Fitbit-Tracked Micromovement for Cardiometabolic Health in Rural Women

Official title

Rural Initiative for Inflammatory Screening & Engagement for Women

Overview

This pilot study tests whether a low-burden prevention program can be integrated into routine care to identify and reduce cardiometabolic risk in rural women. Rural women face high rates of cardiometabolic syndrome, a cluster of conditions (elevated blood pressure, abdominal obesity, abnormal cholesterol, and high blood sugar) that raises the risk of heart disease and diabetes, yet often face barriers to prevention and screening. The study enrolls physically inactive adult women with multiple cardiometabolic risk factors who receive care at a rural federally qualified health center. At a baseline visit, participants complete surveys and clinical assessments including inflammatory biomarkers (C-reactive protein and interleukin-6), metabolic labs, blood pressure, waist circumference, menopausal status, and social determinants of health. Participants then take part in a 12-week program of brief, frequent daily movement supported by a wearable activity tracker. Assessments are repeated at 12 weeks. Because this is a single-group pilot, every participant receives the program and serves as her own comparison. The study evaluates whether the model is feasible to run within routine clinic workflows and examines preliminary changes in cardiometabolic and inflammatory risk indicators. Findings will inform larger studies of scalable prevention strategies for rural women.

Detailed description

Thought process Thought process Here are both, written to PRS conventions and ready to paste. Brief Summary is lay-facing and concise; Detailed Description carries the technical detail.

Brief Summary This pilot study tests whether a low-burden prevention program can be integrated into routine care to identify and reduce cardiometabolic risk in rural women. Rural women face high rates of cardiometabolic syndrome, a cluster of conditions (elevated blood pressure, abdominal obesity, abnormal cholesterol, and high blood sugar) that raises the risk of heart disease and diabetes, yet often face barriers to prevention and screening.

The study enrolls physically inactive adult women with multiple cardiometabolic risk factors who receive care at a rural federally qualified health center. At a baseline visit, participants complete surveys and clinical assessments including inflammatory biomarkers (C-reactive protein and interleukin-6), metabolic labs, blood pressure, waist circumference, menopausal status, and social determinants of health. Participants then take part in a 12-week program of brief, frequent daily movement supported by a wearable activity tracker. Assessments are repeated at 12 weeks.

Because this is a single-group pilot, every participant receives the program and serves as her own comparison. The study evaluates whether the model is feasible to run within routine clinic workflows and examines preliminary changes in cardiometabolic and inflammatory risk indicators. Findings will inform larger studies of scalable prevention strategies for rural women.

Detailed Description Background. Cardiometabolic syndrome (CMS) substantially increases the risk of cardiovascular disease, type 2 diabetes, and early mortality. Rural women experience disproportionately high rates of CMS due to structural and social barriers, and risk is often identified only after disease has progressed. Systemic inflammation contributes to CMS development, and biomarkers such as C-reactive protein (CRP) and interleukin-6 (IL-6) can rise before metabolic abnormalities appear, offering an opportunity for earlier risk identification. Physical inactivity and prolonged sedentary time contribute to metabolic dysregulation; brief, frequent bouts of movement supported by wearable trackers may help interrupt sedentary behavior.

Purpose. This pilot evaluates the feasibility of the Rural Initiative for Inflammatory Screening and Engagement for Women (RISE-W), a pragmatic prevention model designed to support early identification and reduction of cardiometabolic risk among physically inactive rural women receiving care at a federally qualified health center.

Design. Prospective, single-group, pre-post pilot interventional design. All enrolled participants receive the RISE-W intervention and serve as their own control, with outcomes assessed at baseline and at the conclusion of the 12-week intervention.

Objectives.

Evaluate the feasibility of integrating inflammatory biomarkers, metabolic screening, and cardiometabolic risk assessment into routine care.

Implement and assess the acceptability of and adherence to a low-burden prevention strategy incorporating micro-movement physical activity.

Examine preliminary changes in cardiometabolic risk indicators (inflammatory biomarkers, metabolic markers, blood pressure, and waist circumference) over 12 weeks.

Assess the feasibility of embedding the model within existing clinic workflows without increasing clinician workload.

Intervention. A 12-week pragmatic prevention strategy consisting of micro-movement physical activity: brief bouts of light-to-moderate movement each hour during waking hours (target of at least 10 hours per day), supported by a wearable activity tracker (Fitbit Inspire 3) providing automated hourly movement reminders and self-monitoring.

Assessments. At baseline, participants complete demographic and health questionnaires, a social determinants of health questionnaire, and menopausal staging, along with anthropometric measurements (waist circumference, height, weight), blood pressure, and fasting blood samples for metabolic indicators (fasting glucose, triglycerides, HDL) and inflammatory biomarkers (CRP, IL-6). Post-intervention assessments at 12 weeks (study day 84 ± 14 days) repeat anthropometric measures, blood pressure, and biomarker collection, and include a self-report follow-up survey and download of the full activity-tracker dataset.

Outcomes. Primary outcomes are change from baseline to 12 weeks in cardiometabolic risk indicators (waist circumference, systolic and diastolic blood pressure, fasting glucose, triglycerides, HDL) and inflammatory biomarkers (CRP, IL-6), together with feasibility and adherence metrics (assessment completion and adherence to micro-movement activity). Secondary outcomes include anthropometric change (weight, BMI), self-reported physical activity, and exploratory associations of menopausal status and social determinants of health with adherence and outcomes.

Sample size. A target of 125 participants was selected to evaluate feasibility metrics and provide preliminary estimates of effect size and variability to inform future larger trials; the study is not powered for formal hypothesis testing.

Interventions

• Behavioral RISE-W Micro-Movement Program
  Brief, frequent bouts of light-to-moderate movement performed each waking hour (target ≥10 hours/day) over 12 weeks, supported by a Fitbit Inspire 3 activity tracker that delivers automated hourly movement reminders and enables self-monitoring.

Primary outcome measures

• Study completion rate (feasibility) [Time frame: Baseline through 12 weeks]
• Adherence to micro-movement intervention (feasibility) [Time frame: Over the 12-week intervention period]

Secondary outcome measures (9)

• Change in waist circumference [Time frame: Baseline and 12 weeks]
• Change in blood pressure [Time frame: Baseline and 12 weeks]
• Change in fasting blood glucose [Time frame: Baseline and 12 weeks]
• Change in triglycerides [Time frame: Baseline and 12 weeks]
• Change in HDL cholesterol [Time frame: Baseline and 12 weeks]
• Change in C-reactive protein (CRP) [Time frame: Baseline and 12 weeks]
• Change in interleukin-6 (IL-6) [Time frame: Baseline and 12 weeks]
• Change in body weight and BMI [Time frame: Baseline and 12 weeks]
• Change in self-reported physical activity [Time frame: Baseline and 12 weeks]

Eligibility criteria

Inclusion criteria

Female, aged 18 to 80 years Physically inactive, defined as less than 150 minutes of moderate-intensity physical activity per week (by self-report) Metabolic syndrome, defined as three or more cardiometabolic risk factors consistent with NCEP ATP III criteria, based on documented diagnosis or clinical history: waist circumference >88 cm; blood pressure ≥130/85 mmHg; fasting blood glucose ≥100 mg/dL; triglycerides ≥150 mg/dL; HDL cholesterol <50 mg/dL Access to a personal or household smartphone (Apple iOS 16.4 or higher, or Android OS 11.0 or higher) capable of installing the Fitbit application; no cellular data plan required Working email address Able to understand and provide written informed consent in English or Spanish Receiving care at one of the three Larry Combest Community Health \& Wellness Center sites

Exclusion criteria

Current pregnancy or planning to become pregnant during the study period Medical conditions that preclude safe participation in light-to-moderate physical activity (e.g., unstable cardiovascular disease, uncontrolled hypertension, severe musculoskeletal limitations), as determined by the PI through EHR review Participation in another structured lifestyle or cardiometabolic intervention study within the past 6 months (self-report) Use of medications or treatments that significantly alter inflammation or metabolism (e.g., systemic corticosteroids, recent chemotherapy), as determined by the PI through EHR review Inability to comply with study procedures, including wearing the activity tracker or completing follow-up assessments No access to a smartphone, or a smartphone unable to run the Fitbit application due to operating system incompatibility

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Prevention

Study locations

United States · 1 center

• Texas Tech University Health Sciences Center Clinical Research Institute — Lubbock

Publications

• Wan KW, Dai ZH, Wong PS, Huang WY, Lei EF, Little JP, Lin FC, Tam BT. Effects of Exercise Snacks on Cardiometabolic Health and Body Composition in Adults: A Systematic Review and Meta-Analysis. Scand J Med Sci Sports. 2025 Aug;35(8):e70114. doi: 10.1111/sms.70114. PMID 40814152
• Scott J, Dardas L, Sloane R, Wigington T, Noonan D, Simmons LA. Understanding Social Determinants of Cardiometabolic Disease Risk in Rural Women. J Community Health. 2020 Feb;45(1):1-9. doi: 10.1007/s10900-019-00710-0. PMID 31372797
• Ridker PM, MacFadyen JG, Glynn RJ, Bradwin G, Hasan AA, Rifai N. Comparison of interleukin-6, C-reactive protein, and low-density lipoprotein cholesterol as biomarkers of residual risk in contemporary practice: secondary analyses from the Cardiovascular Inflammation Reduction Trial. Eur Heart J. 2020 Aug 14;41(31):2952-2961. doi: 10.1093/eurheartj/ehaa160. PMID 32221587
• National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002 Dec 17;106(25):3143-4 PMID 12485966
• Ferguson T, Olds T, Curtis R, Blake H, Crozier AJ, Dankiw K, Dumuid D, Kasai D, O'Connor E, Virgara R, Maher C. Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses. Lancet Digit Health. 2022 Aug;4(8):e615-e626. doi: 10.1016/S2589-7500(22)00111-X. PMID 35868813
• Fahed G, Aoun L, Bou Zerdan M, Allam S, Bou Zerdan M, Bouferraa Y, Assi HI. Metabolic Syndrome: Updates on Pathophysiology and Management in 2021. Int J Mol Sci. 2022 Jan 12;23(2):786. doi: 10.3390/ijms23020786. PMID 35054972
• Chan A, Chan D, Lee H, Ng CC, Yeo AHL. Reporting adherence, validity and physical activity measures of wearable activity trackers in medical research: A systematic review. Int J Med Inform. 2022 Apr;160:104696. doi: 10.1016/j.ijmedinf.2022.104696. Epub 2022 Jan 31. PMID 35121356
• Bell ML, Whitehead AL, Julious SA. Guidance for using pilot studies to inform the design of intervention trials with continuous outcomes. Clin Epidemiol. 2018 Jan 18;10:153-157. doi: 10.2147/CLEP.S146397. eCollection 2018. PMID 29403314

Identifiers

NCT: NCT07704749 · IRB-FY2026-236 · IRB-FY2026-236

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗