Cluster randomized multilevel intervention for promoting physical activity in rural communities

Summary

This cluster randomized trial (“Heartland Moves”) tested a multi-level approach to increasing physical activity across 14 rural communities in southeast Missouri. One core component was a 24-week text-message exercise program delivered through CareMessage, alongside walking groups and community marketing. Despite disruptions from COVID-19, participants in intervention communities were significantly more likely to meet aerobic activity guidelines, and those who received more of the text messages were the most active, underscoring text messaging as a durable, scalable tool for promoting health in rural, lower-income communities.

Key Findings

• Intervention participants were nearly twice as likely to meet aerobic activity guidelines (odds ratio 1.99; p=0.045).
• Participants who received at least half of the exercise text messages had more than double the weekly activity of those who received none.
• The text-message component maintained fidelity even when COVID-19 disrupted in-person activities.
• The program reached predominantly lower-income rural communities.

Clinical Significance

Text messaging can be a sustainable, scalable way to promote physical activity in rural communities, retaining its impact even when in-person programming is interrupted.

CareMessage Product Features

Programs

Citation

Beck AM, Serrano N, Duncan D, Eyler AA, Gilbert A, Naghiloo F, Reis R, Tabak RG and Brownson RC (2025) Cluster randomized multilevel intervention for promoting physical activity in rural communities. Front. Public Health 13:1577056. doi: 10.3389/fpubh.2025.1577056