Author(s): MORRIS, T., TINNEY, E., NWAKAMMA, M.C., PERKO, M., CHEN, C., HWANG, J., O’BRIEN, A., HACKMAN, L., GOBENA, E., ORCHARD, E., ODOM, H., TORAL, S., KRAMER, A.F., STILLMAN, A., ESPAÑA-IRLA, G. , Institution: NORTHEASTERN UNIVERSITY, Country: UNITED STATES, Abstract-ID: 2126

INTRODUCTION:
Sustained engagement in physical activity is complex. Especially following a traumatic brain injury (TBI). The cognitive burden of moment-to-moment decision making and inability to interrupt automatic habitual and rewarding sedentary behaviors is higher in those with residual brain injury deficits. In absence of social, environmental and cognitive resources, physically inactivity will prevail in this population. Once re-integrated into their community, individuals with TBI have relatively few resources or long-term programs to help them maintain long term healthy habits.
METHODS:
Here, in a 12-week two-arm pilot randomized control trial, we tested the effect of weekly planning, reminders and micro-incentives on walking behaviours in adults with TBI, compared to a control intervention consisting of weekly heath tips. Participants wore a Fitbit Aspire 3 and had access to an online platform containing a calendar of planned walks and aggregated points totals (that were converted into money at the end of the study. Control participants platform contained their weekly tips. Phone calls with study staff were made weekly.
RESULTS:
57 adults aged 40-80 were enrolled, 48 (84.2%) completed all 12 weeks (Intervention: n=23, Control: n=25). Compliance was excellent: 98.2% phone call attendance and 88.6% valid Fitbit wear days (>15 hours daily). No adverse events related to study protocols occurred. The intervention had an immediate effect where at week 1, participants completed significantly more walks than controls (adjusted incidence rate ratio [aIRR]=5.33, 95% CI: 2.27-12.5, z=3.85, p<0.001). Over time, controls showed a declining trend, with predicted walks decreasing from 0.71 at week 1 to 0.31 at week 12 (aIRR per week=0.927, 95% CI: 0.862-0.996, z=-2.07, p=0.038), representing a 7.3% weekly decrease. In contrast, intervention participants maintained relatively stable walk counts (4.1 to 4.4 walks/week). 60% of walks in the intervention group were planned walks. The difference between groups grew significantly over time (interaction aIRR=1.09 per week, 95% CI: 1.01-1.17, z=2.18, p=0.029), where intervention participants completed 5.8x more walks at week 1 and 14.5x more walks at week 12. Intervention participants accumulated significantly more walking time (β=64.04, p=0.040) over 12-weeks.
CONCLUSION:
This pilot trial demonstrates that a multi-component intervention combining planning, reminders, and micro-incentives is feasible, safe, and associated with clinically meaningful increases in walking frequency that were sustained and strengthened across 12 weeks in adults with TBI.