STEP AND GO: A Study of Technology-based Exercise Promotion

Physical activity reduces cardiometabolic risk factors. Unfortunately, a majority of adults
do not meet activity recommendations. Though walking is a preferred method for activity with
proven effectiveness, motivating sustained adherence to activity goals is difficult.
"Gamification" using technology-based tools holds promise for motivating increased adherence
to physical activity goals. Gamification occurs when elements from video games (such as
leaderboards, badges, and progression through a virtual narrative) are integrated into
non-game applications. Game elements may motivate faster, longer, and/or more frequent
walking by making walking and self-monitoring more enjoyable. In the proposed research the
investigators seek to test the feasibility and acceptability of a technology-based
intervention that "gamifies" physical activity using technology. The investigators will
randomize 40 inactive overweight adults (20 women, aged 18 - 69) to either an intervention
group or a wait-list control. (Note: 10 additional participants will be recruited for a
pre-pilot one-arm test of the intervention to ensure that the mobile devices, cellular
service, game, etc. are working correctly.) The intervention will consist primarily of
provision of a mobile device loaded with a narrative-based walking application ("app").
Participants will be instructed to use the app to achieve activity goals increasing from 60
to 150 or more minutes per week. The app uses global positioning systems and accelerometry to
track exercise duration and intensity. Investigators will call participants weekly for brief
counseling and technical support. The intervention will last 12 weeks. Primary outcomes are
process measures of feasibility and acceptability, including attrition, reasons for drop-out,
adherence to use of the app, exposure to calls, and any adverse events. The investigators
will also compare behavioral (physical activity), weight-related (weight, body composition),
and health outcomes (fitness, blood pressure) in the intervention group to the wait-list
control. Finally, theory-based intermediate variables, such as self-efficacy, intrinsic
motivation, and self-regulation, will also be investigated. This study will provide crucial
information regarding the promise of gamified apps and will lay a foundation for a larger
research program in technology-based cardiovascular health promotion.

Inclusion Criteria:

1. Age between 18 and 69 years old

2. BMI is between 25 kg/m2 and 35 kg/m2

3. Able to read and understand English

4. Able to read words in standard applications on a mobile device 5" large

5. Able to walk for exercise

6. Able to find transportation to the study location

7. Willing to use a smartphone provided by the study to participate

8. Willing to listen to a potentially scary or sad story that includes violence

9. Willing to share basic information on walks with other participants via a social
network

Exclusion Criteria:

1. (If female) currently pregnant or nursing or plan to become pregnant in the next 6
months

2. Report a heart condition, chest pain during periods of activity or rest, or loss of
consciousness on the Physical Activity Readiness Questionnaire (PAR-Q, items 1 - 4).
Reporting taking medicine for blood pressure on this questionnaire will require a
doctor's note to participate.

3. Unable to walk for exercise (self-report)

4. Report current symptoms of alcohol or substance dependence

5. Plans to move away from the Galveston-Houston area in the next 4 months or to be out
of town for more than 1 week during the study period

6. Unwillingness to report drugs taken for comorbidities such as hypertension or diabetes

7. Takes medications for diabetes or thyroid issues

8. Stroke, hip fracture, hip or knee replacement, or spinal surgery in the past 6 months

9. Participant is active (60 minutes of moderate-vigorous intensity activity per week or
more)

10. Another member of the household is a participant or staff member on this trial

11. Currently a participant in a physical activity or weight loss research trial

12. Recently (less than six months ago) completed a physical activity or weight loss
research trial

13. Recently (less than six months ago) lost more than 5% of their body weight

14. Report a history of orthopedic complications that would prevent optimal participation
in the physical activities prescribed (e.g., heel spurs, severe arthritis - may be
eligible, but a doctor's note will be required)

15. Current smoker

16. Currently uses Zombies, Run! for exercise