App interventions not found to boost physical activity in HPD patients

App interventions not found to boost physical activity in HPD patients | Image Credit: © Artem Varnitsin - © Artem Varnitsin - stock.adobe.com.

Current app-based interventions do not impact moderate to vigorous physical activity (MVPA) treatment among women with hypertensive pregnancy disorder (HPD), according to a recent study published in JAMA Network Open.¹

Background on MVPA and health risks

According to the World Health Organization (WHO), adults aged 18 to 64 years should perform at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity per week, with a lack of MVPA increasing physical and mental health risks. This includes cardiovascular disease (CVD), which is more common among women with HPD.²

“Many behavior change interventions have focused on MVPA. Although many such interventions have been successful in producing small, short-term effects, evidence of large, long-term effects is scant,” wrote investigators.¹

The randomized controlled trial was conducted to determine the efficacy of MVPA behavior change interventions using 3 integrated behavior change (IBC) model processes. In the control group, participants were told about CVD, MVPA, and HPD.

Intervention groups and methodology

In the motivation group, this information was provided alongside an intervention targeting motivational processes. Finally, patients in the action group received this information alongside an intervention targeting all 3 IBC model processes. MVPA was reported as the primary outcome, measured using a wearable fitness tracker.

Participants included women with HDP. Those aged under 18 years, pregnant, under 3 months postpartum, with physical limitations preventing MVPA, without a smartphone, or unable to speak English or Dutch were excluded from the analysis. Those included were randomized 1:1:1 to the control, motivation, or action group.

App intervention and outcome measures

The app was used to collect sociodemographic data and baseline outcome measures, then deliver an 8-week intervention. Primary outcomes were assessed at week 9, week 21, and week 61. MVPA measurements were also collected at baseline and each week of the intervention.

Patients in the intervention groups received behavior change techniques through the app, which were chosen based on the IBC model. These techniques were provided in weekly modules, including the Get Motivated module for the motivation group and the Get Motivated, Get Activated, and Get Energized modules for the action group.

The Get Motivated module used content-based motivational interviewing techniques, while the Get Activated module targeted volitional processes using personalized features. Finally, the Get Energized module used mindfulness-based stress reduction to target the automatic processes of affect.

All MVPA measures were tracked by the fitness tracker, including running, swimming, and strength training. Secondary outcomes included mean daily resting heart rate, body mass index (BMI), waist-to-hip ratio, cardiorespiratory fitness level, and subjective well-being.

Participant demographics and baseline metrics

There were 619 women included in the final analysis, 205 of whom were in the control group, 209 in the motivation group, and 205 in the action group. These patients were aged a mean 38.9 years, and 67% had a bachelor’s degree or higher education and 95% at least 1 child.

The mean MVPA at baseline was 235 minutes, while the mean resting heart rate was 66.7 bpm. A mean BMI of 26.4 was reported, which is considered overweight. Additionally, the mean waist-to-hip ratio of 0.86 indicated an increased risk of disease. On a subjective well-being score of 1 to 7, participants reported a mean of 5.

Attrition rates of 27%, 41%, and 71% were reported by weeks 9, 21, and 61, respectively. Immediately after the intervention, the control, motivation, and action groups reported attrition rates of 22%, 27%, and 32%, respectively.

MVPA trends and treatment effects

Overall, participants had reduced MVPA by week 9, decreasing from a mean 242 minutes at week 0. These declines were reported in all groups, though the average remained above the minimum time recommended by WHO of 150 minutes.

Exceeding this time at week 9 was reported in 51% of patients, with stability observed between weeks 9 and 21. However, decreases were reported by week 21.

The action and motivation groups did not have significantly different treatment effects on MVPA vs the control group, with week 9 treatment effects of -17 minutes per week and -3 minutes per week, respectively. A significant positive interaction between the action group and having a below-median MVPA at weeks 5 and 9 was reported.

Implications

Most secondary outcomes also had improvements across the 3 groups. However, the lack of treatment effects on MVPA highlighted inhibitions for impacting the primary outcome.

“Potential reasons for the lack of treatment effects were the presence of highly active participants before the trial, a failure to influence automatic processes, a possible disconnect between intervention activities and final outcomes, and unanticipated effects of the control group,” concluded investigators.

References

1. Kókai LL, Ó Ceallaigh D, Wijtzes AI, et al. App-based physical activity intervention among women with prior hypertensive pregnancy disorder: A randomized clinical trial. JAMA Netw Open. 2025;8(4):e252656. doi:10.1001/jamanetworkopen.2025.2656
2. Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association.Circulation. 2011;123(11):1243-1262. doi:10.1161/CIR.0b013e31820faaf8