JMIR Publications

ABSTRACT

Background:

Research indicates that many autistic adults are insufficiently active and overly sedentary. There is limited evidence on effective strategies to increase physical activity (PA) and reduce sedentary behavior (SB) in this population. Gamified mobile health (mHealth) interventions show promise for addressing these challenges by leveraging autistic individuals' strengths in visuospatial learning and their affinity for digital gaming. Despite this potential, how well these interventions translate to real-world settings remains unclear. This gap is compounded by the lack of community-based participatory approaches in the development of mHealth intervention for autistic adults.

Objective:

This study aims to (1) formulate gamification and behavior change strategies for the PuzzleWalk v2 app using a community-based participatory approach and (2) evaluate its feasibility and acceptability in increasing PA and reducing SB among autistic adults, including those with mild intellectual disability, in real-world settings.

Methods:

This study, consisting of two sequential phases, will be conducted entirely remotely: (1) online community-based design workshops to refine the PuzzleWalk v2 gamified mHealth system with input from key autism stakeholders, including autistic adults and caregivers and (2) an 8-week field deployment to assess real-world usability and engagement. In Phase I (completed), weekly workshops and usability testing focused on understanding autistic adults’ technology preferences, evaluating PuzzleWalk v1 and v2 prototypes, and incorporating stakeholder feedback into iterative app development (n=9). Phase II (in progress) will involve a single-arm clinical trial where participants (n=~55) will use the app alongside research-grade activity-tracking accelerometers to measure PA and SB. Outcome measures, including sedentary time, step counts, PA intensities, and app engagement (e.g., time spent for app use), will be collected across four specific time points (i.e., baseline, weeks 3, 5, and 8). Repeated measures ANCOVA will be performed to examine changes in participants’ objective levels of PA and sedentary time before, during, and after the intervention.

Results:

Phase I of the study, community-based participatory design workshops and usability testing, was completed in November 2024. Key autism stakeholders recognized the gamified PuzzleWalk app as a viable tool for enhancing motivation toward PA and SB changes among autistic adults. Data collection for Phase II, the field deployment, is currently underway. The findings of these studies will be shared in a subsequent peer-reviewed publication.

Conclusions:

Results of the ongoing field deployment study (Phase II) will further clarify the app’s effectiveness and real-world applicability. Clinical Trial: NIH ClinicalTrials.gov ID: NCT06566131