Digital Health Interventions Increase Physical Activity in Postpartum Patients with HDP

Jennifer Lewey, MD, MPH

New findings from a randomized clinical trial of postpartum patients with hypertensive disorders of pregnancy (HDP) saw a digital health intervention led to increases in physical activity compared with control.

Over a period of 12 weeks, the intervention included remote monitoring, gamification, and social incentives among postpartum individuals at elevated cardiovascular risk. Data show participants in the intervention arm walked a mean of 647 more steps per day compared to control.

“Current guidelines recommend intensive lifestyle changes to reduce cardiovascular risk in individuals with HDP, and our study contributes to the small but growing literature to inform strategies to engage this population in cardiovascular health behavior change,” wrote study author Jennifer Lewey, MD, MPH, Perelman Center for Advanced Medicine.

In the 2-arm, partially blinded RCT, Social Ties to Encourage Physical Activity among Postpartum Mothers (STEP UP Mom), both the control and intervention arms received wearable activity trackers, while the intervention arm received team-based gamification over 12 weeks.

The trial enrolled postpartum individuals who delivered at 1 of 2 Penn Medicine hospitals in Philadelphia, who were ≥18 years at time of delivery and between 4 and 16 weeks postpartum at enrollment. Patients established a baseline step count, chose a step goal that was 33%, 40%, or 50% higher than baseline, and were randomized to control or intervention.

Participants in both arms were asked to use the wearable device to reach their daily step goal for 12 weeks and received daily automated text messages on goal attainment. Those in the intervention arm were additionally enrolled in a team-based gamification intervention with points and levels.

After exclusions, a total of 127 participants were randomized and had a mean of 8 weeks postpartum. The mean age was 32 years, 70 (55.1%) patients were Black, 52 (40.9%) had Medicaid insurance, and 25 (19.7%) had preeclampsia with severe features.

Data show the mean daily step count as baseline was similar by arm (6042 in the control and 6175 in the intervention groups). In the first week following randomization, a pronounced increase in steps was observed at 6650 steps for the control arm (difference, 608 steps) and 7800 steps for the intervention arm (difference of 1625 steps).

Then, after adjustment for baseline and calendar month, individuals in the intervention arm walked a mean of 647 more steps (95% CI, 1669 - 1124; P = .009) each day compared to control.

Over the follow-up period, the intervention arm achieved their step goal on 47% of days (2487 of 5292) compared with 38% (2043 of 5376) for the control group (adjusted difference, 0.11; 95% CI, 0.04 - 0.19; P = .003).

Lewey and colleagues highlighted the feasibility of recruitment with text messaging in the study. However, data show the magnitude of the intervention effect slowly diminished over time with better completion rates in the intervention arm.

They further noted that individuals who had lower income, were Black, or unmarried were more likely to stop syncing step count data.

“Future studies should examine strategies to sustain the intervention effect over longer periods of follow-up among postpartum individuals to recognize potential cardiovascular health benefits,” they concluded.

The study, “Effectiveness of a Text-Based Gamification Intervention to Improve Physical Activity Among Postpartum Individuals With Hypertensive Disorders of Pregnancy,” was published in JAMA Cardiology.