(OR01-05-26) Associations Between Reductions in Food Insecurity and Moderate-to-Vigorous Physical Activity Among Hypertensive Adults: The Healthy Food First Clinical Trial

Objectives: Food insecurity (FI)—limited or uncertain access to adequate food—affects over 47 million U.S. adults and is associated with chronic disease risk. While FI is known to influence dietary behaviors, its relationship with physical activity (PA) remains unclear. Although Food Is Medicine (FIM) interventions increasingly reduce FI, no study has examined whether reductions in FI correspond with greater moderate-to-vigorous PA (MVPA), the domain most strongly linked with cardiovascular health. We examined whether 12-month change in FI (ΔFI) was associated with MVPA in a pragmatic FIM randomized trial of adults with hypertension.

Methods: Data were drawn from the Healthy Food First study (N=458), a 2×2×2 pragmatic FIM randomized clinical trial testing food assistance interventions among adults with hypertension and FI recruited from 364 clinical sites in North Carolina. This secondary analysis included 338 participants with complete 12-month FI and PA data. MVPA was assessed using the International Physical Activity Questionnaire–Short Form and expressed as MET-min/week. FI was measured using the USDA 10-item Household Food Security Module. ΔFI was calculated as the 12-month minus baseline score. Generalized estimating equation models estimated MVPA as a function of ΔFI, adjusting for sociodemographic and clinical covariates.

Results: Participants were predominantly female (75.3%) and Black (51.7%), with a mean age of 50.2 years at randomization. FI decreased by 1.4 points on average over 12 months. Mean MVPA at 12 months was 1,340 MET-min/week. Across all study conditions, ΔFI was not associated with MVPA (B = 36.9 MET-min/week; SE = 47.6; p = 0.44). Findings were consistent across adjusted models and sensitivity analyses. Improvements in FI did not correspond to meaningful differences in MVPA.

Conclusions: In this pragmatic FIM trial, modest reductions in FI were not associated with higher MVPA. These findings suggest that improvements in food security alone may be insufficient to increase MVPA and that additional PA supports are likely needed within FIM interventions.

Funding Sources: This work was supported by Blue Cross Blue Shield North Carolina.