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Text-based gamification boosts physical activity in hypertensive postpartum women

JAMA Cardiology
Reuters Health - 25/04/2022 - Postpartum women with elevated cardiovascular risk increased their activity levels after signing on for a text-based gamification program, a new study finds.

Data from 127 postpartum women, of whom half were randomly assigned to an intervention group, revealed that participating in the gamification program made the women take significantly more steps compared with women in a control group, researchers report in JAMA Cardiology.

"The unique aspect of our study is that we targeted women who had a pregnancy complicated by high blood pressure, which is an important risk factor for cardiovascular disease later in life," said first author Dr. Jennifer Lewey of Penn Women's Cardiovascular Health Program at the University of Pennsylvania Perelman School of Medicine, in Philadelphia.

"It's especially important to design interventions to promote cardiovascular health in these young and at-risk women," she told Reuters Health by email.

"There are several features that helped to engage women to exercise more," Dr. Lewey added. "First, the intervention was entirely remote, making it easier for postpartum moms to participate. Second, we used game features like points and levels to make achieving step goals fun. Third, women felt accountable to their teammates, since they would lose points for their team if they didn't meet their step goal for the day. Finally, women had the opportunity to start fresh every week, even if they didn't meet their goal the week before."

To explore whether gamification could spur postpartum women with blood pressure issues to be more active, Dr. Lewey and her colleagues recruited 127 women diagnosed with a hypertensive disorder during pregnancy to participate in a randomized controlled trial. The women in the study had a mean age of 32, 55% were Black and 42% had Medicaid insurance.

All of the participants received wearable activity trackers (Fitbit Inspire HR). Those in the intervention group also received team-based gamification throughout the 12-week trial.

After the women were enrolled, they were asked to wear the activity tracker daily for two weeks to become accustomed to the device and for the researchers to calculate a baseline level of activity. Afterward, all the women were asked to use the activity tracker to reach their daily step goal for 12 weeks. They received daily automated text messages providing feedback on whether or not the previous day's step goal was met.

In the intervention group, the women were also enrolled in a team-based gamification intervention consisting of points and levels and leveraging the performance of other participants on the team. For example, if the number of steps were greater than or equal to the daily goal, the team would receive messages such as "Tuesday: XX was selected to represent your team and XX met their goal yesterday. Great job meeting your goal! Your team still has XX points for this week. Keep it up!" and "Sunday: Terrific, XX was selected as team rep and met their goal on Saturday so your team has XX points. Stay active today to finish the week strong!!"

When the number of steps was less than the daily goal, messages could read: "Tuesday: Your team lost 10 points because XX was selected as team rep and they did not meet their step goal on Monday. This week your team has XX points remaining. Try to meet your goal each day in case you are selected as team rep next." And, "Friday: Your team now has XX points as XX was selected as team rep and they didn't meet their step goal yesterday. Your goal is XXXX steps. Don't get discouraged, and try to stay active through Sunday!"

After adjusting for baseline steps and calendar month, the researchers found that the women in the intervention group walked a mean of 647 more steps each day compared with the control arm (P=0.009).

Most of the participants in the study said they would recommend the program to others. And in the intervention arm, 15 participants requested more contact with teammates for encouragement and motivation.

"You can sit and talk with women about lifestyle modifications and tell them they need more steps, but when you engage people like this, it has such positive effects," said Dr. Mary Rosser, director of Integrated Women's Health in the department of obstetrics and gynecology at the Columbia University Irving Medical Center in New York City. "I love it!"

"This is a very effective strategy," Dr. Rosser, who was not involve in the study, told Reuters Health by phone. "What I also love is that there has been so much discussion about people with low resources who don't have WIFI. This is very refreshing. They have shown that texting is a great strategy for connecting with people. It really offers hope for communication purposes."

The new study is "vital," said Dr. Malamo Countouris, a UPMC cardiologist and co-director of the Magee-Womens Postpartum Hypertension Clinic in Pittsburgh.

"It is one of the first to show an intervention that was successful at motivating women with hypertensive disorders of pregnancy to increase activity level in the postpartum period," Dr. Countouris, who also was not involved in the work, told Reuters Health by email. "Importantly, the investigators were able to recruit a socioeconomically and racially diverse population who, at baseline, achieved less than the recommended activity level (10,000 steps per day)."

"In an era of increasing technology use, virtual gamification could be an easily adoptable intervention at centers across the country," Dr. Countouris said. "We will need more longitudinal studies that include women with hypertensive disorders of pregnancy to assess longer term cardiovascular impact of increasing step counts on blood pressure and cardiovascular disease prevention."

SOURCE: https://bit.ly/3rKnnBo JAMA Cardiology, online April 20, 2022.

By Linda Carroll

© 2023 The Author(s). Published by Medicom Medical Publishers.
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