PHYSICAL ACTIVITY AMONG FOOD INSECURE HYPERTENSIVE ADULTS IN THE HEALTHY FOOD FIRST CLINICAL TRIAL: ASSOCIATIONS WITH FOOD INSECURITY LEVELS, COMMUNITY HEALTH WORKER EFFECTIVENESS, AND SOCIOECONOMIC DRIVERS

Food insecurity (FI), defined as limited or uncertain access to adequate food, affects more than 47 million adults in the United States and is associated with elevated cardiometabolic risk. Although FI has been consistently linked to poor diet quality and adverse health outcomes, less is known about its relationship with physical activity (PA), a key determinant of cardiometabolic health. Prior studies examining FI and PA have produced mixed findings, and little is known about whether changes in FI (ΔFI) translate into meaningful changes in PA, particularly within Food Is Medicine (FIM) interventions.Data from the Healthy Food First (HFF) randomized clinical trial were used to examine relationships between FI, PA, and community health worker (CHW) support among adults with hypertension experiencing FI. Secondary quantitative analyses included 458 participants enrolled in the HFF 2×2×2 pragmatic trial. ΔFI from baseline to 12 months was examined in relation to moderate-to-vigorous physical activity (MVPA) at 12 months using generalized estimating equation models. Causal mediation analyses evaluated whether ΔFI mediated the effect of CHW assignment on total PA at 12 and 18 months. In addition, qualitative data were collected through semi-structured interviews with a subsample of participants (n = 38) to examine perceived barriers and facilitators to PA.Across the cohort, FI improved modestly over 12 months; however, ΔFI was not associated with MVPA. Mediation analyses indicated that ΔFI did not mediate the relationship between CHW assignment and PA, and CHW assignment was not independently associated with PA over time. Qualitative findings indicated that participants viewed PA as important for health, but sustained engagement in leisure-time PA was limited by time scarcity, occupational demands, health limitations, and environmental barriers. CHW support was perceived as encouraging but was primarily focused on diet.Together, these findings suggest that modest improvements in FI alone may be insufficient to produce meaningful increases in PA among adults with hypertension. These results underscore the importance of explicitly supporting PA within FIM interventions using tailored, low-burden approaches and highlight the value of using a mixture of quantitative and qualitative methods to understand how FI-related constraints shape health behavior.