Active4Life; optimization of use and effects of eHealth

A study to persistently exercise more

The majority of the chronically ill (84%) and of the less educated adults and elderly (72%) do not get enough exercise. For these groups, even a little more exercise would have major health benefits. Active4Life investigates how to encourage adults and the elderly (healthy and sick) to move more. Special attention is paid to vulnerable groups such as people with a lower education and with low health and digital skills.

Active4Life is funded by ZonMw's Sport and Exercise research program and is executed by prof. dr. Lilian Lechner, professor of Health Psychology at the Open University and his team. The consortium further consists of Open University partners (Psychology, Computer Science, Educational Sciences), Zuyd University of Applied Sciences, the University of Amsterdam and partners Gemeente Kerkrade, and NLActief, the industry association of the recognized and entrepreneurial sports and exercise companies in the Netherlands. The project started at the end of 2019; we spoke with Lilian in early December 2022.

Building on E-health interventions

In recent years, the Open University has already developed several exercise programs that were proven effective: ActiefPlus for healthy people above the age of 50, ActiefPlus65 for people above the age of 65 (with chronic disabilities), Ik Beweeg for adults, OncoActief for cancer patients during/after treatment, and KankernazorgWijzer. All of these programs were found to be effective in encouraging more exercise.

These examples were mostly stand-alone projects. In Active4Life the researchers continue to use this knowledge, experiences and the data to gain new knowledge to encourage adults and the elderly to move more permanently. "How can we help people to actively participate in society, despite limitations they may have? To give exercise a place in their daily life?" adds Lilian.

WP1, data science

The research project consists of 4 steps or Work Packages (WPs).

In step 1, researchers applied advanced data science to search for patterns in the previously developed interventions. By combining this data and through the use of complex data science techniques, we gain more knowledge in the factors and behavioral determinants that play a role in the use and effectiveness of current interventions. Questions include: which relevant factors (such as age, education), behavioral determinants (such as motivation and self-confidence) and (innovative) behavior change strategies can enhance the effectiveness of future online programs? "This work package is at the intersection of health psychology and data science. A great learning opportunity to be able to collaborate outside of one’s own field."

WP2, experimenting with new eHealth interventions

“EHealth has great potential, but participant drop-out is a major issue in eHealth interventions, so we wanted to see how we could encourage people to exercise more over a longer period of time.” In WP2 tests were performed with a (well-functioning) basic intervention and three new mobile program elements;

  1. monitoring exercise via activity trackers;
  2. ESM, a mobile app with instant feedback in all kinds of everyday situations;
  3. a chatbot (based on AI techniques).

For each element, researchers determined whether incorporating the element changes exercise behaviour, commitment, feeling of self-efficacy and motivation.

“It has become clear that the activity tracker functions best as an addition. This one is perhaps the most basic, but it helps when people have it on their wrist and when they can easily set goals and track how much they move. Of course we also have to take into account access to the latest techniques and digital skills, not everyone has this to the same extent.”

WP3, bridging two worlds: psychology and data science

The findings of step 1 and step 2 are integrated and tested in some existing interventions. “What have we learned from data science to improve the content of an intervention? And what could be a good eHealth addition from the WP2 experiment? Here we combine all that we have learned.” This results in an adapted intervention that will be offered to two target groups in step 4.

WP4, implementation

The implementation study will start at the beginning of 2023: the redesigned interventions are implemented to determine whether the new applications also reinforce the effects of the interventions in practice. The target group consists of 200 people over 50 years of age and 200 people with a disability.

Is the redesigned program indeed better when it comes to use, exercise and maintaining the habit of exercise? And how can these new interventions best be integrated into existing practice?

A new addition to this implementation part is to explore three recruitment strategies. “We will approach people in three different ways: via municipalities, via NLActief and via social media. What we want to learn from this is which strategy works best for recruiting participants, but also whether these strategies have an effect on who participates and on possible earlier dropout. We have the extra time that allows us to do this additional research nicely.”

Next steps

“Involving the target groups is the basis of everything, which was still quite difficult to realize due to corona, but with some extra effort and time we succeeded. Fortunately, we have also been given an extra six months for the implementation part of our research. The research will now continue until summer 2024, after which the interventions will remain available.”

Lilian is pleased that the research is taking a broader view and that knowledge is being shared with related research projects into implementation and a more integrated approach in neighbourhoods.

“Placing the right interventions, the right way: that is the challenge for the future.”

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