The UC group received standard care, which included the provision of an individualized home-based exercise program. The home program included similar exercises to those prescribed during the S2S program but modified for the home environment and for any equipment that was available to the participant. An optional referral to a range of community-based physical activity programs was also offered.

In addition to receiving UC, participants randomized to AT were provided with a Jawbone UP24 (TM; Jawbone, Inc) AT and ZTE (TM) mobile device and data plan. Participants who already had a compatible smartphone could choose to use the mobile device provided or their own device. No reimbursement for data costs was provided to those who chose to use their own smartphone. The device was worn on the nondominant wrist for the duration of the 12-month intervention. Participants were provided with an individual information session on how to use, pair, and charge the device at the time of randomization to the AT group. Written instructions and telephone support were provided to troubleshoot any technical issues. A separate Jawbone account was created for each participant, allowing the AEP to remotely access each participant’s daily step data. The Jawbone UP24 (TM) was paired to synchronize with the Jawbone UP (TM) app on the mobile device. A daily step goal was individually prescribed for each participant based on their physical function and current level of physical activity. This daily step goal was programmed into the UP (TM) app at the time of randomization, with automated feedback provided by the tracker and app based on this daily step goal. Participants were asked to synchronize the tracker with the UP (TM) app at the end of each day but could check the progress toward their daily step goal as desired. In addition to daily feedback available through the UP (TM) app, participants received weekly, personalized text messages from an AEP. The text message contained feedback related to average daily steps and a comparison of their daily step goal with that of the previous week. The daily step goal was slightly adjusted (±200-500 steps) during the weekly text message feedback from the AEP based on the previous week’s step data. The daily step goal in the UP (TM) app however remained the same, as this could not be adjusted remotely. If participants continued to significantly underachieve or exceed their initial daily step goal, the UP (TM) app was adjusted during their 3-, 6-, or 12-month assessment. An example of the text messages sent to participants by the AEP is provided in Multimedia Appendix 1.

Participants randomized to the TC group received UC and a physical activity counseling phone call once a fortnight for the first 3 months and once a month for the remaining 9 months of the intervention. Phone calls were delivered by an AEP experienced in motivational interviewing techniques [16], following set protocols to determine the participants’ self-reported physical activity levels. The protocol allowed the AEP to offer tailored support and advice regarding exercise prescription and modification and assist participants to identify and address any barriers limiting their physical activity participation [15]. Participants were asked to self-report activity levels and compliance with their home-based exercise program and to identify any issues preventing them from being physically active. Constructs from the Social Cognitive Theory [17], including the use of goal setting and self-monitoring, the provision of feedback, and motivational interviewing techniques (eg, affirming, reflective listening, summarizing, and informing and advising) to improve self-efficacy were used during phone calls. Participants in the TC group were asked to refrain from using a wearable AT for the duration of the intervention.

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