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Original Investigation
April 20, 2022

Effectiveness of a Text-Based Gamification Intervention to Improve Physical Activity Among Postpartum Individuals With Hypertensive Disorders of Pregnancy: A Randomized Clinical Trial

Author Affiliations
  • 1Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 2Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 3Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 4Ascension, St Louis, Missouri
JAMA Cardiol. 2022;7(6):591-599. doi:10.1001/jamacardio.2022.0553
Visual Abstract. Effectiveness of a Text-Based Gamification Intervention to Improve Physical Activity Among Postpartum Individuals With Hypertensive Disorders of Pregnancy
Effectiveness of a Text-Based Gamification Intervention to Improve Physical Activity Among Postpartum Individuals With Hypertensive Disorders of Pregnancy
Key Points

Question  Can a digital health intervention incorporating gamification, social incentives, and principles of behavioral economics improve physical activity among postpartum individuals with hypertensive disorders of pregnancy?

Findings  In this randomized clinical trial of 127 postpartum individuals, participants receiving the digital health intervention had a significantly greater increase in mean daily steps from baseline compared with the control arm. Participants achieved their steps goals on a greater proportion of days during the 12-week intervention period.

Meaning  Digital health interventions using behavioral strategies result in increased physical activity among postpartum individuals at elevated cardiovascular risk.

Abstract

Importance  Hypertensive disorders of pregnancy are associated with increased risk of cardiovascular disease, yet few interventions have targeted this population to decrease long-term risk.

Objective  To determine whether a digital health intervention improves physical activity in postpartum individuals with hypertensive disorders of pregnancy.

Design, Setting, and Participants  This 12-week randomized clinical trial enrolled postpartum individuals who delivered at the University of Pennsylvania and had a hypertensive disorder of pregnancy between October 2019 and June 2020. Analysis was intention to treat.

Interventions  All participants received a wearable activity tracker, established a baseline step count, selected a step goal greater than baseline, and were randomly assigned to control or intervention. Participants in the control arm received daily feedback on goal attainment. Participants in the intervention arm were placed on virtual teams and enrolled in a game with points and levels for daily step goal achievement and informed by principles of behavioral economics.

Main Outcomes and Measures  The primary outcome was change in mean daily step count from baseline to 12-week follow-up. Secondary outcome was proportion of participant-days that step goal was achieved.

Results  A total of 127 participants were randomized (64 in the control group and 63 in the intervention group) and were enrolled a mean of 7.9 weeks post partum. Participants had a mean (SD) age of 32.3 (5.6) years, 70 (55.1%) were Black, and 52 (41.9%) had Medicaid insurance. The mean (SD) baseline step count was similar in the control and intervention arms (6042 [2270] vs 6175 [1920] steps, respectively). After adjustment for baseline steps and calendar month, participants in the intervention arm had a significantly greater increase in mean daily step steps from baseline compared with the control arm (647 steps; 95% CI, 169-1124 steps; P = .009). Compared with the control arm, participants in the intervention arm achieved their steps goals on a greater proportion of participant-days during the intervention period (0.47 vs 0.38; adjusted difference 0.11; 95% CI, 0.04-0.19; P = .003).

Conclusions and Relevance  In this study, a digital health intervention using remote monitoring, gamification, and social incentives among postpartum individuals at elevated cardiovascular risk significantly increased physical activity throughout 12 weeks.

Trial Registration  ClinicalTrials.gov Identifier: NCT03311230

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