Effects of a Gamified, Behavior Change Technique–Based Mobile App on Increasing Physical Activity and Reducing Anxiety in Adults with Autism Spectrum Disorder: Feasibility Randomized Controlled Trial

Daehyoung Lee; Georgia C Frey; Donetta J Cothran; Jaroslaw Harezlak; Patrick C Shih

doi:10.2196/35701

Effects of a Gamified, Behavior Change Technique–Based Mobile App on Increasing Physical Activity and Reducing Anxiety in Adults with Autism Spectrum Disorder: Feasibility Randomized Controlled Trial

Daehyoung Lee, Georgia C Frey, Donetta J Cothran, Jaroslaw Harezlak, Patrick C Shih

Applied Human Sciences

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Background: Physical activity (PA) has an impact on physical and mental health in neurotypical populations, and addressing these variables may improve the prevalent burden of anxiety in adults with autism spectrum disorder (ASD). Gamified mobile apps using behavior change techniques present a promising way of increasing PA and reducing sedentary time, thus reducing anxiety in adults with ASD. Objective: This study aimed to compare the effectiveness of a gamified and behavior change technique–based mobile app, PuzzleWalk, versus a commercially available app, Google Fit, on increasing PA and reducing sedentary time as an adjunct anxiety treatment for this population. Methods: A total of 24 adults with ASD were assigned to either the PuzzleWalk or Google Fit group for 5 weeks using a covariate-adaptive randomization design. PA and anxiety were assessed over 7 days at 3 different data collection periods (ie, baseline, intervention start, and intervention end) using triaxial accelerometers and the Beck Anxiety Inventory. Group differences in outcome variables were assessed using repeated-measures analysis of covariance, adjusting for age, sex, and BMI. Results: The findings indicated that the PuzzleWalk group spent a significantly longer amount of time on app use compared with the Google Fit group (F_2,38=5.07; P=.01; partial η²=0.21), whereas anxiety was unfavorably associated with increases in light PA and decreases in sedentary time after intervention (all P<.05). Conclusions: Further research is needed to clarify the determinants of physical and mental health and their interrelationship in adults with ASD to identify the factors that facilitate the use and adoption of mobile health technologies in these individuals. Despite these mixed results, the small changes in PA or anxiety may be clinically significant for adults with ASD. Trial Registration: ClinicalTrials.gov NCT05466617; https://clinicaltrials.gov/show/NCT05466617

Original language	English (US)
Article number	e35701
Journal	JMIR Formative Research
Volume	6
Issue number	7
DOIs	https://doi.org/10.2196/35701
State	Published - Jul 1 2022

Bibliographical note

Funding Information:
This study was supported by the Indiana University Collaborative Research Grants Program and ACSM Foundation Doctoral Student Research Grant from the American College of Sports Medicine Foundation (19-01155).

Publisher Copyright:
©Daehyoung Lee, Georgia C Frey, Donetta J Cothran, Jaroslaw Harezlak, Patrick C Shih. Originally published in JMIR Formative Research.

Keywords

anxiety
autism
behavior change techniques
gamification
mental health
mHealth
mobile app
mobile phone
physical activity
sedentary behavior

PubMed: MeSH publication types

Journal Article

Publisher link

10.2196/35701

https://jmir.org/api/download?alt_name=formative_v6i7e35701_app1.pdf&filename=03ceae6f8a022f5732dc4d57c847967f.pdfLicense: CC BY

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Effects of a Gamified, Behavior Change Technique–Based Mobile App on Increasing Physical Activity and Reducing Anxiety in Adults with Autism Spectrum Disorder: Feasibility Randomized Controlled Trial. / Lee, Daehyoung; Frey, Georgia C; Cothran, Donetta J et al.
In: JMIR Formative Research, Vol. 6, No. 7, e35701, 01.07.2022.

Research output: Contribution to journal › Article › peer-review

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title = "Effects of a Gamified, Behavior Change Technique–Based Mobile App on Increasing Physical Activity and Reducing Anxiety in Adults with Autism Spectrum Disorder: Feasibility Randomized Controlled Trial",

abstract = "Background: Physical activity (PA) has an impact on physical and mental health in neurotypical populations, and addressing these variables may improve the prevalent burden of anxiety in adults with autism spectrum disorder (ASD). Gamified mobile apps using behavior change techniques present a promising way of increasing PA and reducing sedentary time, thus reducing anxiety in adults with ASD. Objective: This study aimed to compare the effectiveness of a gamified and behavior change technique–based mobile app, PuzzleWalk, versus a commercially available app, Google Fit, on increasing PA and reducing sedentary time as an adjunct anxiety treatment for this population. Methods: A total of 24 adults with ASD were assigned to either the PuzzleWalk or Google Fit group for 5 weeks using a covariate-adaptive randomization design. PA and anxiety were assessed over 7 days at 3 different data collection periods (ie, baseline, intervention start, and intervention end) using triaxial accelerometers and the Beck Anxiety Inventory. Group differences in outcome variables were assessed using repeated-measures analysis of covariance, adjusting for age, sex, and BMI. Results: The findings indicated that the PuzzleWalk group spent a significantly longer amount of time on app use compared with the Google Fit group (F2,38=5.07; P=.01; partial η2=0.21), whereas anxiety was unfavorably associated with increases in light PA and decreases in sedentary time after intervention (all P<.05). Conclusions: Further research is needed to clarify the determinants of physical and mental health and their interrelationship in adults with ASD to identify the factors that facilitate the use and adoption of mobile health technologies in these individuals. Despite these mixed results, the small changes in PA or anxiety may be clinically significant for adults with ASD. Trial Registration: ClinicalTrials.gov NCT05466617; https://clinicaltrials.gov/show/NCT05466617",

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note = "Funding Information: This study was supported by the Indiana University Collaborative Research Grants Program and ACSM Foundation Doctoral Student Research Grant from the American College of Sports Medicine Foundation (19-01155). Publisher Copyright: {\textcopyright}Daehyoung Lee, Georgia C Frey, Donetta J Cothran, Jaroslaw Harezlak, Patrick C Shih. Originally published in JMIR Formative Research.",

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AU - Cothran, Donetta J

AU - Harezlak, Jaroslaw

AU - Shih, Patrick C

N1 - Funding Information: This study was supported by the Indiana University Collaborative Research Grants Program and ACSM Foundation Doctoral Student Research Grant from the American College of Sports Medicine Foundation (19-01155). Publisher Copyright: ©Daehyoung Lee, Georgia C Frey, Donetta J Cothran, Jaroslaw Harezlak, Patrick C Shih. Originally published in JMIR Formative Research.

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N2 - Background: Physical activity (PA) has an impact on physical and mental health in neurotypical populations, and addressing these variables may improve the prevalent burden of anxiety in adults with autism spectrum disorder (ASD). Gamified mobile apps using behavior change techniques present a promising way of increasing PA and reducing sedentary time, thus reducing anxiety in adults with ASD. Objective: This study aimed to compare the effectiveness of a gamified and behavior change technique–based mobile app, PuzzleWalk, versus a commercially available app, Google Fit, on increasing PA and reducing sedentary time as an adjunct anxiety treatment for this population. Methods: A total of 24 adults with ASD were assigned to either the PuzzleWalk or Google Fit group for 5 weeks using a covariate-adaptive randomization design. PA and anxiety were assessed over 7 days at 3 different data collection periods (ie, baseline, intervention start, and intervention end) using triaxial accelerometers and the Beck Anxiety Inventory. Group differences in outcome variables were assessed using repeated-measures analysis of covariance, adjusting for age, sex, and BMI. Results: The findings indicated that the PuzzleWalk group spent a significantly longer amount of time on app use compared with the Google Fit group (F2,38=5.07; P=.01; partial η2=0.21), whereas anxiety was unfavorably associated with increases in light PA and decreases in sedentary time after intervention (all P<.05). Conclusions: Further research is needed to clarify the determinants of physical and mental health and their interrelationship in adults with ASD to identify the factors that facilitate the use and adoption of mobile health technologies in these individuals. Despite these mixed results, the small changes in PA or anxiety may be clinically significant for adults with ASD. Trial Registration: ClinicalTrials.gov NCT05466617; https://clinicaltrials.gov/show/NCT05466617

AB - Background: Physical activity (PA) has an impact on physical and mental health in neurotypical populations, and addressing these variables may improve the prevalent burden of anxiety in adults with autism spectrum disorder (ASD). Gamified mobile apps using behavior change techniques present a promising way of increasing PA and reducing sedentary time, thus reducing anxiety in adults with ASD. Objective: This study aimed to compare the effectiveness of a gamified and behavior change technique–based mobile app, PuzzleWalk, versus a commercially available app, Google Fit, on increasing PA and reducing sedentary time as an adjunct anxiety treatment for this population. Methods: A total of 24 adults with ASD were assigned to either the PuzzleWalk or Google Fit group for 5 weeks using a covariate-adaptive randomization design. PA and anxiety were assessed over 7 days at 3 different data collection periods (ie, baseline, intervention start, and intervention end) using triaxial accelerometers and the Beck Anxiety Inventory. Group differences in outcome variables were assessed using repeated-measures analysis of covariance, adjusting for age, sex, and BMI. Results: The findings indicated that the PuzzleWalk group spent a significantly longer amount of time on app use compared with the Google Fit group (F2,38=5.07; P=.01; partial η2=0.21), whereas anxiety was unfavorably associated with increases in light PA and decreases in sedentary time after intervention (all P<.05). Conclusions: Further research is needed to clarify the determinants of physical and mental health and their interrelationship in adults with ASD to identify the factors that facilitate the use and adoption of mobile health technologies in these individuals. Despite these mixed results, the small changes in PA or anxiety may be clinically significant for adults with ASD. Trial Registration: ClinicalTrials.gov NCT05466617; https://clinicaltrials.gov/show/NCT05466617

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KW - sedentary behavior

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Effects of a Gamified, Behavior Change Technique–Based Mobile App on Increasing Physical Activity and Reducing Anxiety in Adults with Autism Spectrum Disorder: Feasibility Randomized Controlled Trial

Abstract

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Keywords

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