The moderating impact of neighborhood walkability on mHealth interventions to increase moderate to vigorous physical activity for insufficiently active adults in a randomized trial

Abstract

Background: Ecological models suggest that interventions targeting specific behaviors are most effective when supported by the environment. This study prospectively examined the interactions between neighborhood walkability and an mHealth intervention in a large-scale, adequately powered trial to increase moderate-to-vigorous physical activity (MVPA).

Methods: Healthy, insufficiently active adults (N = 512) were recruited purposefully from census block groups ranked on walkability (high/low) and socioeconomic status (SES, high/low). Participants were block-randomized in groups of four to WalkIT Arizona, a 12-month, 2 × 2 factorial trial evaluating adaptive versus static goal setting and immediate versus delayed financial reinforcement delivered via text messages. Participants wore ActiGraph GT9X accelerometers daily for one year. After recruitment, a walkability index was calculated uniquely for every participant using a 500-m street network buffer. Generalized linear mixed-effects hurdle models tested for interactions between walkability, intervention components, and phase (baseline vs. intervention) on: (1) likelihood of any (versus no) MVPA and (2) daily MVPA minutes, after adjusting for accelerometer wear time, neighborhood SES, and calendar month. Neighborhood walkability was probed at 5th, 25th, 50th, 75th, and 95th percentiles to explore the full range of effects.

Results: Adaptive goal setting was more effective in increasing the likelihood of any MVPA and daily MVPA minutes, especially in lower walkable neighborhoods, while the magnitude of intervention effect declined as walkability increased. Immediate reinforcement showed a greater increase in any and daily MVPA compared to delayed reinforcement, especially relatively greater in higher walkable neighborhoods.

Conclusions: Results partially supported the synergy hypotheses between neighborhood walkability and PA interventions and suggest the potential of tailoring interventions to individuals' neighborhood characteristics.

Trial registration: Preregistered at clinicaltrials.gov (NCT02717663).

Keywords: Ecological models; Moderate-to-vigorous physical activity; Neighborhood walkability; Physical activity; mHealth intervention.

Fig. 1

WalkIT Arizona Participant CONSORT Diagram

Fig. 2

Probed Walkability x Goal Type x Phase Interactions (N = 512)

Fig. 3

Walkability x Goal Type x Phase: Relative Differences in Goal Type Effect Across Walkability (N = 512)

Fig. 4

Probed Walkability x Reinforcement Timing x Phase Interactions (N = 512)

Fig. 5

Walkability x Reinforcement Timing x Phase: Relative Differences in Reinforcement Timing Effect Across Walkability (N = 512)