Fun and games could be a solution to serious problems like preeclampsia and hypertension in pregnant women and promise significant progress, according to a new study from the Perelman School of Medicine at the University of Pennsylvania. The researchers found that gamification – broadly defined as the use of specially designed games to stimulate learning and behavior change – could lead to higher levels of exercise in postpartum people who developed these types. of conditions. In turn, increasing physical activity can help reduce the risk of cardiovascular disease and death. The results are published today in JAMA Cardiology.
“Experts have long recommended that we talk to postpartum women about adopting healthier lifestyle habits to reduce their cardiovascular risk, but there was very little guidance on how to do this,” the first said. study author, Jennifer Lewey, MD, cardiologist and co-director. Penn Medicine’s Pregnancy and Heart Disease Program. “The question we were trying to answer was whether we could develop a remote digital intervention to improve the physical activity of high-risk postpartum women. It was a digital intervention that included gamification and what we call social incentives to improve accountability.”
Conditions such as preeclampsia and gestational hypertension occur in up to 10% of all pregnancies in the United States and can increase the risk of chronic hypertension and heart disease in the months and years following delivery.
The dangers posed by these and similar conditions, known as hypertensive disorders of pregnancy (HDP), are better understood than ever. Nonetheless, effective strategies for improving lifestyle factors like physical activity in this population have remained elusive. Gamification has been used successfully in various health disciplines and beyond, but this is the first time it’s been tested in women with HDP. With that in mind, Lewey and the study’s lead author, Lisa Levine, MD, Michael T. Mennuti, MD, associate professor of reproductive health and director of the pregnancy and heart disease program, decided to apply it in Maternal Fetal Medicine at Penn Medicine.
In the study, 127 participants received a wearable activity tracker to keep track of their daily steps. About half of those people also participated in a game — designed by co-author Mitesh Patel, MD, associate professor of medicine at Penn and vice president of clinical transformation at Ascension — which assigned them to teams and offered points and achievements. benchmarks for those who have met or exceeded their step goals.
“Each postpartum woman was joined virtually with two other postpartum women,” Lewey explained. “Each team started the week with 70 points, and each day a team member was randomly selected. If that person reached their step goals for that day, the team had to keep their points. was not the case, the team lost points.”
On average, the players took 647 more steps per day than those in the control group. With existing evidence showing that people who take an extra 1,000 steps a day can reduce their risk of developing or dying from cardiovascular disease, the finding is significant.
To make the findings potentially even more poignant, about 55% of study participants were black, while about 42% were enrolled in Medicaid — two populations often associated with a higher likelihood of HDP and cardiovascular risk.
“I was thrilled that we were able to enroll a racially diverse population,” Lewey said. “This is important because a woman who identifies as black or who is of lower socioeconomic status has a greater burden of cardiovascular risk factors.”
While further studies will need to test the intervention over longer periods of time, the strategy could be tested now in other hospitals and health systems, Lewey said. Free or low-cost smartphone apps can replace wearable technology, making it a relatively simple and cost-effective solution. As many health systems stay in touch with new moms after they are discharged from hospital and as communication options expand, eligible patients could be easily identified through existing channels.
“We used text messages to recruit our participants,” Lewey said. “Any health system that already uses postpartum monitoring could easily find patients for this type of intervention. The idea is that being part of the team and having this play structure can help keep women postpartum. -partum motivated to maintain their step count goal.”
This study was supported by the National Institutes of Health (K23HL153667, HD65987), the Institute for Translational Medicine and Therapeutics, and the National Center for Advancing Translational Science (UL1TRTOO1878).