mHealth Interventions for Lifestyle and Risk Factor Modification in Coronary Heart Disease: Randomized Controlled Trial

Abstract

Background Self-management of lifestyle and cardiovascular disease risk factors is challenging in older patients with coronary heart disease (CHD). SMS text messaging could be a potential support tool for self-management and the most affordable and accessible method through a mobile phone. High-quality evidence had been lacking, and previous studies evaluated the effects of SMS text messaging on the subjective measures of short-term outcomes. Recently, a large-sized randomized controlled trial in Australia reported promising findings on the objective measures upon 6-month follow-up. However, an examination of the effectiveness of such interventions in an Asian population with unique demographic characteristics would be worthwhile. Objective This study examined the effectiveness of a 1-way SMS text messaging program to modify the lifestyle and cardiovascular disease risk factors of patients who underwent the first percutaneous coronary intervention (PCI). Methods A parallel, single-blinded, 1:1 random allocation clinical trial was conducted with 879 patients treated through PCI. They were recruited during hospital admission from April 2017 to May 2020 at 2 university hospitals in the Republic of Korea. In addition to standard care, the intervention group received access to a supporting website and 4 SMS text messages per week for 6 months regarding a healthy diet, physical activity, smoking cessation, and cardiovascular health. Random allocation upon study enrollment and SMS text messaging after hospital discharge were performed automatically using a computer program. The coprimary outcomes were low-density-lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and BMI. The secondary outcomes were change in lifestyle and 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. The 1-way SMS text messaging program significantly enhanced physical activity (P=.02), healthy diet (P<.01), and medication adherence (P<.04) among patients with CHD. Hence, more people were likely to control their cardiovascular disease risk factors per the recommendations. The intervention group was more likely to control all 5 risk factors by 62% (relative risk 1.62, 95% CI 1.05-2.50) per the recommendations. On the other hand, physiological measures of the primary outcomes, including LDL-C levels, SBP, and BMI, were not significant. Most participants found the SMS text messaging program useful and helpful in motivating lifestyle changes. Conclusions Lifestyle-focused SMS text messages were effective in the self-management of a healthy diet, exercise, and medication adherence, but their influence on the physiological measures was not significant. One-way SMS text messages can be used as an affordable adjuvant method for lifestyle modification to help prevent the recurrence of cardiovascular disease. Trial Registration Clinical Research Information Service (CRiS) KCT0005087; https://cris.nih.go.kr/cris/search/detailSearch.do/19282

The effect of telemedicine on secondary prevention of atherosclerotic cardiovascular disease: A systematic review and meta-analysis

“…We presented their main characteristics in Table 1. These studies were conducted in North America (n = 5) (22)(23)(24)(25)(26), Europe (n = 10) (14, [27][28][29][30][31][32][33][34][35], Asia (n = 9) (19,(36)(37)(38)(39)(40)(41)(42)(43), Africa (n = 1) (44), Australia and New Zealand (n = 6) (45-50), South America (n = 1) (13). We included participants who were diagnosed with…”

Feasibility and Potential Effectiveness of a Smartphone Zero-Time Exercise Intervention for Promoting Physical Activity and Fitness in Patients With Coronary Heart Disease: A Pilot Randomized Controlled Trial

“…WhatsApp was the most common e-platform with an 84.3 % penetration rate in Hong Kong (44). Besides, we used picture e-messages that differed from the previous studies using text messages on PA only or PA combined with other information such as tobacco and diet messages (18,(20)(21)(22)(23)(24)(25)(26)(27)(28). A picture is worth a thousand words, and the ZTEx pictures should be easier for most participants to read than text messages, as some had presbyopia and older age group.…”

“…Five RCTs used PArelated text messages only (18,20,21,23,24), and three of them reported enhanced PA (18,23,24). The other five RCTs using text messages with other interventions (e.g., web-based video messages, telephone coaching, emails, tracking technologies, online discussion) (22,(25)(26)(27)(28), and the remaining 2 RCTs using PA-related Apps also showed increased PA (17,18).…”

“…With the advancement of digital health technologies, phone apps and messaging as mHealth inventions are increasingly popular and have shown more evidence of efficacy in the health care sector. We found 12 randomized controlled trials (RCTs) of the internet-and mobile-based phone delivered interventions to improve PA in CHD patients (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Five RCTs used PArelated text messages only (18,20,21,23,24), and three of them reported enhanced PA (18,23,24).…”

“…We found 12 randomized controlled trials (RCTs) of the internet-and mobile-based phone delivered interventions to improve PA in CHD patients (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Five RCTs used PArelated text messages only (18,20,21,23,24), and three of them reported enhanced PA (18,23,24). The other five RCTs using text messages with other interventions (e.g., web-based video messages, telephone coaching, emails, tracking technologies, online discussion) (22,(25)(26)(27)(28), and the remaining 2 RCTs using PA-related Apps also showed increased PA (17,18).…”