Tailoring Mobile Health Technology to Reduce Obesity and Improve Cardiovascular Health in Resource-Limited Neighborhood Environments

Targeted, effective behavioral interventions are critically needed to ameliorate the
disproportionate prevalence of poor cardiometabolic health for African-American women. We
propose a sequential, multiple-assignment, randomized trial targeting physical activity (PA)
among at-risk African-American women in resource-limited, Washington, D.C. communities using
mobile health (mHealth) technology. We hypothesize that by beginning a community-based,
adaptive PA intervention with remote coaching tailored to neighborhood environment PA
resources, we will see greater increases in PA levels as compared to standard remote
coaching. In Aim 1, we will determine if beginning an adaptive intervention with remote
coaching tailored to neighborhood environment resources and delivered using mHealth
technology (wearables and mobile applications) will lead to a greater PA increase (as
measured by steps per day) as compared to standard remote coaching. In Aim 2, we will examine
which of four embedded adaptive interventions produce the largest PA increase over the
six-month study period. In Aim 3, we will evaluate the feasibility of remote capture of
cardiometabolic measures, including blood pressure, weight, and glucose, using mHealth
technology. We will also examine intervention effects on cardiometabolic health (adiposity,
blood pressure, fasting lipids/glucose, self-reported PA, dietary intake, cigarette smoking).
In Aim 4, we will characterize effects of increasing PA on integrated serologic
cytokine/chemokine and lipid inflammatory intermediates to identify potential novel
inflammatory pathways linked to cardiometabolic risk phenotypes most responsive to the
multi-level, community-based PA intervention. We will also determine the feasibility of
measuring behavioral and psychosocial mediating factors of the relationship between PA change
and cardiometabolic health in this intervention, including chronic
psychological/environmental stress and sedentary behavior/sleep. This project provides
fundamental knowledge towards the development of tailored, effective behavioral interventions
incorporating mHealth technology to promote health among populations most impacted by health
disparities.

- INCLUSION CRITERIA:

Individuals eligible for this protocol are overweight or obese (BMI greater than or equal
to 25 kg/m^2) African American women aged 25-75 years with evidence of insulin resistance
based on fasting plasma glucose (FPG=100-125 mg/dL) or hemoglobin A1c (HgA1c=5.7% to 6.4%)
who live in Washington, DC Wards 5,7, or 8 and neighboring areas of Prince George s County,
MD. Eligible participants should also have access to a smartphone compatible with the
mobile app for the protocol that they can use for the study. Self-directed exercise (walks
around the block, climbing stairs) is acceptable for inclusion, with subjects encouraged to
continue such activity throughout the program. Eligible participants must be able to
provide informed consent independently and also speak and read English at the 8th grade
level.

EXCLUSION CRITERIA:

1. Medical condition, including recent unintentional weight loss, that might prohibit
safe participation in the intervention

2. Diagnosis of diabetes mellitus by self-report

3. Fasting blood glucose greater than or equal to 126 mg/dL in absence of prior diagnosis
of diabetes mellitus

4. Heart disease as indicated by history of myocardial infarction, documented disease on
coronary angiography, coronary artery stent placement, congestive heart failure,
significant structural heart disease (e.g. hypertrophic or dilated cardiomyopathy,
valvular heart disease)

5. Hyper- or hypothyroid by routine lab screening

6. Physically unable to perform the physical activity for any reason

7. Pregnant women due to large hormonal changes during pregnancy that affect study
variables and potential pregnancy-related restrictions on exercise.

8. Currently participating in a structured exercise or weight-loss program (e.g., Weight
Watchers, NutriSystem, or fitness training)

9. Have undergone weight loss (bariatric) surgery