“The gamified app leverages this population’s strengths for visual-spatial learning and recognizing details,” Lee said. 

As part of the game, users travel to popular cities worldwide, and as they achieve certain step levels, they unlock new puzzles, effectively flipping the script on the idea that gaming results in sedentary behavior. 

In a pilot study funded by the donor-created Maggie E. Neumann Health Sciences Research Fund, which targets research and innovation aimed at improving the lives of people with disabilities, dozens of autistic adults from across the country compete with one another to see their name on a leaderboard and earn tangible rewards. The top 10 scorers are eligible for rewards, and leaderboard scores are automatically reset at the end of each month to encourage consistent physical activity engagement among users. Users who take 10,000 steps daily for one month could earn a $65 Amazon gift card. 

Pagan enjoys checking the leaderboard daily. 

“I’m competitive,” Pagan said. “I see other people walking daily, which inspired me to take more steps and solve more puzzles to get ahead of them.” 

However, Lee said early data shows that the competitive aspect doesn’t work for all users.

“There’s no one-size-fits-all approach,” Lee said. “We’ve found older autistic individuals tend not to engage in this kind of intervention due to difficulties with technology.”

That wasn’t the case for 55-year-old Laura Willey of Northern Virginia. 

“There was no learning curve. PuzzleWalk was intuitive,” she said. 

Willey doesn’t consider herself a gamer, but she’s always looking for extra motivation to stay active — outside of walking her dogs.  

“It’s been fun,” she said. “It added a new dimension to connect and compete with others.” 

Next steps

Lee plans to pursue a competitive Small Business Innovation Research grant to commercialize PuzzleWalk with support from UD’s Office of Economic Innovation and Partnerships. 

“The Neumann funding accelerated our research, and it would have been challenging to deploy this initial phase of the study without this critical support,” Lee said.

Lee also aims to expand the app’s reach by collaborating with colleagues at the University of Kansas Medical Center, which provides specialty care for people with Down syndrome. 

“We just submitted an R21 grant proposal to the National Institutes of Health to test whether the app is transferable to individuals with mild-to-moderate intellectual disabilities,” Lee said. 

If the current pilot study results in statistically significant improvements in physical activity in autistic adults, Lee will launch a larger-scale clinical trial. Otherwise, the app will undergo adjustments. But so far, exit interviews show the app has promise.  

“It encouraged me to take an hour out of my day to walk. Even late at night, when I wanted to sleep, I'd walk and play more puzzles if I hadn’t reached my 5,000-step goal,” Pagan said. “It doesn’t feel like real exercise, but every step counts.”

Lee values this input.

“We want to ensure that this population is heard and that their insights are part of future iterations of the intervention,” Lee said. “We are not aiming to replace traditional exercise or physical activity but rather to diversify physical activity options for those who may face barriers in benefiting from the built environment due to accessibility or resource issues.”

Lia McNulty, a doctoral student in the health behavior science and promotion program, oversees the study and collects participants’ valuable input. She worked as a counselor for children with disabilities in high school and college, but this marks her first time working with autistic adults.

“This is a priority population I want to stick with,” McNulty said. “Autistic adults are understudied, and bringing my interest in physical activity promotion into a population that needs it has been fascinating and rewarding.” 

She also finds the use of technology in this study novel. 

“Technology has endless opportunities to improve lives, and autistic individuals have a natural affinity for technology, so I am interested in finding new ways to leverage that for health promotion,” McNulty said. 

This also marks research assistant Swetha Kathiravan’s first time working with autistic adults. She graduated from the neuroscience 4+1 (B.S./M.S.) program at UD’s College of Arts and Sciences last year and brings extensive experience with autistic children.

“As an undergrad at UD, I volunteered with UNICEF, Nemours, and at schools, so I’m passionate about pediatrics,” Kathiravan said. “But through this research, Dr. Lee has wedged in a new, important perspective: these children grow up and need support.” 

About the fund

Maggie E. Neumann Health Sciences Research Fund was established in 2020 to support research designed to improve health and quality of life outcomes for children and adults with physical and developmental disabilities. While the fund resides at the College of Health Sciences, the intent is to support interdisciplinary research across all UD colleges.

The research fund was created with a gift from Donald J. Puglisi and Marichu C. Valencia in honor of their granddaughter, Maggie E. Neumann. Puglisi is a member of UD’s Board of Trustees, and they both serve on the President’s Leadership Council.