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.
Keywords: Blood Pressure, Body Mass Index, Cholesterol, LDL, Coronary Artery Disease, Exercise, Life Style, Lipoproteins, LDL, Metabolic Syndrome X, Motivation, Myocardial Infarction, Primary Prevention, Risk Factors, Smoking, Text Messaging, Tobacco Use Cessation Products
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