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Randomized Controlled Trial
. 2024 Jul;17(7):e010731.
doi: 10.1161/CIRCOUTCOMES.123.010731. Epub 2024 Jun 18.

Text Messages to Promote Physical Activity in Patients With Cardiovascular Disease: A Micro-Randomized Trial of a Just-In-Time Adaptive Intervention

Jessica R Golbus  1   2 , Jieru Shi  3 , Kashvi Gupta  4 , Rachel Stevens  1 , V Swetha E Jeganathan  1 , Evan Luff  1 , Thomas Boyden  5 , Bhramar Mukherjee  6 , Sarah Kohnstamm  1 , Vlad Taralunga  7 , Vik Kheterpal  7 , Sachin Kheterpal  8 , Kenneth Resnicow  6 , Susan Murphy  9 , Walter Dempsey  3 , Predrag Klasnja  10 , Brahmajee K Nallamothu  1   2   11
Affiliations
Randomized Controlled Trial

Text Messages to Promote Physical Activity in Patients With Cardiovascular Disease: A Micro-Randomized Trial of a Just-In-Time Adaptive Intervention

Jessica R Golbus et al. Circ Cardiovasc Qual Outcomes. 2024 Jul.

Abstract

Background: Text messages may enhance physical activity levels in patients with cardiovascular disease, including those enrolled in cardiac rehabilitation. However, the independent and long-term effects of text messages remain uncertain.

Methods: The VALENTINE study (Virtual Application-supported Environment to Increase Exercise) was a micro-randomized trial that delivered text messages through a smartwatch (Apple Watch or Fitbit Versa) to participants initiating cardiac rehabilitation. Participants were randomized 4× per day over 6-months to receive no text message or a message encouraging low-level physical activity. Text messages were tailored on contextual factors (eg, weather). Our primary outcome was step count 60 minutes following a text message, and we used a centered and weighted least squares mean method to estimate causal effects. Given potential measurement differences between devices determined a priori, data were assessed separately for Apple Watch and Fitbit Versa users over 3 time periods corresponding to the initiation (0-30 days), maintenance (31-120 days), and completion (121-182 days) of cardiac rehabilitation.

Results: One hundred eight participants were included with 70 552 randomizations over 6 months; mean age was 59.5 (SD, 10.7) years with 36 (32.4%) female and 68 (63.0%) Apple Watch participants. For Apple Watch participants, text messages led to a trend in increased step count by 10% in the 60-minutes following a message during days 1 to 30 (95% CI, -1% to +20%), with no effect from days 31 to 120 (+1% [95% CI, -4% to +5%]), and a significant 6% increase during days 121 to 182 (95% CI, +0% to +11%). For Fitbit users, text messages significantly increased step count by 17% (95% CI, +7% to +28%) in the 60-minutes following a message in the first 30 days of the study with no effect subsequently.

Conclusions: In patients undergoing cardiac rehabilitation, contextually tailored text messages may increase physical activity, but this effect varies over time and by device.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04587882.

Keywords: cardiac rehabilitation; cardiovascular diseases; exercise; text messaging.

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Conflict of interest statement

Dr Golbus receives funding from the National Institutes of Health (NIH; L30HL143700, 1K23HL168220) and PCORI. Dr Nallamothu is a principal investigator or coinvestigator on research grants from the NIH, VA HSR&D and the American Heart Association. He also receives compensation as Editor-in-Chief of Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association. Finally, he is a coinventor on US Utility Patent Number US15/356 012 (US20170148158A1) entitled Automated Analysis of Vasculature in Coronary Angiograms that uses software technology with signal processing and machine learning to automate the reading of coronary angiograms, held by the University of Michigan. The patent is licensed to AngioInsight Inc, in which Dr Nallamothu holds ownership shares and receives consultancy fees. Dr SachinKheterpal is a principal investigator or coinvestigator on research grants from the US NIH, Blue Cross Blue Shield of Michigan, the American Heart Association, Apple, Merck & Co, and Becton Dickinson & Company; and is a coinventor on US patent number 62/791 257 entitled Automated System To Medical Procedures, which is held by the University of Michigan. Dr Klasnja is a principal investigator or a coinvestigator on research grants from NIH. Dr Murphy is a principal investigator or a coinvestigator on research grants from NIH. Dr Vik Kheterpal is a Principal and employee of CareEvolution. V. Taralunga is a Software Architect employed by CareEvolution. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
CONSORT diagram.
Figure 2:
Figure 2:. Mobile Intervention Effect on Step Count by Watch and Time in Study.
Periods correspond to days in study as follows: initiation (0–30 days), maintenance (31–120 days), and completion (121–182 days) phases. Error bars correspond to 95% confidence intervals.
See this image and copyright information in PMC

Comment in

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