title: Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Cardiovascular disease prevention, including lifestyle modification, is important but underutilized. Mobile health strategies could address this gap but lack evidence of therapeutic benefit.
  
  
  OBJECTIVE
  To examine the effect of a lifestyle-focused semipersonalized support program delivered by mobile phone text message on cardiovascular risk factors.
  
  
  METHODS
  The Tobacco, Exercise and Diet Messages (TEXT ME) trial was a parallel-group, single-blind, randomized clinical trial that recruited 710 patients (mean age, 58 [SD, 9.2] years; 82% men; 53% current smokers) with proven coronary heart disease (prior myocardial infarction or proven angiographically) between September 2011 and November 2013 from a large tertiary hospital in Sydney, Australia.
  
  
  METHODS
  Patients in the intervention group (n = 352) received 4 text messages per week for 6 months in addition to usual care. Text messages provided advice, motivational reminders, and support to change lifestyle behaviors. Patients in the control group (n=358) received usual care. Messages for each participant were selected from a bank of messages according to baseline characteristics (eg, smoking) and delivered via an automated computerized message management system. The program was not interactive.
  
  
  METHODS
  The primary end point was low-density lipoprotein cholesterol (LDL-C) level at 6 months. Secondary end points included systolic blood pressure, body mass index (BMI), physical activity, and smoking status.
  
  
  RESULTS
  At 6 months, levels of LDL-C were significantly lower in intervention participants, with concurrent reductions in systolic blood pressure and BMI, significant increases in physical activity, and a significant reduction in smoking. The majority reported the text messages to be useful (91%), easy to understand (97%), and appropriate in frequency (86%). [table: see text].
  
  
  CONCLUSIONS
  Among patients with coronary heart disease, the use of a lifestyle-focused text messaging service compared with usual care resulted in a modest improvement in LDL-C level and greater improvement in other cardiovascular disease risk factors. The duration of these effects and hence whether they result in improved clinical outcomes remain to be determined.
  
  
  BACKGROUND
  anzctr.org.au Identifier: ACTRN12611000161921.
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia2Westmead Hospital, Sydney, Australia.
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Redfern
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia4Royal Perth Hospital, Perth, Australia5University of Western Australia, Perth.
authors.forename: Graham S
authors.initials: GS
authors.lastname: Hillis
authors.affiliation: Westmead Hospital, Sydney, Australia3The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Jay
authors.initials: J
authors.lastname: Thakkar
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Karla
authors.initials: K
authors.lastname: Santo
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Maree L
authors.initials: ML
authors.lastname: Hackett
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
authors.affiliation: Queensland University of Technology, Queensland, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Laura
authors.initials: L
authors.lastname: de Keizer
authors.affiliation: Westmead Hospital, Sydney, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Barry
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Severine
authors.initials: S
authors.lastname: Bompoint
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Stepien
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Robyn
authors.initials: R
authors.lastname: Whittaker
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Rodgers
authors.affiliation: Westmead Hospital, Sydney, Australia8University of Sydney, Sydney, Australia.
authors.forename: Aravinda
authors.initials: A
authors.lastname: Thiagalingam
mesh_terms: D001794:Blood Pressure; D015992:Body Mass Index; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000517:prevention & control*; D015444:Exercise; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D017010:Reminder Systems; D012307:Risk Factors; D016037:Single-Blind Method; D012907:Smoking; D060145:Text Messaging / Q000706:statistics & numerical data*; D013997:Time Factors
chemical_list: D008078:Cholesterol, LDL