Effects of Activity Tracker Use With Health Professional Support or Telephone Counseling on Maintenance of Physical Activity and Health Outcomes in Older Adults: Randomized Controlled Trial

Background Despite a range of efforts to increase physical activity participation in Australia, inactivity levels in older adults have remained high over recent decades, contributing to increased rates of chronic health conditions. Lifestyle interventions, including telephone counseling (TC), improve physical activity participation and associated health outcomes over the short term; however, ongoing feedback and support is required to maintain these changes. Newer technologies such as wearable activity trackers (ATs) may offer an alternative method for providing ongoing support. Objective This study aims to investigate whether newer technologies such as wearable ATs assist in providing ongoing support to maintain physical activity levels and health outcomes. Methods Older adults aged >60 years who had just completed a 12-week face-to-face individualized community exercise program in Tasmania, Australia, participated in the study. They were randomized to receive AT, TC, or usual care (UC). All groups received a home exercise program and an optional referral to a community-based exercise program. The AT group also received an AT and text message feedback from an accredited exercise physiologist (AEP). The TC group received phone calls from an AEP throughout the 12-month intervention. The primary outcome was daily steps measured by an ActivPAL (TM) accelerometer at baseline and at 3, 6, and 12 months. Secondary outcome measures included body composition, blood pressure, 10-time sit-to-stand (TTSTS) test, timed up and go test, and cardiorespiratory fitness. This trial was approved by the Tasmanian Health and Medical Human Research Ethics Committee (H0014713). Results A total of 117 participants were randomized to the study (AT, n=37; TC, n=38; UC, n=42). At baseline, the participants (75/117, 64.1% female; mean age 72.4 years, SD 6.4) completed an average of 6136 steps (SD 2985) per day. Although there were no significant differences between groups, the TC and AT groups maintained daily step counts (mean difference [MD] −79 steps, 95% CI −823 to 663 steps; P=.81; and MD −588 steps, 95% CI −1359 to 182 steps; P=.09), and UC showed a reduction in daily steps (MD 981 steps, 95% CI −1668 to −294 steps; P=.003) during the 12-month period. Diastolic blood pressure was significantly higher after AT than after UC (MD 5.62 mm Hg, 95% CI 1.30 to 9.94 mm Hg; P=.01), and TTSTS was significantly slower on TC compared with UC (MD 2.36 seconds, 95% CI −0.14 to 4.87 seconds; P=.03). Conclusions The use of an AT with AEP support or TC is effective at maintaining daily step count in older adults over a 12-month period, suggesting that wearable ATs are as effective as TC. Further research to investigate which option is more cost-effective would be beneficial. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12615001104549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369118

yes: all primary outcomes were significantly better in intervention group vs control partly: SOME primary outcomes were significantly better in intervention group vs control no statistically significant difference between control and intervention potentially harmful: control was significantly better than intervention in one or more outcomes inconclusive: more research is needed Other: Approx. Percentage of Users (starters) still using the app as recommended after 3 months * Overall, was the app/intervention effective? * Identify the mode of delivery. Preferably use "web-based" and/or "mobile" and/or "electronic game" in the title. Avoid ambiguous terms like "online", "virtual", "interactive". Use "Internet-based" only if Intervention includes non-web-based Internet components (e.g. email), use "computer-based" or "electronic" only if offline products are used. Use "virtual" only in the context of "virtual reality" (3-D worlds). Use "online" only in the context of "online support groups". Complement or substitute product names with broader terms for the class of products (such as "mobile" or "smart phone" instead of "iphone"), especially if the application runs on different platforms.
Does your paper address subitem 1a-i? * Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The effects of Activity Tracker use with health professional support"

1a-ii) Non-web-based components or important co-interventions in title
Mention non-web-based components or important co-interventions in title, if any (e.g., "with telephone support").

Does your paper address subitem 1a-ii?
Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study or Telephone Counselling" subitem not at all important 1 2 3 4 5 essential 1a-iii) Primary condition or target group in the title Mention primary condition or target group in the title, if any (e.g., "for children with Type I Diabetes") Example: A Web-based and Mobile Intervention with Telephone Support for Children with Type I Diabetes: Randomized Controlled Trial Does your paper address subitem 1a-iii? * Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "older adults"

1b-i) Key features/functionalities/components of the intervention and comparator in the METHODS section of the ABSTRACT
Mention key features/functionalities/components of the intervention and comparator in the abstract. If possible, also mention theories and principles used for designing the site. Keep in mind the needs of systematic reviewers and indexers by including important synonyms. (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) https://docs.google.com/forms/d/e/1FAIpQLSfZBSUp1bwOc_OimqcS64RdfIAFvmrTSkZQL2-3O8O9hrL5Sw/viewform?hl=en_US&formkey=dG… 10/52 subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 1b-i? * Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "This study aims to investigate how newer technologies such as wearable activity trackers may assist in proving ongoing support to maintain physical activity levels and health outcomes. " "117 participants who had just completed a 12-week face-to-face individualised exercise program were randomised to receive either AT (n=37), TC (n=38) or UC (n=42). All groups received a home-exercise program and optional referral to a community-based exercise program. The AT group also received an activity tracker and text message feedback from an Accredited Exercise Physiologist (AEP). The TC group received phone calls from an AEP throughout the 12-month intervention. "

1b-ii) Level of human involvement in the METHODS section of the ABSTRACT
Clarify the level of human involvement in the abstract, e.g., use phrases like "fully automated" vs. "therapist/nurse/care provider/physician-assisted" (mention number and expertise of providers involved, if any). (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) Does your paper address subitem 1b-ii?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The AT group also received an activity tracker and text message feedback from an Accredited Exercise Physiologist (AEP Does your paper address subitem 1b-iii? Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "117 participants who had just completed a 12-week face-to-face individualised exercise program were randomised to receive either AT (n=37), TC (n=38) or UC (n=42). " "The primary outcome was daily steps measured by an ActivPAL™ accelerometer at baseline, 3, 6 and 12-months. Secondary outcome measures included body composition, blood pressure, Ten-time sit to stand, timed up and go and cardiorespiratory fitness. " 1b-iv) RESULTS section in abstract must contain use data Report number of participants enrolled/assessed in each group, the use/uptake of the intervention (e.g., attrition/adherence metrics, use over time, number of logins etc.), in addition to primary/secondary outcomes. (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it)

INTRODUCTION 2a) In INTRODUCTION: Scientific background and explanation of rationale
Does your paper address subitem 1b-iv?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "117 participants who had just completed a 12-week face-to-face individualised exercise program were randomised to receive either AT (n=37), TC (n=38) or UC (n=42). " " The primary outcome was daily steps measured by an ActivPAL™ accelerometer at baseline, 3, 6 and 12-months. Secondary outcome measures included body composition, blood pressure, Ten-time sit to stand, timed up and go and cardiorespiratory fitness. "

1b-v) CONCLUSIONS/DISCUSSION in abstract for negative trials
Conclusions/Discussions in abstract for negative trials: Discuss the primary outcome -if the trial is negative (primary outcome not changed), and the intervention was not used, discuss whether negative results are attributable to lack of uptake and discuss reasons. (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) Does your paper address subitem 1b-v?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The use of an activity tracker with AEP support or telephone counselling are effective at maintaining daily step count and lean mass in older adults over a 12-month period" subitem not at all important . While these methods provide an initial increase in physical activity participation, physical activity levels tend to revert to pre-intervention levels once the structured intervention finishes [5,6]. As physical activity participation needs to be maintained to preserve the associated health benefits, effective strategies to assist older adults to continue to be physically active following a lifestyle intervention are required. Several systematic reviews have assessed methods of maintaining physical activity participation [7,8]. Telephone counselling has shown to be effective as both a booster strategy [7] and as an intervention to provide ongoing support to promote habitual behaviour change [8]. Evidence suggests that longer duration interventions with more regular phone calls demonstrate greater effectiveness [8]. Despite the established benefits of telephone counselling, there are significant time and resource barriers to its implementation in standard practice [9]. Activity trackers provide consumers with the ability to objectively monitor and receive feedback relating to daily physical activity and can provide health professionals with an objective measure, allowing for the provision of targeted feedback and ongoing support [10]. Furthermore, activity trackers may offer a less resource intensive alternative to telephone counselling. The use of an activity tracker, particularly when included as part of a broader behavioural intervention has been shown to be effective at increasing physical activity levels in different populations [11]. There is a paucity of long-term interventions (>6 months) in relation to older adults. Additionally, few studies have compared the use of an activity tracker as a stand-alone intervention compared to other established behavioural or lifestyle interventions [12,13]. " METHODS 3a) Description of trial design (such as parallel, factorial) including allocation ratio 3b) Important changes to methods after trial commencement (such as eligibility criteria), with reasons Does your paper address CONSORT subitem 2b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Consequently, this study aimed to compare the use of a commercially available activity tracker (AT) with usual care (UC) and an established method of post intervention follow up; telephone counselling (TC), to assist older adults to maintain their daily step count over a 12-month period.
Does your paper address CONSORT subitem 3a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The study was a three-arm, 12-month randomised controlled trial investigating the use of an activity tracker, telephone counselling and usual care on maintenance of physical activity levels and health outcomes in older adults. " "Randomisation was performed using computer generated blocks of fifteen by a third person not directly involved in the study and was recorded in sealed opaque envelopes with envelopes opened sequentially at the end of S2S to reveal the intervention allocation. Participants from the same household, were randomised to the same intervention group to maintain intervention integrity. "

4a) Eligibility criteria for participants
Does your paper address CONSORT subitem 3b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study No changes to methods were made after commencement of trial.

3b-i) Bug fixes, Downtimes, Content Changes
Bug fixes, Downtimes, Content Changes: ehealth systems are often dynamic systems. A description of changes to methods therefore also includes important changes made on the intervention or comparator during the trial (e.g., major bug fixes or changes in the functionality or content) (5-iii) and other "unexpected events" that may have influenced study design such as staff changes, system failures/downtimes, etc. [2].
Does your paper address subitem 3b-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Written instructions and telephone support were provided to troubleshoot any technical issues. " Any technical issues were dealt with as quickly as possible and didn't have a major impact on the study. Does your paper address CONSORT subitem 4a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "To be eligible, participants had to have completed the 12-week Strength2Strength (S2S) Tasmania Exercise Treatment Initiative, be over the age of 60 and have or be at risk of developing a chronic medical condition. The S2S program was an individually tailored 12week exercise and education program, led by Accredited Exercise Physiologists. Participants were excluded if they chose not to participate in the S2S program, had an unstable medical condition that prevented them from participating in regular physical activity, had a neurological condition or had limited understanding of English which prevented them from meeting the self-reporting requirements of the study. "

4a-i) Computer / Internet literacy
Computer / Internet literacy is often an implicit "de facto" eligibility criterion -this should be explicitly clarified.
Does your paper address subitem 4a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Smartphone literacy or ownership was not required to be eligible for the study as participants were provided with a smartphone in addition to the activity tracker. 4a-ii) Open vs. closed, web-based vs. face-to-face assessments: Open vs. closed, web-based vs. face-to-face assessments: Mention how participants were recruited (online vs. offline), e.g., from an open access website or from a clinic, and clarify if this was a purely webbased trial, or there were face-to-face components (as part of the intervention or for assessment), i.e., to what degree got the study team to know the participant. In online-only trials, clarify if participants were quasi-anonymous and whether having multiple identities was possible or whether technical or logistical measures (e.g., cookies, email confirmation, phone calls) were used to detect/prevent these.
Does your paper address subitem 4a-ii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "All participants were provided with information regarding the study at the beginning of the S2S program. The lead researcher answered questions and completed the consent process with interested participants. "

4a-iii) Information giving during recruitment
Information given during recruitment. Specify how participants were briefed for recruitment and in the informed consent procedures (e.g., publish the informed consent documentation as appendix, see also item X26), as this information may have an effect on user self-selection, user expectation and may also bias results.

Does your paper address subitem 4a-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "All participants were provided with information regarding the study at the beginning of the S2S program. The lead researcher answered questions and completed the consent process with interested participants. " 4b) Settings and locations where the data were collected subitem not at all important 1 2 3 4 5 essential Does your paper address CONSORT subitem 4b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "To be eligible, participants had to have completed the 12-week Strength2Strength (S2S) Tasmania Exercise Treatment Initiative" "The study was approved by the Tasmanian Health and Medical Human Research Ethics Committee (H0014713) and was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615001104549). "

4b-i) Report if outcomes were (self-)assessed through online questionnaires
Clearly report if outcomes were (self-)assessed through online questionnaires (as common in web-based trials) or otherwise.
Does your paper address subitem 4b-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study No online questionnaires were utilised Does your paper address subitem 4b-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer 5-i) Mention names, credential, affiliations of the developers, sponsors, and owners Mention names, credential, affiliations of the developers, sponsors, and owners [6] (if authors/evaluators are owners or developer of the software, this needs to be declared in a "Conflict of interest" section or mentioned elsewhere in the manuscript).
Does your paper address subitem 5-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The UC group received standard care which included the provision of an individualised home-based exercise program and an optional referral to a range of community-based physical activity programs. In addition to receiving usual care, participants randomised to AT were provided with a Jawbone UP24™ (Jawbone, Inc. 99 Rhode Island St, San Francisco, CA 94103) activity tracker and ZTE™ mobile device and data plan. Participants who already had a compatible smartphone could chose to use the mobile device provided or their own device. No reimbursement for data costs was provided to those who chose to use their own smartphone. The device was worn on the non-dominant wrist for the duration of the 12month intervention. Participants were provided with an individual information session on how to use, pair and charge the device at the time of randomisation to the AT group. Written instructions and telephone support were provided to troubleshoot any technical issues. The Jawbone UP24™ was paired to synchronise with the Jawbone UP™ application (UP™ app) on the mobile device. A daily step goal was individually prescribed for each participant, based on their physical function and current level of physical activity. This daily step goal was programmed into the UP™ app at the time of randomisation, with automated feedback provided by the tracker and app based on this daily step goal. Participants were asked to synchronise the tracker with the UP™ app at the end of each day but could check the progress towards their daily step goal as desired. In addition to daily feedback available through the UP™ app, participants received weekly text messages from an Accredited Exercise Physiologist (AEP). Text message contained feedback relating to average daily steps, comparison to their daily step goal and the previous week. Participants were meeting their step goal, were encouraged to maintain their current activity levels. Participants recording step counts below their goal, were encouraged to increase steps by a small amount each day to help progress towards achieving their goal (Supplementary Figure 1). Participants randomised to TC received usual care as well as a physical activity counselling phone call once a fortnight for the first 3 months and once a month for the remaining 9 months of the intervention. Phone calls, were delivered by an AEP, following set protocols and utilising standard motivational interviewing techniques [14]. Participants were asked to self-report activity levels, compliance to their home-based exercise program and to identify any issues preventing them from being physically active. Participants were provided with assistance for any specific issues reported. "

5-ii) Describe the history/development process
Describe the history/development process of the application and previous formative evaluations (e.g., focus groups, usability testing), as these will have an impact on adoption/use rates and help with interpreting results.
Does your paper address subitem 5-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Additional detail regarding the S2S initiative and the design of the larger study has been published elsewhere as a protocol paper " doi: 10.1186/s13102-016-0066-5

5-iii) Revisions and updating
Revisions and updating. Clearly mention the date and/or version number of the application/intervention (and comparator, if applicable) evaluated, or describe whether the intervention underwent major changes during the evaluation process, or whether the development and/or content was "frozen" during the trial.
Describe dynamic components such as news feeds or changing content which may have an impact on the replicability of the intervention (for unexpected events see item 3b).

Does your paper address subitem 5-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer

5-iv) Quality assurance methods
Provide information on quality assurance methods to ensure accuracy and quality of information provided [1], if applicable.
Does your paper address subitem 5-iv?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer 5-v) Ensure replicability by publishing the source code, and/or providing screenshots/screen-capture video, and/or providing flowcharts of the algorithms used Ensure replicability by publishing the source code, and/or providing screenshots/screen-capture video, and/or providing flowcharts of the algorithms used. Replicability (i.e., other researchers should in principle be able to replicate the study) is a hallmark of scientific reporting.

Does your paper address subitem 5-v?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer

5-vi) Digital preservation
Digital preservation: Provide the URL of the application, but as the intervention is likely to change or disappear over the course of the years; also make sure the intervention is archived (Internet Archive, webcitation.org, and/or publishing the source code or screenshots/videos alongside the article). As pages behind login screens cannot be archived, consider creating demo pages which are accessible without login.
Does your paper address subitem 5-vi?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer

5-vii) Access
Access: Describe how participants accessed the application, in what setting/context, if they had to pay (or were paid) or not, whether they had to be a member of specific group. If known, describe how participants obtained "access to the platform and Internet" [1]. To ensure access for editors/reviewers/readers, consider to provide a "backdoor" login account or demo mode for reviewers/readers to explore the application (also important for archiving purposes, see vi).
Does your paper address subitem 5-vii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer Does your paper address subitem 5-viii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "In addition to receiving usual care, participants randomised to AT were provided with a Jawbone UP24™ (Jawbone, Inc. 99 Rhode Island St, San Francisco, CA 94103) activity tracker and ZTE™ mobile device and data plan. Participants who already had a compatible smartphone could chose to use the mobile device provided or their own device. No reimbursement for data costs was provided to those who chose to use their own smartphone. The device was worn on the non-dominant wrist for the duration of the 12month intervention. Participants were provided with an individual information session on how to use, pair and charge the device at the time of randomisation to the AT group. Written instructions and telephone support were provided to troubleshoot any technical issues. The Jawbone UP24™ was paired to synchronise with the Jawbone UP™ application (UP™ app) on the mobile device. A daily step goal was individually prescribed for each participant, based on their physical function and current level of physical activity. This daily step goal was programmed into the UP™ app at the time of randomisation, with automated feedback provided by the tracker and app based on this daily step goal. Participants were asked to synchronise the tracker with the UP™ app at the end of each day but could check the progress towards their daily step goal as desired. In addition to daily feedback available through the UP™ app, participants received weekly text messages from an Accredited Exercise Physiologist (AEP). Text message contained feedback relating to average daily steps, comparison to their daily step goal and the previous week. Participants were meeting their step goal, were encouraged to maintain their current activity levels. Participants recording step counts below their goal, were encouraged to increase steps by a small amount each day to help progress towards achieving their goal (Supplementary Figure 1)

5-ix) Describe use parameters
Describe use parameters (e.g., intended "doses" and optimal timing for use). Clarify what instructions or recommendations were given to the user, e.g., regarding timing, frequency, heaviness of use, if any, or was the intervention used ad libitum.
Does your paper address subitem 5-ix?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer

5-x) Clarify the level of human involvement
Clarify the level of human involvement (care providers or health professionals, also technical assistance) in the e-intervention or as co-intervention (detail number and expertise of professionals involved, if any, as well as "type of assistance offered, the timing and frequency of the support, how it is initiated, and the medium by which the assistance is delivered". It may be necessary to distinguish between the level of human involvement required for the trial, and the level of human involvement required for a routine application outside of a RCT setting (discuss under item 21 -generalizability).

Does your paper address subitem 5-x?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer Does your paper address subitem 5-xi? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "In addition to daily feedback available through the UP™ app, participants received weekly text messages from an Accredited Exercise Physiologist (AEP). Text message contained feedback relating to average daily steps, comparison to their daily step goal and the previous week. Participants were meeting their step goal, were encouraged to maintain their current activity levels. Participants recording step counts below their goal, were encouraged to increase steps by a small amount each day to help progress towards achieving their goal "

5-xii) Describe any co-interventions (incl. training/support)
Describe any co-interventions (incl. training/support): Clearly state any interventions that are provided in addition to the targeted eHealth intervention, as ehealth intervention may not be designed as stand-alone intervention. This includes training sessions and support [1]. It may be necessary to distinguish between the level of training required for the trial, and the level of training for a routine application outside of a RCT setting (discuss under item 21 -generalizability. 6a) Completely defined pre-specified primary and secondary outcome measures, including how and when they were assessed Does your paper address subitem 5-xii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Participants were provided with an individual information session on how to use, pair and charge the device at the time of randomisation to the AT group. Written instructions and telephone support were provided to troubleshoot any technical issues. " Does your paper address CONSORT subitem 6a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The primary outcome measure obtained was physical activity participation in the form of a daily step count measured by an ActivPAL™ accelerometer (PAL Technologies Ltd, Scotland, UK), which has been shown to be a valid and reliable device for monitoring physical activity in older adults and individuals with an altered walking gait. The device was fitted to the front over the thigh and worn day and night for a 7-day period with a minimum of five days' worth of valid data required for inclusion at each assessment time. Data from the ActivPAL™ was downloaded using the proprietary software, which provided a daily step count and the time (minutes) spent in sedentary behaviours over a 24 hour period. Self-reported physical activity (total minutes of activity and MET.min-1 per week) were obtained using the Active Australia questionnaire [15]. Secondary outcomes included health risk factors, functional measures and quality of life. Health risk factors were measured using standardised protocols and included body weight, BMI, body fat percentage (BF%), lean mass (LM) and systolic and diastolic blood pressure (SBP and DBP) [14]. Lean mass was reported in kilograms to provide an absolute measure of lean mass rather than percentage, which may change relative to other body composition factors. The ten-time sit to stand ( Does your paper address subitem 6a-i?

Copy and paste relevant sections from manuscript text
Your answer 6a-ii) Describe whether and how "use" (including intensity of use/dosage) was defined/measured/monitored Describe whether and how "use" (including intensity of use/dosage) was defined/measured/monitored (logins, logfile analysis, etc.). Use/adoption metrics are important process outcomes that should be reported in any ehealth trial.

Does your paper address subitem 6a-ii?
Copy and paste relevant sections from manuscript text "Wear time of the activity tracker was calculated as the total number of days in which the tracker was worn, divided by the total number of available days (365 days). Non-wear days were defined as days in which zero steps were recorded. " subitem not at all important 1 2 3 4 5 essential 6b) Any changes to trial outcomes after the trial commenced, with reasons 7a) How sample size was determined NPT: When applicable, details of whether and how the clustering by care provides or centers was addressed 6a-iii) Describe whether, how, and when qualitative feedback from participants was obtained Describe whether, how, and when qualitative feedback from participants was obtained (e.g., through emails, feedback forms, interviews, focus groups).
Does your paper address subitem 6a-iii? Does your paper address subitem 7a-i?
Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "During the 12-week S2S intervention, participants reported a mean increase of 450 MET.min of physical activity per week, with a SD of 1.5x the change. Sample size was calculated on a predicted maintenance of 100% of additional physical activity in the AT and TC groups and a decrease of 50% of additional physical activity in the UC group over the 12month intervention. STATA 12 (Stata Corp, TX, USA) was used to calculate the sample size on the basis of a mean difference of 225 Met.min/week with a SD of the change of 350 MET.min/week, a power of 80% and an alpha level of 0.05. This indicated a required sample size of 38 participants per group. To allow for withdrawals, 50 participants per group were recruited. " Does your paper address CONSORT subitem 7b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study na 8b) Type of randomisation; details of any restriction (such as blocking and block size) 9) Mechanism used to implement the random allocation sequence (such as sequentially numbered containers), describing any steps taken to conceal the sequence until interventions were assigned Does your paper address CONSORT subitem 8a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Randomisation was performed using computer generated blocks of fifteen by a third person not directly involved in the study and was recorded in sealed opaque envelopes with envelopes opened sequentially at the end of S2S to reveal the intervention allocation. Participants from the same household, were randomised to the same intervention group to maintain intervention integrity. " Does your paper address CONSORT subitem 8b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Randomisation was performed using computer generated blocks of fifteen by a third person not directly involved in the study and was recorded in sealed opaque envelopes with envelopes opened sequentially at the end of S2S to reveal the intervention allocation. Participants from the same household, were randomised to the same intervention group to maintain intervention integrity. " https://docs.google.com/forms/d/e/1FAIpQLSfZBSUp1bwOc_OimqcS64RdfIAFvmrTSkZQL2-3O8O9hrL5Sw/viewform?hl=en_US&formkey=dG… 33/52 10) Who generated the random allocation sequence, who enrolled participants, and who assigned participants to interventions 11a) If done, who was blinded after assignment to interventions (for example, participants, care providers, those assessing outcomes) and how NPT: Whether or not administering co-interventions were blinded to group assignment subitem not at all important 1 2 3 4 5 essential Does your paper address CONSORT subitem 9? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Randomisation was performed using computer generated blocks of fifteen by a third person not directly involved in the study and was recorded in sealed opaque envelopes with envelopes opened sequentially at the end of S2S to reveal the intervention allocation. Participants from the same household, were randomised to the same intervention group to maintain intervention integrity. " Does your paper address CONSORT subitem 10? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Randomisation was performed using computer generated blocks of fifteen by a third person not directly involved in the study and was recorded in sealed opaque envelopes with envelopes opened sequentially at the end of S2S to reveal the intervention allocation. Participants from the same household, were randomised to the same intervention group to maintain intervention integrity. " 11a-i) Specify who was blinded, and who wasn't Specify who was blinded, and who wasn't. Usually, in web-based trials it is not possible to blind the participants [1, 3] (this should be clearly acknowledged), but it may be possible to blind outcome assessors, those doing data analysis or those administering co-interventions (if any).

11b) If relevant, description of the similarity of interventions
(this item is usually not relevant for ehealth trials as it refers to similarity of a placebo or sham intervention to a active medication/intervention) Does your paper address subitem 11a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Participants were not blinded to intervention due to the nature of the interventions.
11a-ii) Discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator" Informed consent procedures (4a-ii) can create biases and certain expectations -discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator".

Does your paper address subitem 11a-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study

Your answer
Does your paper address CONSORT subitem 11b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study na https://docs.google.com/forms/d/e/1FAIpQLSfZBSUp1bwOc_OimqcS64RdfIAFvmrTSkZQL2-3O8O9hrL5Sw/viewform?hl=en_US&formkey=dG… 35/52 12a) Statistical methods used to compare groups for primary and secondary outcomes NPT: When applicable, details of whether and how the clustering by care providers or centers was addressed subitem not at all important 1 2 3 4 5 essential Does your paper address CONSORT subitem 12a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Data were graphically represented using GraphPad Prism (version 7.00 for Windows, GraphPad Software, La Jolla California USA). Intention to treat analysis included all 117 participants who were randomised. Analysis of only those participants who completed all four assessment time points (per protocol analysis) was also conducted (n=75; UC=26, TC=25, AT=24). Comparisons between the three interventions (as change from baseline) were made using mixed effects ordered logistic regression adjusted for repeated measures (Stata, v. 13.1, StataCorp, TX, USA) because assumptions of linear regression were not met for most variables tested. For ease of understanding, comparison results are shown as mean difference and 95% confidence interval (MD; 95%CI) but with p values obtained from logistic regression analyses. " 12a-i) Imputation techniques to deal with attrition / missing values Imputation techniques to deal with attrition / missing values: Not all participants will use the intervention/comparator as intended and attrition is typically high in ehealth trials. Specify how participants who did not use the application or dropped out from the trial were treated in the statistical analysis (a complete case analysis is strongly discouraged, and simple imputation techniques such as LOCF may also be problematic [4]).
Does your paper address subitem 12a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Intention to treat analysis included all 117 participants who were randomised. Analysis of only those participants who completed all four assessment time points (per protocol analysis) was also conducted (n=75; UC=26, TC=25, AT=24). " 12b) Methods for additional analyses, such as subgroup analyses and adjusted analyses

X26) REB/IRB Approval and Ethical Considerations [recommended as
subheading under "Methods"] (not a CONSORT item) subitem not at all important 1 2 3 4 5 essential Does your paper address CONSORT subitem 12b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study na X26-i) Comment on ethics committee approval Does your paper address subitem X26-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study

x26-ii) Outline informed consent procedures
Outline informed consent procedures e.g., if consent was obtained offline or online (how? Checkbox, etc.?), and what information was provided (see 4a-ii). See [6] for some items to be included in informed consent documents.
Does your paper address subitem X26-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer

X26-iii) Safety and security procedures
Safety and security procedures, incl. privacy considerations, and any steps taken to reduce the likelihood or detection of harm (e.g., education and training, availability of a hotline)

Does your paper address subitem X26-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer 13a) For each group, the numbers of participants who were randomly assigned, received intended treatment, and were analysed for the primary outcome NPT: The number of care providers or centers performing the intervention in each group and the number of patients treated by each care provider in each center 13b) For each group, losses and exclusions after randomisation, together with reasons subitem not at all important 1 2 3 4 5 essential Does your paper address CONSORT subitem 13a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Between September 2014 and June 2016, 152 people consented to participate when starting S2S, with 117 randomised to one of the study intervention groups upon completion of S2S. Figure 2 shows the progression of participants through the trial. : CONSORT flow diagram also provided.
Does your paper address CONSORT subitem 13b? (NOTE: Preferably, this is shown in a CONSORT flow diagram) * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study CONSORT Flow diagram included

13b-i) Attrition diagram
Strongly recommended: An attrition diagram (e.g., proportion of participants still logging in or using the intervention/comparator in each group plotted over time, similar to a survival curve) or other figures or tables demonstrating usage/dose/engagement.

14a) Dates defining the periods of recruitment and follow-up
subitem not at all important 1 2 3 4 5 essential 14b) Why the trial ended or was stopped (early) Does your paper address subitem 13b-i?
Copy and paste relevant sections from the manuscript or cite the figure number if applicable (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study

Your answer
Does your paper address CONSORT subitem 14a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Between September 2014 and June 2016," 14a-i) Indicate if critical "secular events" fell into the study period Indicate if critical "secular events" fell into the study period, e.g., significant changes in Internet resources available or "changes in computer hardware or Internet delivery resources" Does your paper address subitem 14a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Does your paper address CONSORT subitem 14b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The target number of 150 participants were recruited at the start of S2S, however a number of participants did not complete S2S and were not randomised. Due to the cessation of the S2S program, additional participants could not be recruited to account for the withdrawals prior to the intervention" Does your paper address CONSORT subitem 15? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study

16-i) Report multiple "denominators" and provide definitions
Report multiple "denominators" and provide definitions: Report N's (and effect sizes) "across a range of study participation [and use] thresholds" [1], e.g., N exposed, N consented, N used more than x times, N used more than y weeks, N participants "used" the intervention/comparator at specific pre-defined time points of interest (in absolute and relative numbers per group). Always clearly define "use" of the intervention.
Does your paper address subitem 16-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Intention to treat analysis included all 117 participants who were randomised. Analysis of only those participants who completed all four assessment time points (per protocol analysis) was also conducted (n=75; UC=26, TC=25, AT=24). "

16-ii) Primary analysis should be intent-to-treat
Primary analysis should be intent-to-treat, secondary analyses could include comparing only "users", with the appropriate caveats that this is no longer a randomized sample (see 18-i). Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Intention to treat analysis included all 117 participants who were randomised. " Does your paper address CONSORT subitem 17a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Mean and SD or Median and IQR presented for all outcomes (depending on if normally distributed or not) Graphically representation of steps include SEM 17a-i) Presentation of process outcomes such as metrics of use and intensity of use In addition to primary/secondary (clinical) outcomes, the presentation of process outcomes such as metrics of use and intensity of use (dose, exposure) and their operational definitions is critical. This does not only refer to metrics of attrition (13-b) (often a binary variable), but also to more continuous exposure metrics such as "average session length". These must be accompanied by a technical description how a metric like a "session" is defined (e.g., timeout after idle time) [1] (report under item 6a).
Does your paper address subitem 17a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer 17b) For binary outcomes, presentation of both absolute and relative effect sizes is recommended 18) Results of any other analyses performed, including subgroup analyses and adjusted analyses, distinguishing pre-specified from exploratory subitem not at all important 1 2 3 4 5 essential Does your paper address CONSORT subitem 17b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study na Does your paper address CONSORT subitem 18? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Per protocol analysis completed "Analysis of only those participants who completed all four assessment time points (per protocol analysis) was also conducted (n=75; UC=26, TC=25, AT=24). "

18-i) Subgroup analysis of comparing only users
A subgroup analysis of comparing only users is not uncommon in ehealth trials, but if done, it must be stressed that this is a self-selected sample and no longer an unbiased sample from a randomized trial (see 16-iii).

19) All important harms or unintended effects in each group
(for specific guidance see CONSORT for harms) subitem not at all important 1 2 3 4 5 essential Does your paper address subitem 18-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study

Your answer
Does your paper address CONSORT subitem 19? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study na

19-i) Include privacy breaches, technical problems
Include privacy breaches, technical problems. This does not only include physical "harm" to participants, but also incidents such as perceived or real privacy breaches [1], technical problems, and other unexpected/unintended incidents. "Unintended effects" also includes unintended positive effects [2].

Does your paper address subitem 19-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer Does your paper address subitem 19-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer 22-i) Restate study questions and summarize the answers suggested by the data, starting with primary outcomes and process outcomes (use) Restate study questions and summarize the answers suggested by the data, starting with primary outcomes and process outcomes (use). Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "We found that both activity trackers and telephone counselling are similarly effective at maintaining daily step count in older adults over a 12-month period. In contrast, UC showed a significant reduction in daily steps at 12-months. A reduction in lean mass over the 12month follow-up was also observed in the UC group, but not in the TC or AT groups. These findings highlight activity trackers as an effective alternative for providing ongoing support to older adults to maintain physical activity and preserve lean mass. "

22-ii) Highlight unanswered new questions, suggest future research
Highlight unanswered new questions, suggest future research.

Does your paper address subitem 22-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The costs associated with delivering each intervention and the effects each intervention may have on health utility should also be taken into consideration and investigated further. "

20-i) Typical limitations in ehealth trials
Typical limitations in ehealth trials: Participants in ehealth trials are rarely blinded. Ehealth trials often look at a multiplicity of outcomes, increasing risk for a Type I error. Discuss biases due to non-use of the intervention/usability issues, biases through informed consent procedures, unexpected events.
Does your paper address subitem 20-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "A limitation of this study potentially affecting ability to interpret results was that the a priori sample size was not met. The target number of 150 participants were recruited at the start of S2S, however a number of participants did not complete S2S and were not randomised. Due to the cessation of the S2S program, additional participants could not be recruited to account for the withdrawals prior to the intervention. Further drop-outs occurred during the 12-month intervention. The primary reason for withdrawal was ill-health which is not unexpected given over 70% of the study population had two or more chronic conditions. Five participants withdrew from the AT group due to feeling uncomfortable using the device. While activity trackers are well accepted in older adult populations [33], this highlights that activity trackers may not be suitable for all older adults. "

21-i) Generalizability to other populations
Generalizability to other populations: In particular, discuss generalizability to a general Internet population, outside of a RCT setting, and general patient population, including applicability of the study results for other organizations

23) Registration number and name of trial registry
Does your paper address subitem 21-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer 21-ii) Discuss if there were elements in the RCT that would be different in a routine application setting Discuss if there were elements in the RCT that would be different in a routine application setting (e.g., prompts/reminders, more human involvement, training sessions or other co-interventions) and what impact the omission of these elements could have on use, adoption, or outcomes if the intervention is applied outside of a RCT setting.
Does your paper address subitem 21-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Your answer Does your paper address CONSORT subitem 23? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study This study is registered at www.anzctr.org.au (ACTRN12615001104549).
Does your paper address CONSORT subitem 24? * Cite a Multimedia Appendix, other reference, or copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study This study is registered at www.anzctr.org.au (ACTRN12615001104549).
Published protocol -doi: 10.1186/s13102-016-0066-5 Does your paper address CONSORT subitem 25? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "This research was supported by internal funding available through the University of Tasmania. In kind support was provided by Primary Health Tasmania during the recruitment and data collection phase of this research. " In addition to the usual declaration of interests (financial or otherwise), also state the relation of the study team towards the system being evaluated, i.e., state if the authors/evaluators are distinct from or identical with the developers/sponsors of the intervention.
Does your paper address subitem X27-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study

Your answer
As a result of using this checklist, did you make changes in your manuscript? * What were the most important changes you made as a result of using this checklist?
Your answer