title: Evaluating the Maintenance of Lifestyle Changes in a Randomized Controlled Trial of the 'Get Healthy, Stay Healthy' Program.
abstract: BACKGROUND
  Extending contact with participants after initial, intensive intervention may support maintenance of weight loss and related behaviors.
  
  
  OBJECTIVE
  This community-wide trial evaluated a text message (short message service, SMS)-delivered, extended contact intervention ('Get Healthy, Stay Healthy' (GHSH)), which followed on from a population-level, behavioral telephone coaching program.
  
  
  METHODS
  This study employed a parallel, randomized controlled trial: GHSH compared with no continued contact (standard practice). Participants (n=228) were recruited after completing a 6-month lifestyle telephone coaching program: mean age = 53.4 (standard deviation (SD)=12.3) years; 66.7% (152/228) female; mean body mass index (BMI) upon entering GHSH=29.5 kg/m2 (SD = 6.0). Participants received tailored text messages over a 6-month period. The message frequency, timing, and content of the messages was based on participant preference, ascertained during two tailoring telephone calls. Primary outcomes of body weight, waist circumference, physical activity (walking, moderate, and vigorous sessions/week), and dietary behaviors (fruit and vegetable serves/day, cups of sweetened drinks per day, takeaway meals per week; fat, fiber and total indices from the Fat and Fiber Behavior Questionnaire) were assessed via self-report before (baseline) and after (6-months) extended contact (with moderate-vigorous physical activity (MVPA) also assessed via accelerometry).
  
  
  RESULTS
  Significant intervention effects, all favoring the intervention group, were observed at 6-months for change in weight (-1.35 kg, 95% confidence interval (CI): -2.24, -0.46, P=.003), weekly moderate physical activity sessions (0.56 sessions/week, 95% CI: 0.15, 0.96, P=.008) and accelerometer-assessed MVPA (24.16 minutes/week, 95% CI: 5.07, 43.25, P=.007). Waist circumference, other physical activity outcomes and dietary outcomes, did not differ significantly between groups.
  
  
  CONCLUSIONS
  The GHSH extended care intervention led to significantly better anthropometric and physical activity outcomes than standard practice (no contact). This evidence is useful for scaling up the delivery of GHSH as standard practice following the population-level telephone coaching program.
authors.affiliation: School of Public Health, Cancer Prevention Research Centre, The University of Queensland, Herston, Brisbane, Australia. b.fjeldsoe@sph.uq.edu.au.
authors.forename: Brianna S
authors.identifier: http://orcid.org/0000-0003-3800-4173
authors.initials: BS
authors.lastname: Fjeldsoe
authors.forename: Ana D
authors.identifier: http://orcid.org/0000-0003-4388-7054
authors.initials: AD
authors.lastname: Goode
authors.forename: Philayrath
authors.identifier: http://orcid.org/0000-0003-2460-5031
authors.initials: P
authors.lastname: Phongsavan
authors.forename: Adrian
authors.identifier: http://orcid.org/0000-0002-0369-4621
authors.initials: A
authors.lastname: Bauman
authors.forename: Genevieve
authors.identifier: http://orcid.org/0000-0002-6137-6437
authors.initials: G
authors.lastname: Maher
authors.forename: Elisabeth
authors.identifier: http://orcid.org/0000-0003-1452-6102
authors.initials: E
authors.lastname: Winkler
authors.forename: Elizabeth G
authors.identifier: http://orcid.org/0000-0002-8835-9995
authors.initials: EG
authors.lastname: Eakin
keywords: behavior change; diet; exercise; mHealth; maintenance; nutrition; physical activity; text message