Step-2-It: A Pilot Study to Assess Feasibility of Using SMS Based Mobile Technology to Increase Physical Activity in Adult Rural Women at Risk for Cardiovascular Disease

Rural women are significantly more likely to be obese than non-rural women, which is associated at least in part to inadequate physical activity (PA). It is well established that physical activity (PA) can lower the risk for heart disease, stroke, type 2 diabetes, and certain cancers and that physical inactivity is the fourth leading risk factor for mortality worldwide. Given these associations between PA engagement and mortality as well as disease risk, and that PA levels typically decrease with age, interventions to encourage PA among rural women who are middle-aged and older are essential. Rural women report personal barriers to PA engagement including the lack of time and injury, as well as barriers in their physical and social environments, including limited access to exercise facilities and lack of social support.

Walking is an affordable PA option that in part addresses the barriers to PA engagement and is associated with a low injury risk. Previous interventions to encourage walking, including those implemented in rural communities, have achieved success in increasing PA, weight loss and improving risk factors for multiple chronic diseases.

Mobile health (mHealth) technology and PA trackers are two technologies that can be used to promote walking in rural women. Mobile health, or mHealth, is the application of wireless devices to support medical or public health practices. Text-messaging is one mHealth strategy that has the ability to reach a large number of people at a relatively low cost.Cell phone use in the US is nearly universal, 97% of urban adults and 95% of rural adults are cell-phone users. mHealth interventions using text messaging have been used to address a variety of health concerns, including PA promotion. However, few studies have examined the use of mobile health technologies to promote PA in rural women, and to our knowledge, no such studies have focused on midlife and older, rural women. Mobile health or mHealth when used to promote walking in rural women can broaden the reach of these interventions and gives the ability to communicate with women in real-time.

Physical activity trackers and wearable devices are easily available and affordable and there is evidence to show that their use is helpful in promoting increasing physical activity. In the America on the Move study, adults who were using a pedometer accumulated significantly more steps than those who were not. This finding suggests that using physical activity tacking devices such as pedometers might motivate individuals to increase their physical activity and is supported by a review that shows that pedometer-based walking programs increased participants' activity levels by 2,183 steps per day. A systematic review of 14 mobile health interventions with physical activity as an outcome showed that 7 of the 14 showed significant positive benefits on self-reported physical activity outcomes.

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