Gamification texting intervention enhances physical activity after childbirth

April 22 2022

3 minutes to read

Source / Disclosures

Liu makes no relevant financial disclosures. Please see the study for all relevant financial disclosures by other authors.

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The data showed that postpartum women who participated in the texting intervention that included gamification walked an average of 647 extra steps per day compared to similar women who received daily responses to texting without the use of gamification.

Jennifer Lewis

“Preeclampsia and other hypertensive disorders during pregnancy are important risk factors for developing postpartum chronic hypertension and heart disease later in life,” Jennifer Lewi, MD, MPH, Assistant professor of medicine, associate director of the Pregnancy and Cardiology Program and director of the Women’s Cardiovascular Health Program at the University of Pennsylvania at the University of Pennsylvania, told Healio. The American Heart Association and the American College of Obstetrics and Gynecology recommend that these women receive counseling to adopt healthy lifestyle changes to improve cardiovascular health; However, it is not clear how to advise postpartum women to make these health changes, especially while they are caring for a newborn. We found that digital intervention using wearable activity trackers, manipulation, and social incentives helped keep participants accountable for achieving their daily goal. As a result, at the end of 12 weeks, women walked into the intervention more than women who had just received wearable activity trackers.”

young woman on the phone

Source: Adobe Stock

Step Count and Motivation

For the STEP UP Mom Study, Lowe and colleagues analyzed data from 127 postpartum women who gave birth at the University of Pennsylvania and had hypertensive gestational disorder from October 2019 to June 2020 (median, 7.9 weeks postpartum). The average age of the women was 32 years. 55.1% were black and 41.9% had Medicaid insurance. Women received a wearable activity tracker, established a baseline step count and chose a goal step greater than the baseline. The researchers then randomly assigned participants to virtual ‘teams’ of three for 12 weeks, and scored them in a game with points and levels for achieving a daily step goal or on a joystick where the women received daily feedback on goal achievement.

“Each team earned 70 weekly points every Monday,” the researchers wrote. “Every day, a team member is chosen at random. The team keeps its points if the selected member achieved the step goal the previous day and loses 10 points vice versa if the member doesn’t achieve the step goal. In addition to loss aversion, each member is accountable to other team members for reaching to the daily step goal.

The primary outcome was the change in mean daily step count from baseline to 12 weeks; The secondary outcome was the proportion of participants’ days in which the step goal was achieved. The study was conducted using Way to Health, an online research platform at the University of Pennsylvania that syncs with remote monitoring devices and automates the delivery of behavioral interventions using text messages and email.

The results have been published in Heart gamma.

For the intervention and control arms, the mean number of baseline steps was similar at 6,175 and 6,042 steps per day, respectively.

After adjusting for baseline and calendar month steps, the intervention arm experienced a greater increase in mean daily steps from baseline than the control arm (647 steps; 95% CI, 169–1124; q = .009). Participants in the intervention arm achieved their stride goals on a greater proportion of participant days than those in the control arm (0.47 versus 0.38; adjusted difference, 0.11; 95% CI, 0.04–0.19; q = .003).

You need to increase participation

“We know that physical activity is an important part of cardiovascular health,” Lewy told Helio. “If we can help the participants stay more active over a longer period of time, it could help lower blood pressure and, in the long run, reduce the risk of cardiovascular disease. It is also important to note that all of these participants are mothers with a new baby, And in many cases, other children in the home. If we can get mothers to be more active, this could have later benefits for other family members.”

By the end of follow-up, 37.5% of the control participants and 31.7% of the intervention participants had stopped syncing their step count data for more than 6 days. Participants in the control arm were more likely to stop syncing data early in the study than in the intervention arm, according to the researchers.

Liu said more research is needed to understand the behavioral strategies needed to maintain engagement, particularly as demands change at home and at work during the first year after birth.

“We need to understand whether increases in levels of physical activity affect the risk of developing high blood pressure in the months to years after birth,” Lewy told Healio. Postpartum depression was common in our study, and we found that many participants requested more communication with others in the study. Finding ways to facilitate social support in the postpartum period has a potential benefit for physical activity, but also for mental health.”

for more information:

Jennifer Lewi, MD, MPHAnd She can be reached at

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