 1.05) in the pre-test, t(76) = 0.74, p =
.46, d = 0.17. In contrast, in the post-test, participants who used a fitness app reported to have
walked more (M = 4.18, SD = 1.02) than did participants in the control condition (M = 3.38, SD =
1.07), t(76)=3.36, p =.001, d = 0.76. In other words, participants who used a fitness app reported to
have walked more in the post-test compared to the pre-test, t(43) = 2.41, p = .02, d = 0.87, whereas
self-reported behavior did not change for participants in the control condition, t(33) = 0.74, p = .46,
d = 0.17.
-- Insert figure 3 here --
In contrast, no significant interactions were found for subjective norm and time of test (p =
.22) and for intentions and time of test (p = .27).
Please recall that the TPB proposes that attitudes, norms, and PBC determine intentions,
whereas intentions and PBC determine behavior. Hence, we examined whether intentions are
influenced by attitudes, norms, and PBC and whether self-reported behavior is influenced by
intentions and PBC. To this end, multiple regressions were performed (separately for pre-test and
post-test). In the first regression, attitudes, norms, and PBC were used as predictors for intentions.
For both time-points, the overall regressions were significant, F(3, 73) = 9.62, R2 = .28, p < .001;
F(3, 74) = 9.53, R2 = .28, p < .001, respectively. At both pre-test and post-test, norms were
significantly associated with intentions, β=.49, p < .001, β = .28, p = .012, respectively. At the post-
test, PBC was also significantly associated with intentions, β = .32, p = .003. The other predictors
were not significant.
In the second regression, intentions and PBC were used as predictors for self-reported
behavior. For both time-points, the overall regressions were significant, F(2, 74) = 14.02, R2 = .28,
p < .001; F(2, 75) = 8.95, R2 = .19, p < .001, respectively. At the pre-test, both intentions, β = .41, p
< .001, and PBC, β = .24, p = .025, were significantly associated with self-reported behavior. At the
post-test, PBC was significantly associated with self-reported behavior, β = .29, p = .014, whereas
the impact of intentions was marginally significant, β = .23, p = .050.
Discussion
In 2014, almost 46 millions of people actively used apps from the fitness and health
category 1 and this number is even increasing, thanks to the diffusion of fitness band and smart
watches. Given the large popularity of fitness apps, we deemed it important to investigate whether
the use of mobile apps for monitoring physical activities could positively influence people’s health
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
10
behaviors as well as its antecedents. Most importantly, fitness app use did have an impact on
participant’s self-reported health behavior. Participants who used a fitness app reported to be more
likely to have a walk than did participants in the control condition and the use of the fitness app
increased the reported likelihood that they had a walk (whereas participants’ reported behavior in
the control condition did not change).
With regard to possible antecedents, and based on the TPB theoretical framework, we
examined whether the use of a pedometer mobile app could have positively affected attitudes,
subjective norm, PBC, and intentions in two weeks of use. According to TPB, attitudes, subjective
norm, PBC, and intentions explain the way in which goals and plans guide behavior, and the factors
that induce people to change their behavior when it is conceived as a behavior-goal unit 10. Our
study corroborated the two main postulates of TPB, namely that intentions are influenced by
attitudes, norms, and PBC, whereas intentions and PBC are the most direct predictors of behavior.
At both pre-test and post-test did these predictors explain considerable variance of the criteria, with
norms being the most robust predictor of intentions and intentions and PBC explaining self-reported
behavior.
It is worth noting that the adoption of a mobile app for a period of two weeks positively
affected some, but not all, antecedents. It did change participant’s attitudes. Self-perception theory
suggests that behavior may change a person's perception of the self and may alter attitudes
specifically related to a given behavior 24 25. Indeed, people come to know their own attitudes,
beliefs, and other internal states by inferring them from their own behavior. We assume that the
daily use of a mobile app for tracking physical activities could have made participants more aware
of their performances by monitoring their actual behavior, which in turn has led to more positive
attitudes toward healthy activities.
The use of the app also positively affected PBC. This is not surprising, since the main
feature of this kind of mobile apps is the setting of a daily goal, allowing people to control for their
own progresses toward that goal. We speculate that the adoption of a mobile app may have offered
users a strong instrument for controlling their behavior, their progresses, achievements or failures
enhancing the perceptions of their ability to perform better every day.
In contrast, no significant effects of app usage on intentions were found. When considering
health behaviors, before they change their intentions people need to be motivated to do so 26. It is
important to note that our sample consisted of university students who did not spontaneously decide
to use a fitness app (i.e., because they were motivated to walk more); rather, they were asked to do
it. The mere use of a mobile app without any previous motivation to adopt a healthy life-style, may
not be sufficient to influence volitional intentions. For this reason, we speculate that individual
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
11
motivations could play a moderating role on the relationship between the use of a mobile app and
intentions and future studies should explore this possibility.
Some limitations have to be acknowledged. First, we employed a self-reported measure for
participants’ behavior. Second, even if correlational analyses revealed a significant association
between attitudes, subjective norm, PBC and intentions at T2, our sample was too small to test a
structural model; thus, we tested the effect of the apps on these constructs separately. By
considering such limitations, future research should consider a larger sample size for a longer
period of time with multiple observations for determining the cause-effect relationships among
constructs and the long-term effects of using a fitness app on attitude and behavior. Third, our
results may be due in part to demand characteristics of the situation. Although we employed a cover
story and there was no indication that participants questioned it, future studies should consider this
aspect. Fourth, it is noteworthy that we controlled for participants’ previous use of apps, but we
only focused on pedometer-like apps. Future studies should measure the actual behavior and should
also consider apps designed for different fitness activities. Moreover, we did not check whether
participants had turned off the notifications pushed by the apps. Indeed, as proposed by previous
research, notifications can be used for sustaining motivation over time 27. Although we controlled
for previous use of fitness apps, we did not ask participants whether they used smartwatches or
other wearable devices to keep track of daily physical activity. Indeed, we speculate that the
adoption of wearable devices, which are easier to use, could be more effective than accessing an
app on the smartphone in fostering motivation toward a more active life-style. In this regard, more
research is needed to explore whether the combined use of apps and wearable devices have stronger
effects on attitude-behavior change. Indeed, the constant presence of a bracelet may further
influence the PBC.
Conclusions
Despite its well-known benefits, more than 59% of adults do not engage in sufficient
physical activity 28. Therefore, the present study provides encouraging evidence of the positive
effects of using a mobile app on people’s life-style. Psychological research on the impact of fitness
app it still is in its infancy and constantly chases technological developments. It is important that
social psychology, health psychology, and computer science work together for developing more
effective technological instruments to promote people’s physical well-being. Our findings suggest
that fitness apps could be such an instrument.
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
12
Notes
1. Although we asked participants in the experimental condition to report the actual number of
daily steps recorded by the apps for each day of the two-week study, we did not have a
comparable measure for the participants in the control condition. For this reason, analyses
were conducted considering the self-reported item.
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
13
REFERENCES
1 Nielsen 2014. Hacking health: how consumers use smartphones and wearable tech to track their
health; Available from http://www.nielsen.com/us/en/insights/news/2014/hacking-health-
how-consumers-use-smartphones-and-wearable-tech-to-track-their-health.html
2 Krebs P, Duncan DT. Health app use among US mobile phone owners: a National survey. J Med
Internet Res 2015;3:e101.
3 Swan M. Emerging patient-driven health care models: an examination of health social networks,
consumer personalized medicine and quantified self-tracking. Int J Env Res Pub He
2009;6:492-525.
4 Fanning J, Mullen SP, McAuley E. Increasing physical activity with mobile devices: a meta-
analysis. J Med Internet Res 2012;14:e161.
5 Muntaner A, Vidal-Conti J, Palou P. Increasing physical activity through mobile device
interventions: A systematic review. Health inform J 2015;22:451-69.
6 Fjeldsoe BS, Miller YD, O'Brien JL, Marshall AL. Iterative development of MobileMums: a
physical activity intervention for women with young children. Int J Behav Nutr Phy
2012;9:151.1-151.11.
7 Kirwan M, Duncan MJ, Vandelanotte C, Mummery WK. Using smartphone technology to
monitor physical activity in the 10,000 steps program: a matched case-control trial. J Med
Internet Res 2012;14:e55.
8 Eagly A, Chaiken S. The psychology of attitudes. Forth Worth, TX: Harcourt Brace Jovanovich
College Publishers; 1993.
9 Slater MD. Reinforcing spirals: the mutual influence of media selectivity and media effects and
their impact on individual behavior and social identity. Commun Theor 2007;17:281-303.
10 Ajzen I. The theory of planned behavior. Organ Behav Hum Dec 1991;50:179-211.
11 Ajzen I. Attitudes, personality, and behavior. Milton-Keynes, England: Open University Press &
Chicago, IL: Dorsey Press; 1988.
12 Nguyen MN, Potvin L, Otis J. Regular exercise in 30 to 60 years old men: combining the stages-
of-change model and the theory of planned behavior to identify determinants for targeting
heart health interventions. J Commun Health 1997;22:233-247.
13 Ajzen I. Perceived behavioral control, self-efficacy, locus of control, and the theory of planned
behavior. Journal of Applied Social Psychology 2002;32:665-683.
14 Zhao J, Freeman B, Li M. Can mobile phone apps influence people’s health behavior change? an
evidence review. J Med Internet Res 2016;18:e287.
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
14
15 Froming WJ, Walker GR, Lopyan KJ. Public and private self-awareness: when personal
attitudes conflict with societal expectations. J Exp Soc Psyhcol 1982;18:476-487.
16 Gibbons FX. Sexual standards and reactions to pornography: enhancing behavioral consistency
through self-focused attention. J Exp Soc Psyhcol 1978;36:976-987.
17 Gill D. Psychological dynamics of sport. Champaign, IL: Human Kinetics Publishers; 1986.
18 Terry J. Changing habits by changing attitudes. JOPERD 1996;1:3-48.
19 Aboelmaged M, Gebba R. Mobile banking adoption: an examination of technology acceptance
model and theory of planned behavior. IJBRD 2013;2:35-50.
20 Wells GL, Windschitl PD. Stimulus sampling and social psychological experimentation. Pers
Soc Psychol B 1999;25:1115-1125.
21 Khan S, Abbass SA, Islam ZU, Khan W, Din MU. A study regarding the students’ attitudes
towards physical activities. IJ-ARBSS 2012;2:189-198.
22 Perugini M, Bagozzi RP. The role of desires and anticipated emotions in goal-directed
behaviours: broadening and deepening the theory of planned behaviour. Brit J Soc Psychol
2001;40:79-98.
23 Gosling SD, Rentfrow PJ, Swann WB. A very brief measure of the BigFive personality domains.
J Res Pers 2003;37:504–528.
24 Bem DJ. Self-perception: an alternative interpretation of cognitive dissonance phenomena.
Psychol Rev 1967;74:183-200.
25 Bem DJ. Self-perception theory. In: Berkowitz L, editor., Advances in experimental social
psychology. New York: Academic Press; 1972. p. 1-62.
26 Schwarzer R. Models of health behaviour change: intention as mediator or stage as moderator?
Psychol Health 2008;23:259-263.
27 Asimakopoulos S, Asimakopoulos G, Spillers F. Motivation and user engagement in fitness
tracking: heuristics for mobile healthcare wearables. Informatics 2017;4:5.
28 De Souto Barreto P. (2013). Why are we failing to promote physical activity globally? World
health Organization. Bulletin of the World Health Organization 2013; 91. Available from
http://www.who.int/bulletin/volumes/91/6/13-120790/en/
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
15
Authors’ contributions. Alessandro Gabbiadini and Tobias Greitemeyer conceived of the
presented idea. Alessandro Gabbiadini carried out the experiment and wrote the manuscript with
support from Tobias Greitemeyer. Both authors developed the theory, performed the computations
and verified the analytical methods. All authors discussed the results and contributed to the final
manuscript.
Funding. This research did not receive any specific grant from funding agencies in the public,
commercial, or not-for-profit sectors.
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
16
TITLES OF TABLES
Table I. Means, standard deviations, and bivariate correlations.
TITLES OF FIGURES
Figure 1. Attitudes change between Time 1 and Time 2 across the two experimental conditions. The
capped vertical bars denote 1 standard error (SE).
Figure 2. PBC change between Time 1 and Time 2 across the two experimental conditions. The
capped vertical bars denote 1 standard error (SE).
Figure 3. Self-reported behavior between Time 1 and Time 2 across the two experimental
conditions. The capped vertical bars denote 1 standard error (SE).
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
RUNNING HEAD: Fitness apps, attitudes, PBC and healthy behavior
17
Table 1. Means, standard deviations, and bivariate correlations.
M
SD
1
2
4
5
6
7
8
9
1 Attitude T1
6.18
0.56
.65
2 Attitude T2
6.32
0.52
.73
.677**
3 Subjective norm T1
4.30
1.35
.60
-.119
-.025
4 Subjective norm T12
4.31
1.14
.42
.019
.178
.533**
5 PBC T1
4.39
1.14
.70
.174
.154
.331**
.314**
6 PBC T2
4.91
0.99
.61
-.009
.110
.305**
.337**
.508**
7 Intentions T1
5.42
1.15
.95
.066
.095
.513**
.304**
.264*
.296**
8 Intentions T2
5.67
1.21
.92
.136
.225*
.362**
.407**
.276*
.426**
.382**
9 Behavior T1
3.65
0.99
-
-.003
.007
.299**
.291**
.334**
.319**
.473**
.085
10 Behavior T2
3.83
1.11
-
.030
.149
.191
.134
.374**
.387**
.297**
.352**
Note. * p < .05 ** p < .01.
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.
COPYRIGHT© EDIZIONI MINERVA MEDICA
This docum ent i s pro tected by internat ional copyright laws. No additional reproduction is authorized. I t is per mitted for personal use to download and save only one file and print only one
copy of this Article. It is not permitted to make additional copies (either sporadically or systemati cally, either printed or electronic) of t he Article for any purpose. It is not permitted to distribute
the electronic copy of the article through online internet and/or intranet file sharing syste ms, electronic mailing or any other means which may allow acce ss to th e Article. The use of a ll or any
part of t he Article for any Commercial Use is not p ermitted. The cre ation of derivative works from th e Article is no t permitted. The production of reprints for personal or commercial use is not
permitted. It is n ot permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not p ermitted to
frame or use framing technique s to enclose any trade mark, logo, or other prop rietary in formation of the Publisher.