title: Efficacy of a Text Message-Delivered Extended Contact Intervention on Maintenance of Weight Loss, Physical Activity, and Dietary Behavior Change.
abstract: BACKGROUND
  Extending contact with participants after the end of an initial intervention is associated with successful maintenance of weight loss and behavior change. However, cost-effective methods of extending intervention contact are needed.
  
  
  OBJECTIVE
  This study investigated whether extended contact via text message was efficacious in supporting long-term weight loss and physical activity and dietary behavior change in breast cancer survivors.
  
  
  METHODS
  Following the end of an initial 6-month randomized controlled trial of a telephone-delivered weight loss intervention versus usual care, eligible and consenting intervention participants received a 6-month extended contact intervention via tailored text messages targeting a range of factors proposed to influence the maintenance of behavior change. In this single-group, pre-post designed study, within group changes in weight, moderate-to-vigorous physical activity (Actigraph GT3X+ accelerometers), and total energy intake (2x24 hour dietary recalls) were evaluated from baseline to end of initial intervention (6 months), end of extended contact intervention (12 months), and after a no-contact follow-up (18 months) via linear mixed models. Feasibility of implementation was assessed through systematic tracking of text message delivery process outcomes, and participant satisfaction was assessed through semistructured interviews.
  
  
  RESULTS
  Participants at baseline (n=29) had a mean age of 54.9 years (SD 8.8), body mass index of 30.0 kg/m(2) (SD 4.2), and were recruited a mean 16.6 months (SD 3.2) post diagnosis. From baseline to 18 months, participants showed statistically significantly lower mean weight (-4.2 kg [95% CI -6.0 to -2.4]; P<.001) and higher physical activity (mean 10.4 mins/day [95% CI 3.6-17.2]; P=.003), but no significant differences in energy intake (P=.200). Participants received a mean of 8 text messages every 2 weeks (range 2-11) and reported a high rate of satisfaction.
  
  
  CONCLUSIONS
  In comparison to interventions without extended contact, results suggest text message-delivered extended contact may support the attenuation of weight regain and promote the maintenance of physical activity.
authors.affiliation: Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Brisbane, Australia.
authors.forename: Lauren C
authors.identifier: http://orcid.org/0000-0001-5175-5743
authors.initials: LC
authors.lastname: Spark
authors.forename: Brianna S
authors.identifier: http://orcid.org/0000-0003-3800-4173
authors.initials: BS
authors.lastname: Fjeldsoe
authors.forename: Elizabeth G
authors.identifier: http://orcid.org/0000-0002-8835-9995
authors.initials: EG
authors.lastname: Eakin
authors.forename: Marina M
authors.identifier: http://orcid.org/0000-0003-3052-2013
authors.initials: MM
authors.lastname: Reeves
keywords: SMS; behavior change; diet; intervention; maintenance; mhealth; mobile telephone; physical activity; textmessaging; weight