Background: Older adults (65 years) are the largest growing population in the U.S., projected to reach 78.0 million by 2035. The number of older adults residing in residential living facilities (e.g., retirement communities, nursing homes) will likely double from 13 million in 2000, to 27 million by 2050. Older adults are the least active age group placing them at increased risk for a number of chronic diseases and mortality. Past interventions have been primarily focused on the individual level. Multilevel interventions are thought to be more effective, but few examples exist.

Objective: To determine the efficacy and acceptability of a multilevel mHealth intervention (MapTrek Residential) for increasing physical activity of older adults living in a retirement community.

Methods: We recruited 54 retirement community-dwelling older adults (81.2 years, 77.8% Female, 98.1% White) and 14 staff members (45.1 years, 92.9% Female, 100% White) to participate in an 8-week intervention. MapTrek Residential is a multilevel mobile health platform that engages users to participate in a series of team based virtual walking challenges. Participant’s physical activity is monitored daily with a Fitbit Zip which automatically syncs with public monitors located within the retirement community. The monitors display team results, a game board map, a Google street view image, and daily educational/motivational messages. Psychosocial outcomes (self-efficacy for exercise, social support, outcome expectations, social isolation) were measured at pre- and post-intervention. Descriptive statistics and linear mixed models were used to determine the intervention effects.

Results: Participant adherence was high with participants wearing the Fitbit 92% of all intervention days. Participants walked an average of 5,438 steps/day at baseline (95% CI, 4620 – 6256) which increased significantly to 6,201 steps/day by Week 8. No significant changes were observed for outcome expectations, social support, or social isolation. Self-efficacy for exercise significantly declined from baseline to post-intervention (p = 0.02). Of participants that completed the exit survey, 77% thought MapTrek was easy to play.

Conclusions: These findings suggest the multilevel mHealth physical activity intervention was effective for increasing physical activity (+15%) among a sample of older adults over eight weeks. Further research is needed to refine the intervention and then retest among a sample of older adults who are in greater need for a physical activity intervention.