• Clara K Chow, Julie Redfern, Graham S Hillis, Jay Thakkar, Karla Santo, Maree L Hackett, Stephen Jan, Nicholas Graves, Laura de Keizer, Tony Barry, Severine Bompoint, Sandrine Stepien, Robyn Whittaker, Anthony Rodgers, and Aravinda Thiagalingam.
• The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia2Westmead Hospital, Sydney, Australia.
• JAMA. 2015 Sep 22; 314 (12): 125512631255-63.

ImportanceCardiovascular disease prevention, including lifestyle modification, is important but underutilized. Mobile health strategies could address this gap but lack evidence of therapeutic benefit.ObjectiveTo examine the effect of a lifestyle-focused semipersonalized support program delivered by mobile phone text message on cardiovascular risk factors.Design And SettingThe 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.InterventionsPatients 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.Main Outcomes And MeasuresThe 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.ResultsAt 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 And RelevanceAmong 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.Trial Registrationanzctr.org.au Identifier: ACTRN12611000161921.

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