Digital Peer Support to Increase Walking Among Older Adults: Cluster Randomized Trial

Background: As the population ages, older adults face an increasing risk of physical inactivity and related health complications, highlighting the need for scalable interventions. Smartphone-based programs have emerged as a promising strategy to support sustained physical activity among older adults. Objective: This study aimed to evaluate whether a smartphone lecture program incorporating a digital peer support app would increase physical activity among older adults, compared to a conventional smartphone lecture program. Methods: This 2-arm, 1:1 parallel-arm, cluster-randomized trial was conducted in 2 urban regions of Japan (Sumida Ward, Tokyo, and Chiba City, Chiba). Eligible participants were community-dwelling adults aged ≥60 years, able to walk independently, and smartphone users; exclusion criteria included prior use of the peer support app or medical restrictions on walking. Participants were recruited offline during community smartphone lectures (closed-group recruitment). The intervention combined face-to-face lectures with app-based peer support, while outcomes were assessed both objectively (via smartphones) and through self-administered paper questionnaires. All participants received a baseline smartphone lecture. Intervention participants attended 2 additional sessions using a digital peer support app (Minchalle; A10 Lab Inc), which included features such as daily step goals, peer sharing, and group encouragement. Control participants attended 2 standard follow-up smartphone lectures. The primary outcome was the change in weekly average daily step count from baseline to Week 12. Secondary outcomes included total metabolic equivalent of task (MET)–minutes per week (assessed via the International Physical Activity Questionnaire), walking time (≥30 minutes per day), daily smartphone use, and number of smartphone use purposes. Results: A total of 156 community-dwelling older adults were grouped into 40 clusters and randomized (20 intervention clusters, n=80 and 20 control clusters, n=76). In total, 124 participants (79.5%) completed the follow-up, and valid step data were available for 117 participants, with missing data ranging from 5.1% to 29.1%. Baseline daily steps averaged 3951 (SD 1686) in controls versus 4583 (SD 1973) in the intervention arm. An unadjusted mixed model for repeated measures showed significantly higher step changes for intervention participants at Week 12 (difference=579, 95% CI 36-1123; =.04). No significant differences emerged for total METs (difference=646 MET-min per week, 95% CI –12 to 1303; =.054) or walking ≥30 minutes per day (odds ratio [OR] 1.56, 95% CI 0.63-3.90; =.33). However, the intervention arm demonstrated a significant increase in daily smartphone use (OR 4.10, 95% CI 1.15-14.6; =.03) and in the number of smartphone use purposes (difference=0.58, 95% CI 0.12-1.05; =.01). Conclusions: A smartphone lecture program integrated with app-based peer support led to modest but meaningful improvements in step counts among older Japanese adults, at Week 12 of the 12-week intervention. Future research should investigate long-term maintenance, additional measures of physical activity, and subpopulation responses to optimize digital health programs for older adults. Trial Registration: UMIN-CTR UMIN000051904; https://tinyurl.com/4m4zm99v