Digital Gamification Intervention to Improve Postpartum Exercise

Quick Takes

  • Increases in physical activity were seen among postpartum women using a wearable activity tracker together with gamification and step count goals.
  • Approximately one-third of participants stopped syncing step count data before study completion.

Study Questions:

Can a digital health intervention improve physical activity in postpartum women with hypertensive disorders of pregnancy?


A randomized clinical trial design was used to examine a digital intervention to promote physical activity among postpartum women. The intervention duration was 12 weeks, conducted between October 2019–June 2020, at the University of Pennsylvania. All participants received a wearable activity tracker, established a baseline step count, selected a step goal greater than baseline, and were randomly assigned to control or intervention. Participants in the intervention arm were placed on virtual teams and enrolled in a game with points and levels for daily step goal achievement and informed by principles of behavioral economics. Participants in the control arm received daily feedback on goal attainment. The primary outcome was a change in mean daily step count from baseline to 12-week follow-up.


A total of 127 participants were randomized (63 in the intervention group) and were enrolled a mean of 7.9 weeks postpartum. The mean age was 32.3 (SD 5.6) years, 70 (55.1%) were Black, and 52 (41.9%) had Medicaid insurance. The mean (SD) baseline step count was similar in the control and intervention arms (6,042 [2,270] vs. 6,175 [1,920] steps, respectively). After adjustment for baseline steps and calendar month, participants in the intervention arm had a significantly greater increase in mean daily steps from baseline compared with the control arm (647 steps; 95% confidence interval [CI], 169-1,124 steps; p = 0.009). Compared with the control arm, participants in the intervention arm achieved their step goals on a greater proportion of participant-days during the intervention period (0.47 vs. 0.38; adjusted difference, 0.11; 95% CI, 0.04-0.19; p = 0.003). By the end of the follow-up, 24 participants (37.5%) in the control arm and 20 participants (31.7%) in the intervention arm had stopped syncing step count data for >6 days. Participants in the control arm were more likely to stop syncing data earlier in the study compared with the intervention arm.


In this trial, the investigators concluded that a digital health intervention using remote monitoring, gamification, and social incentives among postpartum individuals at elevated cardiovascular risk significantly increased physical activity throughout 12 weeks.


Women with hypertensive disorders during pregnancy are at increased risk for cardiovascular disease later in life. Therefore, healthy lifestyle behavior is important to initiate in this group. This study suggests that a digital health intervention with gamification can promote physical activity. However, further study is required to reduce disengagement and promote the long-term sustainability of physical activity behaviors.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Exercise, Hypertension

Keywords: Economics, Behavioral, Exercise, Fitness Trackers, Healthy Lifestyle, Heart Disease Risk Factors, Hypertension, Pregnancy-Induced, Postpartum Period, Pregnancy, Primary Prevention, Risk Factors

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