Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Apr 26, 2021
Date Accepted: Aug 27, 2021
Mobile health interventions for lifestyle and risk factor modification in coronary heart disease: A randomized controlled trial
ABSTRACT
Background:
The self-management of lifestyle and cardiovascular risk factors is challenging in older patients with coronary heart disease (CHD). Text messaging could be a potential support tool for self-management, but high-quality evidence is lacking.
Objective:
This study aimed to evaluate the effectiveness of a text message program to modify the lifestyle and cardiovascular risk factors in patients who underwent the first percutaneous coronary intervention (PCI).
Methods:
A parallel, single-blinded, 1:1 random allocation clinical trial was conducted on 879 patients treated by PCI, who were recruited during hospital admission from April 2017 to May 2020 in two university hospitals in the Republic of Korea. In addition to standard care, the intervention group received access to a supporting website and four text messages per week for six months regarding a healthy diet, physical activity, smoking, and cardiovascular health. Random allocation at study enrollment and text messaging after hospital discharge was performed automatically using a computer program. The primary outcomes were LDL cholesterol (LDL-C), systolic blood pressure (SBP), and body mass index (BMI). The secondary outcomes were the change in lifestyle and the adherence to the recommended health behaviors.
Results:
Of the eligible population, 440 and 439 patients who underwent PCI were assigned to the intervention and control groups, respectively. A one-way text message program could enhance the physical activity, healthy diet, and medication adherence significantly in patients with CHD (p-value=0.02, <0.01, and <0.04, respectively), so more people were likely to control their cardiovascular risk factors as recommended. The intervention group was more likely to keep all five risk factors as guidelines recommended by 62% (95% CI, 1.05-2.50). On the other hand, it could not reach statistical significance in the physiological measures of the primary outcomes: LDL-C level, SBP, and BMI. Most participants found the text message program to be useful and helpful for motivation to change lifestyle.
Conclusions:
Lifestyle-focused text messages were effective in the self-management of a healthy diet, exercise, and medication adherence, but their influence on physiological measures was modest and limited. Clinical Trial: Clinical Research Information Service (CRiS) at https://cris.nih.go.kr, Identification: KCT0005087
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