Health apps: How to pick the useful ones and what to know when using one

SINGAPORE — These days, it is easy to find a mobile application on your smartphone to help you track your physical activity, manage calorie intake or monitor a chronic condition such as diabetes.

Dr Alexander Yip, a gastroenterology surgeon with Alexandra Hospital, told TODAY that health apps and wearable trackers and smartwatches can play a significant role in Singapore’s shift in focus towards preventive healthcare.

Dr Yip is also the clinical director of healthcare redesign at the hospital, looking into the introduction and use of technology-enabled care there and within the community.

“These digital tools can help individuals make informed decisions about their lifestyle choices and take proactive steps to prevent the onset (of chronic illnesses),” he said.

Wearables can also monitor vital signs and provide alerts to remind users to move more and avoid sedentary behaviour, which are essential for preventing many chronic conditions.

“Additionally, health apps and wearables can be leveraged by healthcare providers to support lifestyle modification, which is a cornerstone for any preventive health strategy,” Dr Yip added.

A recent study commissioned by insurer Prudential Singapore found that three in four Singapore residents aged 25 to 65 report rated themselves as “good” or “excellent” at using apps to monitor their physical health.

More than half (54 per cent) said that mobile devices and apps are the most important tools they have to help them live well for longer.

However, another study last year by electronics firm Philips showed that although more than a third of Singapore residents are using personal health devices such as fitness trackers to monitor heart health and nutrition, about two in five said that they “rarely or never take action” based on the health data collected.

Of those who took part in the Philips’ survey, 42 per cent were more inclined to act on their digital health data if recommended by their doctor and healthcare providers.

Dr Yip’s colleague, Dr Koh Tsingyi, who is head of healthcare redesign at Alexandra Hospital, said that health apps can complement the management of chronic conditions, especially if the information is shared with the patient’s doctors.

“It can give doctors additional insights to manage their patients holistically, taking into account some of their lifestyle and activity information.”

Dr Lim Su Lin, chief dietitian and head of the department of dietetics at National University Hospital (NUH), said that getting patients to modify their lifestyles can involve many face-to-face sessions with healthcare professionals and these tend to be more labour-intensive and require facilities and appointment planning.

“Supporting face-to-face visits with mobile health apps in-between visits to clinics may help to cut back the cost and yield good health outcomes,” she added.

WHAT TO KNOW WHEN USING A HEALTH APP

How would you know which app to use?

Dr Koh from Alexandra Hospital said that it depends on each individual’s behaviour, motivation, lifestyle and health condition.

Look out for features that align with your lifestyle and goals, as well as how credible the app is, to ensure that information provided is reliable, she advised.

Mr Peter Forbes, group chief digital officer of the National University Health System (NUHS), suggested considering the organisation behind the app and looking for one developed with inputs from qualified medical professionals. An example is the Nutritionist Buddy, or nBuddy, conceptualised by Dr Lim from NUH.

They should also look into user reviews of the app and the permissions requested by the app, such as camera access, and consider that the app may be sharing data with third parties, Mr Forbes added.

ACCURACY MATTERS

One of the biggest concerns when using health apps is accuracy and reliability.

Dr Yip warned that some apps may use inaccurate algorithms or unreliable data sources, which can be dangerous and potentially life-threatening especially for individuals with serious health conditions.  

“For example, a patient with kidney failure receiving nudges to drink water every hour may not be appropriate for their health condition,” he cautioned.

Dr Lim highlighted that different apps use different methods and tools to collect and analyse health data.

For instance, some people may find that their fitness trackers’ (such as Garmin, Fitbit watch) steps count differs from those that are tracked on their smartphone app. This could be due to the different method of tracking activities, she said.

When it comes to monitoring blood sugar, such inaccuracies in data could lead to wrong treatment decisions and potential harm, she said.

For this reason, she advised choosing apps that are backed by evidence-based science and have shown good health outcomes in high-level studies such as randomised controlled trials. Even better if the apps provide an option of health coaching from healthcare professionals.

And although knowing when a blood sugar spike occurs or the amount of calories consumed at mealtimes can be useful, the experts all emphasised that data from health apps should not replace professional medical advice or clinical care.

AN APP CANNOT REPLACE YOUR DOCTOR

Dr Yip and Dr Koh from Alexandra Hospital warned against over-relying on health apps, which could potentially lead to missed diagnoses, delayed treatment and other negative health outcomes.

“Data made available through health apps, especially those generated from wearables, may create unnecessary anxiety for patients who do not understand its significance.

“On the flipside, those who use these apps may also feel that they have good control of their health and do not seek help when they need to,” Dr Yip said.

For these reasons, Dr Lim from NUH said that it would be a good idea to use health apps alongside advice from healthcare practitioners. This is particularly important for people with medical conditions or are on certain medications.

“For example, if you are on diabetes medications, you will need to work closely with your healthcare providers to manage your medical condition to avoid hypoglycaemia (a condition where the blood glucose goes too low).

“The doctors may need to reduce the diabetes medicine as your blood glucose become under control with lifestyle changes,” she explained.

With so many options in the app store, it can be hard to know where to start. TODAY picked out some well-used health apps that support different health concerns and needs.

1. FOR MOTIVATION AND REWARDS: LUMIHEALTH AND HEALTHY 365

If you have an Apple Watch, check out the LumiHealth app designed by the Health Promotion Board (HPB) in conjunction with Apple as part of the country’s Smart Nation initiative, a national effort to leverage technology to deliver benefits to its citizens and businesses.

Created in collaboration with a team of physicians, public health experts and powered by Apple Watch, LumiHealth encourages healthy lifestyle changes through a personalised programme, designed with built-in privacy and data security. It is best paired with an Apple Watch Series 3 or later models.

Besides tracking physical activity, it monitors your mental well-being, sleep, nutrition, preventive screening and vaccinations. The app is also programmed to motivate and guide you through everyday challenges using personalised health tips and nudges — think of it as having your very own health cheerleader.

Participants get to earn coin rewards, by reading articles and completing customised challenges, for example, and redeem the coin rewards for HPB e-vouchers that can be used at major lifestyle retailers, food-and-beverage outlets, and supermarkets.

Another fitness and lifestyle app by HPB to check out is Healthy 365, a must-have app for the National Steps Challenge, an initiative that encourages residents in Singapore to adopt a more active lifestyle.

Users may sign up for health challenges and programmes to earn “Healthpoints”, and convert their healthier actions into rewards. The app pairs with a range of fitness tracking devices to help users log their daily steps count and amount of time spent on active exercises.

There is also an option to scan QR codes via the app to earn Healthpoints when buying healthier meals, drinks and groceries from participating partners.

The LumiHealth and Healthy 365 apps are free.

2. FOR FOOD INTAKE, MANAGING DIABETES: NUTRITIONIST BUDDY (NBUDDY)

There are many diet and nutritional apps that track calories, vitamin and mineral content of various food, as well as help you plan meals.

But not all will tell you the nutritional content of food and drink found in Singapore, for example, teh C (tea with evaporated milk), kaya toast or roti prata.

Nutritionist Buddy has that and scientifically backed by several randomised controlled trials carried out in Singapore.

The app was conceptualised by Dr Lim and developed by HeartVoice, a Singapore company that offers medical technology solutions for healthcare providers, patients and corporate organisations.

There is also nBuddy Diabetes, for people who have been diagnosed with pre-diabetes or Type 2 diabetes. 

Like nBuddy, it integrates behavioural treatment and evidence-based strategies to promote weight loss or maintenance and glycaemic control.

Users log their daily food intake by selecting the app’s database of more than 14,000 food items available in Singapore. It automatically prompts and recommends healthier food alternatives catered to the individual’s ethnicity.

The step-counting function of the app is synced with the built-in pedometers of participants’ smartphones, allowing users to track their physical activity. Users may also input a range of physical activities manually, if exercises are done in the absence of mobile devices.

It is used by NUH’s dietitian team to help patients manage their health conditions and diet, particularly those who are overweight, obese and those with pre-existing or are at risk of developing chronic diseases. 

Dr Lim said that nBuddy Diabetes has been used to support women with gestational diabetes at NUH, to help them achieve good blood glucose control during pregnancy.

However, the public may download app at no cost and access basic features, such as a food diary logging system that allows people to monitor their calorie intake.

It also has an automated response system that evaluates food choices and generate healthier alternatives. A peer support chat channel feature is available as well.

In the paid modes, more features are unlocked. For a monthly fee, added features include in-app coaching by a dietitian and weekly educational videos on strategies for weight loss.

Studies conducted by Dr Lim and her team of researchers found that compared to people who only received advice from a dietitian, participants who also used the app to guide them on food choices and exercises had significantly greater reductions in body weight and improvements in blood sugar levels.

For example, the pre-diabetes group assigned to the nBuddy Diabetes app were 2.1 times more likely to achieve normal blood glucose. In patients with poorly controlled diabetes, the app group had significantly greater reduction in average blood sugar levels.

They were also four to five times more likely to achieve weight loss of 5 per cent or more, and had three times more weight loss that those in the control group.

3. FOR MANAGING KETO DIETS: NBUDDY KETO

For people considering going on a keto diet, the nBuddy Keto app can help support weight loss goals, in a healthier and more sustainable manner without compromising on heart health.

The keto diet involves consuming very little carbohydrates and replacing them with high fat foods. Traditionally, people on such diets tend to have a high intake of saturated fat, which can increase bad cholesterol levels and heart disease risk, Dr Lim said.

A key feature of the app is that it integrates and tracks the limit of 50g of net carbohydrates a day.

The app was developed based on the principles of the Healthy Keto plan — a healthy version of the diet developed by Dr Lim — which includes calorie restriction according to the individual.

It emphasises on healthy fats, such as those found in nuts, seeds, avocados, fatty fish and unsaturated oils, which do not increase bad cholesterol levels.

This Healthy Keto diet includes adequate amounts of lean protein, high fibre from non-starchy vegetables and fruits low in carbohydrates.

An ongoing randomised controlled trial, comprising 80 employee participants from the NUHS, shows that those on this Healthy Keto diet lost an average of 7.4 kg over six months without increasing their cholesterol levels.

The nBuddy Keto app was used to assist with food selection and meal planning.

All participants with diabetes or pre-diabetes managed to reduce their blood glucose levels, and 70 per cent of those with high blood pressure saw an improvement. Participants who followed the diet closely found a reduced dependence on their prescribed medications and overall, a better quality of life, Dr Lim said.

4. FOR MANAGING MEDICAL APPOINTMENTS: HEALTHHUB SG, ONENUHS, HEALTH BUDDY

There is nothing more confusing and frustrating than managing multiple medical appointments, reports and medication prescriptions across different hospitals and healthcare centres.

One-stop health apps can make things easier, and are a must-have, especially if you are a caregiver caring for the young and old.

Check out the OneNUHS app (for NUHS patients) and Health Buddy (for patients from SingHealth public healthcare group).

They allow for a range of healthcare services, such as managing and changing appointments, request for medical reports, viewing of test results or even order medications.

The OneNUHS app has a chatbot feature, which allows you to clear up commonly ask questions, as well as get information on clinic operating hours. This can be useful if you do not wish to trawl through the app or websites to find information.

The HealthHub SG app, a national digital healthcare platform, also allows you to access health records and perform various transactions across participating restructured hospitals, polyclinics and specialist outpatient clinics from the public sector. 

All three apps are free.

5. FOR TELECONSULTATIONS: WHITECOAT, MANADR  

The Covid-19 pandemic led to a surge of telehealth services and their advantages and drawbacks have been debated.

For common sicknesses where patients are feeling too weak and do not want to put up with long queues at the clinic — or potentially spreading germs along their way there — they may book a video consultation with a registered doctor and have medications delivered to wherever they are. 

Some of the top telehealth apps available here include WhiteCoat and MaNaDr.

WhiteCoat offers general practitioner, paediatrician and professional mental wellness services, as well as home-based health screenings.

In addition to health consultations, the MaNaDr app allows you to book home visits from nurses and doctors. It also offers a weight management programme, where users may consult a weight management doctor, exercise instructor or dietitian.

The apps are free, but service charges apply and vary with each provider.