App-based physical activity intervention may have a limited role among women with prior hypertensive pregnancy disorder

1. App-based interventions enhanced psychological readiness for activity but did not translate to increased moderate-to-vigorous physical activity in this already-active cohort

Evidence Rating Level: 1 (Excellent) 

This randomized clinical trial evaluated two app-based interventions designed to increase moderate-to-vigorous physical activity (MVPA) among 619 women with prior hypertensive pregnancy disorder (HPD), a population at elevated cardiovascular risk. Participants were randomized into three groups: a control group receiving general health information, a motivation group adding motivational interviewing techniques, and an action group incorporating additional behavior change strategies (goal-setting, planning, and mindfulness). All participants used a wearable activity tracker and a purpose-built app over 8 weeks, with MVPA measured as the primary outcome. Despite high baseline activity levels (mean 242 minutes/week, exceeding WHO guidelines), MVPA declined modestly post-intervention across all groups (197 minutes/week at 9 weeks), with no significant treatment effects observed (action group: −17 min/week [95% CI, −58 to 23]; motivation group: −3 min/week [−58 to 51]). Notably, the action intervention improved motivational and volitional psychological processes (e.g., coping planning increased by 0.9 SD) but failed to influence automatic processes like stress or affect. Subgroup analysis suggested a potential benefit for those with low baseline MVPA (interaction effect: +86 min/week at 9 weeks), though this did not withstand multiple-testing correction. Key limitations included high attrition (71% by 12 months) and baseline activity levels potentially creating a ceiling effect. The app was well-received, with 66–77% module completion rates. While app-based interventions enhanced psychological readiness for activity, they did not translate to increased MVPA in this already-active cohort. Future interventions might target automatic processes or focus on inactive subgroups. The findings underscore the challenge of bridging the intention-behavior gap, even with theory-driven tools.

Click to read the study in JAMA Network Open

Image: PD

©2025 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.