A multicomponent behavior change intervention to promote walking in adults after traumatic brain injury: A Pilot...

Sedentary behavior is highly prevalent following traumatic brain injury (TBI) and compounds existing risks for cardiovascular, neurodegenerative, and affective disorders. The cognitive and behavioral sequelae of TBI, including impaired decision-making, blunted reward processing, and cognitive fatigue, create particular barriers to adopting and maintaining an active lifestyle. Effective behavior change interventions targeting physical activity in community-dwelling TBI survivors remain scarce. Here, we evaluated the feasibility, compliance, and preliminary efficacy of a 12-week remotely delivered walking intervention combining planning, reminders, and monetary micro-incentives.

Fifty-six community-dwelling adults aged 40-80 years with a mild-to-moderate TBI diagnosed between 3 months and 15 years prior were randomized to either a planning, reminders, and micro-incentives intervention (n=23) or a health advice control condition (n=25). Participants wore a Fitbit Inspire 3 continuously throughout the study. Intervention participants completed weekly phone calls to plan five 30-minute walks for the following week, received daily text message or email reminders on planned walk days, and earned small incentives (redeemed for money at the end of the study) upon walk completion. Control participants received weekly health education calls. Feasibility was operationalized as recruitment, retention, and adverse event rates. Compliance was assessed via phone call completion rates and Fitbit wear time. Efficacy outcomes included weekly walk counts, walking duration, and step counts. Modifiers and exploratory outcome measures included environmental and psychosocial variables.

Forty-eight participants completed the study (retention rate: 84.2%), with high phone call compliance in both groups (intervention: 98.4%; control: 98.1%). Intervention participants completed more walks than controls from week 1 onward (aIRR = 5.33, 95% CI: 2.27-12.5), with the group difference growing over time (interaction aIRR = 1.09 per week, 95% CI: 1.01-1.17). The intervention group also walked significantly longer at week 1 (b = 62.14 min, 95% CI: 1.05-123.23), with the difference growing over time. Similarly, the intervention group accumulated significantly more steps during walks at week 1 (b = 4,779 steps, 95% CI: 45.50-9,513.00). Baseline intrinsic motivation increased the probability of walking on any given day and those who on average walked for >150 minutes per week saw higher improvement in their perceived cognitive abilities (b = 4.21, 95% CI: 0.15, 8.27).

Remotely delivered, multicomponent walking interventions consisting of planning, reminders, and micro-incentives are possible candidate programs to fill a gap in community-based healthcare for individuals living with lifelong consequences of TBI. With high retention and compliance, and strong preliminary efficacy of the intervention these findings provide compelling support for a larger, fully powered trial prior to implementation in a clinical setting.