BACKGROUND
Participation in outpatient cardiac rehabilitation (CR) Phase II reduces morbidity, mortality, and improves the quality of life. After Phase II, patients enter Phase III where they attempt to maintain the heart-healthy lifestyle learned during CR Phase II. Despite the benefits of CR Phase II, adherence to lifestyle recommendations can be challenging to sustain in Phase III. The use of mobile health (mHealth) technologies (accelerometer, text messaging, self-monitoring, etc.) can impact adherence and cardiovascular health; however, the impact of utilization frequency of text messaging on CR sustainability should be assessed.
OBJECTIVE
This trial aimed to determine CR sustainability, at 12 weeks post CR Phase II, by utilization of i) accelerometer, and ii) text messaging either at a) low-frequency with minimal supportive content or b) high-frequency with enhanced supportive content.
METHODS
The trial was a single-blinded randomized controlled trial with a 2-arm parallel group design. 42 participants were randomized to receive text messaging either a) bi-monthly (low-frequency group; N=22), with text messages being reminders of study participation and the date for the 12-week assessment; or b) tri-weekly (high-frequency group; N=20), with text messages being educational (nutrition, exercise, medication compliance) or supportive (encouragement). All participants were instructed to track steps using accelerometers (Fitbit, Smartphone, Smartwatch, etc.). A 6-minute walk test was used to determine physical fitness as measured by metabolic equivalents (METs). Rate Your Plate (RYP) scores, body mass index (BMI), weight, and waist-to-hip ratio (W:H) were used to assess dietary compliance.
RESULTS
Two-way repeated measure of analysis of variance found that the high-frequency and low-frequency group had similar sustainability (no decline), with no significant difference in METs (P = .62), RYP scores (P = .15), or BMI (P = .73). However, the high-frequency group did average significantly more steps per week vs. the low-frequency group (52,542 2,611 vs. 43,077 1,550; P = .002).
CONCLUSIONS
This trial showed that CR sustainability at 12-weeks can be achieved with a simple utilization of mobile health (mHealth) technology (accelerometer and low-frequency text messaging), thus eliminating the decline in fitness and dietary compliance often seen at 12-weeks post-CR Phase II.
CLINICALTRIAL
IRBNet ID: 957218-2
Reducing Parent-School Information Gaps and Improving Education Outcomes: Evidence from High-Frequency Text Messages