Trial Outcomes & Findings for Testing Adaptive Interventions to Improve Physical Activity for Sedentary Women (NCT NCT03558828)

Last Updated: 2025-08-03

Results Overview

Physical activity-Steps: Average daily steps were measured with ActiGraph worn on the right hip during waking hours for one week.

Recruitment status

COMPLETED

Study phase

Target enrollment

301 participants

Primary outcome timeframe

Baseline plus change is being assessed after 8 weeks, 34 weeks, and 50 weeks for steps.

Results posted on

2025-08-03

Participant Flow

Response to reviewer's comment #2- Each arm includes a specific title and time period. For Column #7 during the maintenance period, a total of 301 participants were analyzed. If we were to include "301" again in this column, the total would add up to 602, which would count the same participants twice. To avoid the double-counting and to keep the total participant number as 301, I've added column #7 but entered n as 0 in the maintenance period column. Comment #3. Response: footnote removed

Excluded: 453 * Unable to be reached: 163 * Not Interested: 193 * Ineligible: 97 * failed phone screening: 14 * failed health screening: 33 * failed physical activity screening: 50

Participant milestones

Participant milestones
Measure	Enhanced Physical Activity Monitor Only Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Responder Treatment (weeks 9-34)- responders to "Enhanced Physical Activity Monitor only" treatment continued with this assigned treatment. Step 3: Maintenance (weeks 35-50)- responders to "Enhanced Physical Activity Monitor only" treatment continued with this assigned treatment.	Enhanced Physical Activity Monitor+ Motivational Text Messages Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Responder Treatment (weeks 9-34)- responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment. Step 3: Maintenance (weeks 35-50)- responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only .	Enhanced Physical Activity Monitor Only+ Personal Calls Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with Enhanced Physical Activity Monitor plus were randomized to receive Personal Calls. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor Only+ Group Meetings Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with Enhanced Physical Activity Monitor plus were randomized to participate in Group Meetings. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor+ Motivational Text Messages+ Personal Calls Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment plus were randomized to receive Personal Calls. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only .	Enhanced Physical Activity Monitor+ Motivational Text Messages+ Group Meetings Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment plus were randomized to participate in Group Meetings. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only .
Overall Study STARTED	76	81	38	35	35	36
Overall Study COMPLETED	71	77	35	30	33	33
Overall Study NOT COMPLETED	5	4	3	5	2	3

Reasons for withdrawal

Reasons for withdrawal
Measure	Enhanced Physical Activity Monitor Only Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Responder Treatment (weeks 9-34)- responders to "Enhanced Physical Activity Monitor only" treatment continued with this assigned treatment. Step 3: Maintenance (weeks 35-50)- responders to "Enhanced Physical Activity Monitor only" treatment continued with this assigned treatment.	Enhanced Physical Activity Monitor+ Motivational Text Messages Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Responder Treatment (weeks 9-34)- responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment. Step 3: Maintenance (weeks 35-50)- responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only .	Enhanced Physical Activity Monitor Only+ Personal Calls Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with Enhanced Physical Activity Monitor plus were randomized to receive Personal Calls. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor Only+ Group Meetings Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with Enhanced Physical Activity Monitor plus were randomized to participate in Group Meetings. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor+ Motivational Text Messages+ Personal Calls Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment plus were randomized to receive Personal Calls. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only .	Enhanced Physical Activity Monitor+ Motivational Text Messages+ Group Meetings Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment plus were randomized to participate in Group Meetings. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only .
Overall Study Lost to Follow-up	4	3	3	5	2	3
Overall Study dropped before the intervention	1	1	0	0	0	0

Baseline Characteristics

Testing Adaptive Interventions to Improve Physical Activity for Sedentary Women

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Step1: Initial Treatment (Weeks 1-8) Enhanced Physical Activity Monitor Only n=149 Participants Step1: Initial Treatment (weeks 1-8) enhanced physical activity monitor only: In this group, participants were randomly assigned to an enhanced physical activity monitor only, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. For baseline characteristics, this step includes both responders and non-responders from the physical activity monitor-only treatment group.	Step1: Initial Treatment (Weeks 1-8) Enhanced Physical Activity Monitor + Text Messages n=152 Participants Step1: Initial Treatment (weeks 1-8) enhanced physical activity monitor +motivational text messaging: In this group, participants were randomly assigned to an enhanced physical activity monitor (Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps) + text messages. For baseline characteristics, this step includes both responders and non-responders from the physical activity monitor + text messages treatment group.	Total n=301 Participants Total of all reporting groups
Age, Categorical <=18 years	0 Participants n=39 Participants	0 Participants n=41 Participants	0 Participants n=35 Participants
Age, Categorical Between 18 and 65 years	149 Participants n=39 Participants	152 Participants n=41 Participants	301 Participants n=35 Participants
Age, Categorical >=65 years	0 Participants n=39 Participants	0 Participants n=41 Participants	0 Participants n=35 Participants
Age, Continuous	45.1 years STANDARD_DEVIATION 11.6 • n=39 Participants	46.1 years STANDARD_DEVIATION 11.2 • n=41 Participants	45.6 years STANDARD_DEVIATION 11.4 • n=35 Participants
Sex: Female, Male Female	149 Participants n=39 Participants	152 Participants n=41 Participants	301 Participants n=35 Participants
Sex: Female, Male Male	0 Participants n=39 Participants	0 Participants n=41 Participants	0 Participants n=35 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=39 Participants	0 Participants n=41 Participants	0 Participants n=35 Participants
Race (NIH/OMB) Asian	7 Participants n=39 Participants	16 Participants n=41 Participants	23 Participants n=35 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=39 Participants	0 Participants n=41 Participants	0 Participants n=35 Participants
Race (NIH/OMB) Black or African American	44 Participants n=39 Participants	48 Participants n=41 Participants	92 Participants n=35 Participants
Race (NIH/OMB) White	78 Participants n=39 Participants	74 Participants n=41 Participants	152 Participants n=35 Participants
Race (NIH/OMB) More than one race	0 Participants n=39 Participants	0 Participants n=41 Participants	0 Participants n=35 Participants
Race (NIH/OMB) Unknown or Not Reported	20 Participants n=39 Participants	14 Participants n=41 Participants	34 Participants n=35 Participants
Region of Enrollment United States	149 participants n=39 Participants	152 participants n=41 Participants	301 participants n=35 Participants
Average daily steps	4913.95 Number of steps (M, 95% CI) n=39 Participants	5082.05 Number of steps (M, 95% CI) n=41 Participants	4998 Number of steps (M, 95% CI) n=35 Participants
Average daily minutes of moderate/vigorous PA (MVPA)	13.5 Number pf MVPA minutes/day (M, 95% CI) n=39 Participants	13.7 Number pf MVPA minutes/day (M, 95% CI) n=41 Participants	13.6 Number pf MVPA minutes/day (M, 95% CI) n=35 Participants

PRIMARY outcome

Timeframe: Baseline plus change is being assessed after 8 weeks, 34 weeks, and 50 weeks for steps.

Population: Total N=301 participants were analyzed.

Physical activity-Steps: Average daily steps were measured with ActiGraph worn on the right hip during waking hours for one week.

Outcome measures

Outcome measures
Measure	Enhanced Physical Activity Monitor Only n=76 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Responder Treatment (weeks 9-34)- responders to "Enhanced Physical Activity Monitor only" treatment continued with this assigned treatment. Step 3: Maintenance (weeks 35-50)- responders to "Enhanced Physical Activity Monitor only" treatment continued with this assigned treatment.	Enhanced Physical Activity Monitor+ Motivational Text Messages n=81 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Responder Treatment (weeks 9-34)- responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment. Step 3: Maintenance (weeks 35-50)- responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor Only+ Personal Calls n=38 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with Enhanced Physical Activity Monitor plus were randomized to receive Personal Calls. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor Only+ Group Meetings n=35 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with Enhanced Physical Activity Monitor plus were randomized to participate in Group Meetings. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor+ Motivational Text Messages+ Personal Calls n=35 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment plus were randomized to receive Personal Calls. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor+ Motivational Text Messages+ Group Meetings n=36 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment plus were randomized to participate in Group Meetings. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only .
Physical Activity-Steps	5637.2 Number of steps/day Interval 5215.0 to 6045.0	5863.3 Number of steps/day Interval 5443.0 to 6275.0	5603.9 Number of steps/day Interval 5164.0 to 6044.0	5631.6 Number of steps/day Interval 5194.0 to 6070.0	5636.7 Number of steps/day Interval 5214.0 to 6060.0	5322.0 Number of steps/day Interval 4892.0 to 5752.0

PRIMARY outcome

Timeframe: Baseline plus change is being assessed after 8 weeks, 34 weeks, and 50 weeks for MVPA.

Population: Total N=301 participants were analyzed.

Average daily minutes of Moderate to Vigorous Physical Activity (MVPA) were measured with ActiGraph worn on the right hip during waking hours for one week.

Outcome measures

Outcome measures
Measure	Enhanced Physical Activity Monitor Only n=76 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Responder Treatment (weeks 9-34)- responders to "Enhanced Physical Activity Monitor only" treatment continued with this assigned treatment. Step 3: Maintenance (weeks 35-50)- responders to "Enhanced Physical Activity Monitor only" treatment continued with this assigned treatment.	Enhanced Physical Activity Monitor+ Motivational Text Messages n=81 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Responder Treatment (weeks 9-34)- responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment. Step 3: Maintenance (weeks 35-50)- responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor Only+ Personal Calls n=38 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with Enhanced Physical Activity Monitor plus were randomized to receive Personal Calls. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor Only+ Group Meetings n=35 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with Enhanced Physical Activity Monitor plus were randomized to participate in Group Meetings. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor+ Motivational Text Messages+ Personal Calls n=35 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment plus were randomized to receive Personal Calls. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor+ Motivational Text Messages+ Group Meetings n=36 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment plus were randomized to participate in Group Meetings. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only .
Physical Activity- Moderate to Vigorous Physical Activity (MVPA)	17.4 Number of MVPA minutes/day Interval 14.9 to 19.7	18.0 Number of MVPA minutes/day Interval 15.2 to 21.1	18.8 Number of MVPA minutes/day Interval 15.5 to 22.2	17.9 Number of MVPA minutes/day Interval 14.8 to 21.0	18.6 Number of MVPA minutes/day Interval 15.7 to 21.5	17.7 Number of MVPA minutes/day Interval 14.1 to 21.3

SECONDARY outcome

Timeframe: Baseline plus change is being assessed after 8 weeks, 34 weeks, and 50 weeks for aerobic fitness.

Population: Total N=301 participants were analyzed.

Aerobic fitness: participants step in place to a predesignated height for 2 minutes and the average number of steps taken in 2 minutes are counted.

Outcome measures

Outcome measures
Measure	Enhanced Physical Activity Monitor Only n=76 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Responder Treatment (weeks 9-34)- responders to "Enhanced Physical Activity Monitor only" treatment continued with this assigned treatment. Step 3: Maintenance (weeks 35-50)- responders to "Enhanced Physical Activity Monitor only" treatment continued with this assigned treatment.	Enhanced Physical Activity Monitor+ Motivational Text Messages n=81 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Responder Treatment (weeks 9-34)- responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment. Step 3: Maintenance (weeks 35-50)- responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor Only+ Personal Calls n=38 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with Enhanced Physical Activity Monitor plus were randomized to receive Personal Calls. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor Only+ Group Meetings n=35 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with Enhanced Physical Activity Monitor plus were randomized to participate in Group Meetings. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor+ Motivational Text Messages+ Personal Calls n=35 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment plus were randomized to receive Personal Calls. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor+ Motivational Text Messages+ Group Meetings n=36 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment plus were randomized to participate in Group Meetings. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only .
Cardiovascular Health (1)	85.7 Number of steps/2 minutes Interval 81.5 to 90.1	87.1 Number of steps/2 minutes Interval 82.2 to 92.2	86.3 Number of steps/2 minutes Interval 81.2 to 91.4	89.9 Number of steps/2 minutes Interval 85.2 to 94.7	86 Number of steps/2 minutes Interval 81.4 to 90.6	88.7 Number of steps/2 minutes Interval 83.9 to 93.5

SECONDARY outcome

Timeframe: Baseline plus change is being assessed after 8 weeks, 34 weeks, and 50 weeks for BMI.

Population: Total N=301 participants were analyzed.

Body composition: Average BMI (weight measured in pounds; height measured in inches) was measured utilizing BMI calculation formula: BMI = Weight (kg) / Height (m)²

Outcome measures

Outcome measures
Measure	Enhanced Physical Activity Monitor Only n=76 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Responder Treatment (weeks 9-34)- responders to "Enhanced Physical Activity Monitor only" treatment continued with this assigned treatment. Step 3: Maintenance (weeks 35-50)- responders to "Enhanced Physical Activity Monitor only" treatment continued with this assigned treatment.	Enhanced Physical Activity Monitor+ Motivational Text Messages n=81 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Responder Treatment (weeks 9-34)- responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment. Step 3: Maintenance (weeks 35-50)- responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor Only+ Personal Calls n=38 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with Enhanced Physical Activity Monitor plus were randomized to receive Personal Calls. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor Only+ Group Meetings n=35 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor only" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with Enhanced Physical Activity Monitor plus were randomized to participate in Group Meetings. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor only" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor+ Motivational Text Messages+ Personal Calls n=35 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment plus were randomized to receive Personal Calls. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only.	Enhanced Physical Activity Monitor+ Motivational Text Messages+ Group Meetings n=36 Participants Step1: Initial Treatment (weeks 1-8)- participants were randomly assigned to an "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment, which included Fitbit with goal setting, a physical activity prescription, and self-monitoring of daily steps + Text Messages. Step 2: Non-responder Treatment (weeks 9-34)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with this assigned treatment plus were randomized to participate in Group Meetings. Step 3: Maintenance (weeks 35-50)- non-responders to "Enhanced Physical Activity Monitor + Motivational Text Messages" treatment continued with "Enhanced Physical Activity Monitor" only .
Cardiovascular Health (2)	31.8 weight (pounds)/height (Inches)^2x703 Interval 30.4 to 33.2	32.4 weight (pounds)/height (Inches)^2x703 Interval 30.8 to 34.2	31.3 weight (pounds)/height (Inches)^2x703 Interval 29.8 to 32.8	31.6 weight (pounds)/height (Inches)^2x703 Interval 30.1 to 33.1	32.2 weight (pounds)/height (Inches)^2x703 Interval 30.6 to 33.9	32.1 weight (pounds)/height (Inches)^2x703 Interval 30.5 to 33.8

SECONDARY outcome

Timeframe: Baseline plus change is being assessed after 8 weeks, 34 weeks, and 50 weeks for waist measurement.

Population: Total N=301 participants were analyzed.

Body composition: Average waist circumference was measured in inches.