Text Messaging for Risk Factor Modification in Coronary Disease
Does text messaging to promote lifestyle modification improve cardiovascular risk factors?
The TEXT ME (Tobacco, Exercise and Diet Messages) trial was a parallel-group, single-blind, randomized trial with a study population of men and women with documented coronary heart disease (CHD), including prior myocardial infarction and/or angiographically demonstrated coronary artery disease. Enrollment occurred between September 2011 and November 2013 in a large tertiary hospital in Sydney, Australia. Subjects randomized to the intervention (n = 352) received four text messages per week for 6 months in addition to usual care. Texts included advice, motivational reminders, and support for lifestyle modification. Text messages were selected from a bank of messages and were chosen for each participant based on their personal characteristics. Messages were derived via an automated messaging service. The control group (n = 358) received usual care. The primary outcome of interest was low-density lipoprotein (LDL) cholesterol at 6 months. Secondary outcomes included systolic blood pressure, body mass index (BMI), physical activity, and smoking status.
A total of 710 patients (mean age, 58 [standard deviation, 9.2] years; 82% men; 53% current smokers) were included in the TEXT ME trial. At 6 months, LDL cholesterol was significantly lower in the participants who received the intervention (mean LDL 79 mg/dl, 95% confidence interval [CI], 76-82) compared to the usual care group (84 mg/dl, 95% CI, 81-87). Systolic blood pressure and BMI were also reduced. Those in the intervention group significantly increased their physical activity compared to the control group (mean difference, 293.2 MET minute/week; 95% CI, 102-484.8; p = 0.003). The number of participants who smoked was also lower at 6 months in the intervention group compared to the control group (26% vs. 42.9%, p < 0.001). Most participants in the intervention group reported that the text messages were useful (91%), easy to understand (97%), and appropriate in number per week (86%).
The investigators concluded that among patients with CHD, text messaging to promote lifestyle modification was associated with improvements in cardiovascular risk factors.
This trial demonstrated the potential of a health text intervention to assist patients in changing behaviors to promote health. Longer-term studies are warranted given that the adherence to lifestyle behaviors often declines after 6 months. Additional information on culturally appropriate interventions and the possible associations with adherence for medications may be important areas to examine.
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