Effectiveness of a Text-Based Gamification Intervention to Improve Physical Activity Among Postpartum Individuals With Hypertensive Disorders of Pregnancy

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 MEASURESThe 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 RELEVANCEIn 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.

Challenges and opportunities to improving research in maternal cardiovascular health

“…Digital interventions, such as remote blood pressure monitoring following a hypertensive pregnancy, have improved rates of blood pressure screening and treatment, especially among Black women 14 . Digital interventions that promote physical activity and weight loss have also been successful in the postpartum period to improve cardiovascular health metrics 15 . Digital tools that promote cardiovascular health that can be incorporated within health systems or community organizations have the greatest potential to become standard of care and reach the majority of patients.…”

Improving Postpartum and Long-Term Health After an Adverse Pregnancy Outcome: Examining Interventions From a Health Equity Perspective

“…In order to be culturally appropriate for the target audience, the acceptability, efficiency, and effectiveness of the app are designed in accordance with patient preferences. Similarly, Social Ties to Encourage Physical activity among Postpartum Mothers is designed specifically for postpartum individuals with HDP;72 participants are enrolled in a mobile, team-based gamification intervention with points, levels, and small prizes to encourage daily step-count goals. Further study is required to determine whether mHealth interventions can improve postpartum health and reduce disparities on a larger scale.…”

The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care

“…Remote monitoring intervention using wearable activity trackers has been shown to be effective in increasing daily physical activity during the postpartum period. Lewey et al studied the role of gamified digital health intervention (involving text messages providing feedback, social incentives, and points for meeting goals) in increasing daily step counts in women diagnosed with a hypertensive disorder during a recent pregnancy and found the intervention effective in increasing physical activity over the 12-week study period [ 89 ]. Additional studies are needed to study the cost-effectiveness of these interventions for weight reduction and activity promotion.…”